Macular degeneration is an age-related ocular ailment where light-sensitive retinal cells get damaged over time. It usually develops after 60 years and can lead to severe or permanent vision loss. Patients usually complain of the appearance of dark spots or blurred vision, as the nerve tissue in the macular region (small area in the center of the retina) becomes degenerated. It may first start in one eye and then progress to the other. In some rare cases, macular degeneration can also develop among kids or young adults, and it is then known as Stargardt disease or juvenile macular degeneration.

Types of macular degeneration

There are two types of macular degeneration. They are:

• Dry macular degeneration
  In dry macular degeneration, patients develop yellow deposits (drusen) in their macular region. When they are few, people do not experience many changes in their vision. However, if drusen becomes more prominent and grows in number, then they can distort the vision. Within a few months, retina cells might degenerate, and the macula can become thinner and die eventually. Since there is no leakage of blood or fluid, this condition is termed as dry macular degeneration. About 85 to 90 percent of patients complain of this ailment.
• Wet macular degeneration
  Wet macular degeneration develops when additional blood vessels start arising under the macula, leading to leaking of blood and fluid in the region. It is also known as neovascular AMD due to the generation of new blood vessels. Wet macular degeneration is more severe than the dry type. About 10 percent of patients complain of this illness. Patients often complain of complete loss of central vision or severely impaired vision with the appearance of straight lines in the field. Peripheral vision remains nearly unaffected in wet macular degeneration. The disease progresses rapidly and requires immediate medical intervention. In some cases, dry macular degeneration can also transform into wet macular degeneration.

Symptoms

Symptoms of macular degeneration depend on the type and the stage of the degenerative disease. Symptoms appear gradually, so many patients are unaware of the underlying condition until the vision gets impacted.

• Dry macular degeneration
  It may take up to 10 years or longer for the onset of symptoms if dry macular degeneration affects only one eye. Listed below are the symptoms of this ailment.

∙       Newspapers and books appeared blurred even after using spectacles

∙       Patients might require bright light to observe things

∙       Colors and patterns lose their vibrancy

∙       It becomes challenging to identify people in standard lighting

∙       Patients might find it difficult to adjust to dim light conditions

• Wet macular degeneration
  All the symptoms of dry macular degeneration are present in the wet macular degeneration. Additionally, patients can also experience:

∙       Metamorphopsia (straight lines look wavy)

∙       The central vision becomes blurred, while the peripheral image is distinct

Causes

The exact cause of macular degeneration is still unknown to scientists. However, researchers feel that a relationship exists between the genetic constituents of the patients and the occurrence of the disease. They have also identified approximately 20 genes associated with the development of the disease. If any member of your family has macular degeneration, then your chances of getting the ailment are higher than others.

• In dry macular degeneration, a compound called drusen gets deposited under the retina. Though the origin of this compound is still unclear, people above 50 have a higher tendency to develop it from the waste products of the retina. In asymptomatic patients, drusen are harmless (when not deposited in the macular region). However, as the patient progresses from early to intermediate and advanced stages, they become large and impair the vision. They prevent oxygen from coming in contact with retinal cells, and they start degenerating.

• In wet macular degeneration, new blood vessels develop beneath the macula. In the advanced stage, these blood vessels start leaking fluid and blood. However, the origin of these blood vessels is still not clear. Some scientists feel that leaking of these blood vessels can be an effort to get rid of drusen.

Diagnostic tests

If your symptoms match those of macular degeneration, then the ophthalmologist will advise you to undergo a few diagnostic tests to determine the underlying medical conditions.

• Optical coherence tomography (OCT)
  In OCT, doctors can obtain magnified 3D images of the retina by passing unique light rays through it. It helps to ascertain when the light-sensitive nervous tissues in the macular region have become distorted. It also aids in determining if the treatment process conducted on the patient is bearing fruitful results (the macular area is regaining its thickness).

• Fluorescein angiography

In fluorescein angiography, ophthalmologists inject a specific dye in the vein present on the arm. Doctors then observe the inner details of the retina through photographs of the pathway of the stain. The color can trace the formation of new blood vessels in the macular region. It also determines whether neo blood vessels are leaking fluid. It is a helpful technique for diagnosing wet macular degeneration.

• Amsler grid

Amsler grid is a non-invasive technique for diagnosing macular degeneration. Here, the ophthalmologist directs a patient to observe a unique network consisting of several horizontal and vertical lines. If the patient notices the center lines to be distorted, curved, broken, or faded, then there is a chance of macular degeneration.

Treatment options

If the diagnostic tests for macular degeneration turn out to be positive, then ophthalmologists immediately design the treatment plan. It is not possible to completely cure this ocular condition. However, early treatment can arrest vision loss.

Dry macular degeneration

Since patients do not experience total vision loss in dry macular degeneration, ophthalmologists prescribe supportive therapy and lifestyle adaptations to cope with damage in the macular region. The use of magnifying lenses, bold-printed books, and intense light for reading can help the patients. These days, you also get low vision aids consisting of specialized lenses or electronic devices. They create laser images of surrounding objects for the benefit of patients.

Wet macular degeneration

There are multiple therapies available for controlling wet macular degeneration. Detailed below are a few of these treatment practices.

• Anti-angiogenesis medication

Ophthalmologists often prescribe anti-angiogenesis injections for preventing the formation of new blood vessels in the macular region. Aflibercept, pegaptanib, and ranibizumab belong to this group of medications. They contain the anti-vascular endothelial growth factor (Anti-VEGF), which blocks the compound needed to develop new blood vessels. Doctors apply anesthetic lotion before administering the injection via fine needles. Many patients have reported a considerable improvement in their field of vision after the regular administration of this treatment. These injections usually do not produce any side effects. However, in some cases, patients complain of redness, pain, and swelling at the injection site.

• Laser therapy

Laser beams are high-energy light rays, which can penetrate through the skin and destroy unwanted tissues. In laser therapy for wet macular degeneration, the eye surgeon projects a laser beam to damage the abnormal blood vessels formed in the macular region. The intensity of the laser beam depends on the extent of damage to the retina.

• Photodynamic laser therapy

Photodynamic laser therapy helps in destroying the blood vessels formed in the macula. In this procedure, doctors inject Verteporfin- a light-sensitive compound, in the patient’s arm. It quickly attaches to the protein present in the blood vessels of the macula and helps in their identification. After this, the ophthalmologist targets a laser beam for 1 minute on the retina. In this way, the activated Verteporfin destroys abnormal blood vessels without damaging the adjacent tissues in the eye. Patients experience much improvement in their field of vision as a result. There are also no chances of leaking of blood or fluid in the eye after this therapy. However, in some cases, patients require repetition of the photodynamic laser therapy for fruitful results.

• Retinal translocation
  It is a highly advanced treatment procedure, where the eye surgeon at first rotates the center of the macula to a separate region on the retina, away from the newly-formed blood vessels. Then he uses a laser beam to destroy the abnormal blood vessels on the retina. This state-of-the-art eye surgery does not cause any damage to the light-sensitive macular region of the eye. Chances of improvement of the field of vision are higher if the surgery becomes successful.

Natural remedies

In the case of macular degeneration, if the patient is aged and does not wish to go ahead with conventional therapies, doctors often advocate the use of home remedies to cope with the symptoms. Here are a few alternative therapies for arresting the progression of this ocular ailment.

• Omega-3 fatty acids

Regular consumption of omega-3 fatty acids could be beneficial in reducing the symptoms of macular degeneration. You can obtain omega-3 fatty acids from fatty fishes like mackerel, tuna, sardines, salmon, herring, cod liver oil, and caviar. Vegetarians can also include omega-3 fatty acids in their diet by consuming flax seeds, chia seeds, soybeans, and walnuts. Include a generous amount of these food items in your daily meals to limit the progression of macular degeneration.

• Quit smoking

Cigarette smoke contains hazardous chemicals like nicotine, carbon monoxide, hydrogen cyanide, ammonia, arsenic, and nickel. They lead to multiple damages in the body, including nerve deterioration, inflammation, and vision loss. It can also accelerate the aging process. Quitting smoking can help you prevent the symptoms of macular degeneration. You can take the help of several nicotine-replacement therapies (nicotine gums, lozenges, inhaler, and nasal spray) for quitting this habit. These kits are readily available at local pharmacy stores and supermarkets, and you can avail them without any doctor’s prescription.

• Regular exercises

Try to set aside at least thirty minutes for five days a week for workouts. They can help in slowing down your aging process and maintain your weight in the standard rage. It can also normalize the blood pressure level, reduce blood sugar, and have a compelling anti-inflammatory effect on organ systems. Exercising even boosts immune cells and protects the body from various diseases. All these positive factors help in reducing the development of abnormal blood vessels in the macula. Elderly patients don’t need to indulge in strenuous exercises. Simple activities like walking, jogging, and playing badminton are enough to keep you fit and active.

Supplements

Age-Related Eye Disease Studies supplement (AREDS and AREDS2), consisting of vitamin C (500 mg), vitamin E (400 IU), cupric oxide (2 mg), zinc oxide (80 mg), lutein (10 mg), and zeaxanthin (2 mg), can help in limiting the progression of age-related macular degeneration. You can obtain these supplements from your nearest pharmacy even without the prescription of an ophthalmologist. However, it is essential to consult your doctor about the brand and doses to prevent side-effects.

Foods to eat

Along with proper treatments and natural remedies, you also need to practice healthy eating habits to keep macular degeneration at bay. Studies have established that consumption of fresh and nutritious items can reduce symptoms of many ailments. So, consider the following pointers to maintain eye health even at an advanced age.

• Antioxidant-rich diet

Consuming a generous serving of dietary antioxidants can limit the appearance of macular degeneration symptoms. Even in the advanced stage of this ocular disease, antioxidants can slow down the progression. Carotenoids-rich fruits and vegetables like berries, oranges, grapes, squash, carrots, and apricots can prevent oxidative injuries to the eyes. Super fruits like cherries and blueberries are also rich in anthocyanin, which has a positive effect on the eyes. They prevent the degeneration of nervous tissues in the retina and slow down the progression of macular degeneration.

• Water

Drink plenty of water every day to flush out toxins and debris from your system. It can prevent the formation of drusen in the retina and keep the eyes hydrated for good-quality vision. You can also consider drinking herbal tea and coconut water from time to time, as they are rich in nutrients.

So, this was all about the signs, causes, and treatments for macular degeneration. Remember, though there is no cure for this disease, timely medical intervention can limit its progression. Hence, going for regular eye-disease screening can ensure healthy eyes even as you age.