Update on Macular Degeneration
By Dr Latif Hamed MD
What is the macula? Why and how does it degenerate in over 15 million Americans? Two disarmingly simple questions that undercut years of ongoing study by many of our brightest minds. We'll do our best to cover the highlights for the conscientious patient in the next paragraphs.
To use a (now old-fashioned) analogy, the retina is to the eye as the film used to be to a camera. It is the thin, delicate, incredibly complex layer that receives light information from the outside world to make a picture. The macula, specifically, is the centermost part of the retina that provides our finest detailed vision. When you are reading, your eyes scan the page to focus the macula on each word. When you look at your grandchild, his image is projected onto the macula - the rest of the world projects onto the periphery of the retina which sees lesser detail and in black and white.
The retina consists of 10 intricate layers of nerve tissue. Embryologically speaking, you can think of the retina as a part. of the brain. It forms from an outpouching of brain tissue during embryogenesis and remains connected to the rest of the brain by the optic nerve. Those who have an interest in neuroscience (or these days, neural networks) know that the intricate nerve cells which comprise the human brain and nervous tissue are themselves connected by 100 trillion synapses (nerve-to-nerve connections). This fact alone provides a little insight into why, unlike the cornea which can be readily transplanted, we have yet made little progress in the realm of retinal transplantation. In 2024 the main thrust of gold standard macular care is still maintenance through laser treatment and various medications, and prevention through lifestyle modification.
Ever a curious bunch, our patients often also ask, what causes macular degeneration (also called age related macular degeneration or ARMD)? The answer is manifold. A combination of genetic predisposition and environmental risk factors lead to gradual but accelerated aging of the macula. The earliest clinical signs of macular degeneration are yellow spots called drusen which are essentially cellular waste products that are inefficiently cleared from the outer layer of the retina. As the process continues, new friable blood vessels can form and leak, hence the term "wet" macular degeneration, the visual sequelae of which tend to me more dramatic.
What should someone who is concerned about macular degeneration do about it? So far, the buttons we can push to deal with macular degeneration are both preventative and therapeutic. We advise everyone to prevent excessive radiation to the eye by wearing sunglasses, to optimize their nutrition, and to avoid alcohol and tobacco. If there is a family history of ARMD one can add the AREDS 2 formula eye supplement that has been shown through population studies to slow down the disease.
If you're not sure about your personal risk for macular degeneration, we recommend a baseline eye examination with your local ophthalmologist. He or she can then help you understand your risk for the disease, assess the appropriate follow up timeline, and help you mitigate risk for progression. Early detection and treatment of macular degeneration, particularly of the "wet" variety, can improve long term outcomes.
What does treatment of wet macular degeneration consist of? In the not-so-distant past, treatment for wet ARMD employed laser to cauterize leaking blood vessels (neovascularization). As you can update lead to damage to innocent bystanding retinal cells and create scars that can lead to blind spots in the vision. Although laser is still sometimes used for treatment of peripheral neovas cularization, it has largely been replaced by intravitreal injection of anti-VEGF medications for treatment of wet ARMD lesions near the center of our vision where thermal burns are now generally considered unacceptably sight-threatening. These injections allow delivery of medications that slowly and gently coax these abnormal blood vessels to regress and allow the retina's natural mechanisms for managing fluid to take over. At this point in time, anti-VEGF treatments such as Avastin, Eylea and Lucentis are the gold standard of treatment for "leaky" retinal vessels in conditions such as wet ARMD and diabetic retinopathy. Several other very promising treatments are currently under investigation.
If you’re concerned about your macular health or have a family history of macular degeneration, you don’t have to navigate it alone. Early evaluation and personalized guidance can make all the difference. Schedule an eye exam with our team today, and let us help protect your vision with the most advanced care available.
