Macular Degeneration Services Bradenton, Sarasota, Ellenton, Sun City, Florida
Macular degeneration, often called AMD (Age-related Macular Degeneration) is the leading cause of vision loss and blindness in people age 60 and older. It is a progressive eye disease that occurs when there is a breakdown in the macula; destroying sharp, central vision. Because seniors represent an increasingly larger percentage of the general population, AMD vision loss is growing at an alarming rate.
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What Is Age Related Macular Degeneration?
Age Related Macular Degeneration (AMD) occurs when there is a breakdown in the macula, the very center of the retina inside the eye. The macula has the greatest density of light sensitive cells and is the only part of the retina capable of seeing fine details.
AMD does not affect peripheral vision, but it does affect both distance and close vision when you are looking straight ahead. This makes many daily activities, such as reading a book and driving a car, difficult, and even impossible for some. Patients with severe macular degeneration do not go completely blind, but they are considered legally blind.
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Types of AMD
“Dry” Age Related Macular Degeneration
Dry age related macular degeneration is the most common of the 2 types of AMD. In fact, 90 percent of AMD patients are diagnosed with this dry form. It is diagnosed when cells and blood vessels underneath the macula break down and cause yellowish deposits, known as drusen, in the macula. It is this drusen that causes a loss of central vision. Dry AMD usually causes a slow, gradual deterioration of vision unlike the acute symptoms of the wet form of AMD.
“Wet” Age Related Macular Degeneration
Wet age related macular degeneration is the more serious of the 2 forms of AMD, and occurs in about 10 percent of cases. With wet AMD, sometimes known as neovascular AMD, there is abnormal blood vessel growth beneath the retina. It is caused when the body responds to the lack of nutrients and oxygen in the retina by forming a new network of blood vessels. As the blood vessels grow, they can leak blood, causing scarring and permanently damaging light-sensitive retinal cells. Eventually these cells die, which creates a large black spot in the central vision.
Unlike dry AMD, wet AMD can cause rapid changes in vision. In fact, a change in vision from one day to the next is quite possible. That is the reason that we recommend that all patients with AMD, both wet and dry, use the amsler grid everyday. If you notice a change in the grid that has occurred over a day or two, it could be the start of wet macular degeneration and you should contact us quickly. Dr. Katia Taba, one of The Eye Associates’ three Fellowship Trained Retina Specialists explains, “Today, retina specialists can prevent vision loss from getting worse or even help you get some of your vision back. But early diagnosis is critical.”
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While no one knows the exact cause of AMD, some of the hereditary and environmental factors that studies have found to be associated with the disease include:
- Age - Age is the biggest factor. As people get older, risk of AMD increases. At age 50, there is a 2 percent risk for developing AMD. By age 75, that risk rises to 30 percent.
- Smoking - Studies have consistently found AMD to be associated with smoking.
- Gender - Women are at higher risk than men.
- Heredity - AMD appears to run in families. Those with immediate family members with the disease are at greater risk and should be monitored closely.
- Diet - Consumption of alcohol and saturated fats can create free radical reactions that can harm the macula. Inadequate intake of antioxidants can add to the negative effects.
- Sun exposure - A significant cumulative UV exposure increases risk.
- Other risk factors include high blood pressure, lighter eye color, and obesity.
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- Gray or blank spots in your central vision
- Faces appear blurry in the middle but focused towards the edges
- Straight lines, vertical and/or horizontal, appear wavy or disconnected
- The need for more light when you do close-up work
- Difficulty reading street signs
Your eye doctor can often detect early signs of AMD even before symptoms occur. If any defect is discovered in your central vision, your doctor may order a fluorescein angiography to specifically examine the retinal blood vessels surrounding the macula.
Using an Amsler Grid
It is important to detect wet macular degeneration at the earliest possible stage. Obviously, we cannot examine your eyes every day for abnormal vessels, but fortunately, you can perform a simple, easy self-screening right in your home using an amsler grid. The amsler grid consists of evenly spaced horizontal and vertical lines on a piece of paper with a small dot in the center. You simply focus on the dot and look for any wavy lines or missing areas of the grid. If you notice a change in the grid that has occurred over the course of just a day or two, it may be the start of wet macular degeneration, and you should contact us quickly. Remember, early detection and treatment is important in saving your vision.
FREE Amsler Grid
Stop by any of The Eye Associates’ locations to pick up a FREE Amsler Grid, or download and print one now, to monitor any changes in your own vision. Use the Amsler Grid every day. Just hold it 12 inches from your face, cover one eye and look at the lines. Then repeat with the other eye. If you notice any distortion, that’s a signal to have your eyes examined right away.
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The Eye Associates’ S.T.E.P. Program (Systematic Tracking and Early Prevention)
Dr. Scott Han at The Eye Associates is one of the first in the United States to offer the STEP program, a comprehensive wellness program for those with AMD as well as their family members who are at a higher risk for getting AMD.
Our goal with the STEP program is to reduce the risk factors for AMD, slow progression of dry AMD, and detect wet AMD sooner, therefore saving vision.
How the STEP program works:
1. Patients at increased risk for AMD
We will identify individuals who are at risk for developing AMD with one of the non-modifiable risk factors for AMD: family history, retinal exam findings of retinal Drusen, or low antioxidant concentration in the macula. This requires a comprehensive dilated exam with baseline Fundus Photo (FP) documentation and a Macular Pigment Optical Densitometer (MPOD) measurement. Using this information, we are then able to prescribe nutritional supplements (lutein and zeaxanthin) and recommend lifestyle modifications based on your level of risk. Specific recommendations are tailored to each individual.
Patients are then brought in at appropriate intervals and re-tested with the MPOD to measure their antioxidant concentration improvement and compare it against their baseline measurements. The goal is to lower your risk and prevent macular degeneration (AMD).
2. Patients with dry and/or wet AMD
We will identify individuals who already have AMD (dry and/or wet) and provide the same baseline measurements as above. Also, a Preferential Hyperacuity Perimetry (PHP) test will be performed to assess risk for dry AMD converting to wet AMD. This type of systematic tracking has been shown to discover the conversion of dry AMD into wet AMD sooner. Earlier detection of wet AMD allows for more rapid initiation of treatment and better visual outcomes.
Again, recommendations for a personalized nutritional supplement and lifestyle modification would be prescribed based on the level of AMD. Patients will be brought back in at appropriate intervals and re-tested with the MPOD and PHP.
Technology used in the STEP Program
Fundus Photography (FP)
This highly specialized form of medical imaging uses a customized camera that is mounted on a microscope. Using intricate high-powered lenses, the technician can photograph the back of the eye to document the health of the optic nerve, vitreous, macula, retina and its blood vessels. The photographs are used for comparison, documentation, and sometimes to diagnose. Baseline documentation is important for monitoring changes and detecting disease progression.
Macular Pigment Optical Density (MPOD)
Carotenoids are antioxidants found in the macula. Higher levels of carotenoids correspond with more protection and less risk for AMD. Using the new technology of the Quantifeye equipment, we are able to get a measurement of Macular Pigment Optical Density (MPOD) and a quantitative measurement of the eye’s lutein and zeaxanthin concentrations. This test for your MPOD measurement is simple, quick, and non-invasive, and helps us assess the relative health of your macula. If it is found that your MPOD measurement is low, recommendations will be made to increase it. Four months after these recommendations are implemented, the MPOD testing is repeated to quantitively determine the effectiveness.
Preferential Hyperacuity Perimetry (PHP)
The PHP is a visual field analyzer designed specifically for monitoring disease progression in patients with AMD. It provides a simple, quick and non-invasive way to detect abnormalities in the macula. In fact, the PHP has an 82% sensitivity for detecting early wet AMD, even before visual symptoms and before macular damage has resulted in permanent vision loss.
The PHP works by identifying deviations in the retina using a vision test based on hyperacuity. Hyperacuity is defined as the ability to identify a subtle misalignment of one object compared to another. Once this test is complete, the doctor can use the information as a baseline to monitor future changes in the visual field. Regular testing with the Foresee PHP enhances your doctor’s ability to know if your AMD is progressing to the severe, wet form of the disease at a stage when treatment is most effective.
Optical Coherence Tomography (OCT)
The Optical Coherence Tomography (OCT) is an optical signal acquisition and processing system for taking extremely high quality, three dimensional images of disruption of retinal pigment from drusen to wet AMD. Also, any changes resulting from your prescribed therapy can be quantified for success and monitored for future recommendations.
How To Sign Up
Call 941-792-2020 or toll free 1-866-865-2020 and please make sure that you mention that you want to enroll in the STEP Program. If you have had a comprehensive eye examination by any of the doctors at The Eye Associates within 3 months, you are eligible to begin the STEP testing with Dr. Scott Han. If not, then you will need to set up an appointment with Dr. Scott Han for your comprehensive eye examination and the STEP testing.
If you have any questions, please feel free to call Dr. Han at 941-792-3937 ext 2218.
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Despite ongoing medical research, neither the exact cause, nor a cure for AMD, is known. However, there are treatment options that may slow the progression, and sometimes even improve vision.
In the past, patients with wet AMD could only be treated with traditional laser surgery, which left a small but permanent blind spot, in order to halt the progression of the disease. However, within the past few years, breakthrough technology has offered patients with wet AMD new hope.
LUCENTIS® is an FDA-approved anti-VEGF (vascular endothelial growth factor) medicine that has been shown to slow vision loss and even sometimes restore some degree of the lost vision in wet AMD patients. These drugs work by blocking an essential signal that causes abnormal blood vessels to grow and leak. In a clinical study of patients receiving treatment with LUCENTIS® on a monthly basis, 70 percent of patients could see at least one more letter on the eye chart, and up to 40 percent of patients achieved vision of 20/40 or better.
Other medicines are AVASTIN®, MACUGEN® and EYLEA™. All have shown to slow vision loss and sometimes restore some vision.
Photodynamic Therapy (PDT)
PDT is another approved treatment of "wet" macular degeneration. It is an outpatient procedure that combines a light-activated drug with a non-thermal laser (a laser that does not burn) to selectively treat abnormal blood vessels that threaten macular health. With PDT treatment, VISUDYNE®, a porphyrin dye, is injected intravenously into the patient's arm. The drug tends to concentrate in the abnormal blood vessels. After the dye travels into the abnormal subretinal blood vessels in the macula, a non-thermal laser is focused on this tissue, which causes the dye to activate and release a substance that halts the abnormal leaking while reducing damage to surrounding retinal tissue. It should be noted that PDT treatment did not stop vision loss in all patients. Retreatment is permitted and studies show that 96 percent of patients do require retreatment. It is estimated that patients might need three to four treatments the first year and then fewer treatments in the years thereafter.
No FDA-approved treatments are available for dry AMD, but there are some studies, such as the original AREDS study http://www.nei.nih.gov/amd, that have led scientists to believe that nutritional supplements may be helpful.
The original AREDS formulation contains vitamin C, vitamin E, beta-carotene, zinc and copper. In 2006, the same research group, which is based at the National Institute of Health’s - National Eye Institute, began a second study called AREDS2 to determine if they could improve on the AREDS formulation.
The National Eye Institute AREDS2 clinical study is an updated formula recommendation to the Age-Related Eye Disease Study (AREDS) reported in 2001 that a nutritional supplement called the AREDS formulation can reduce the risk of developing advanced age-related macular degeneration (AMD).
For more information on AREDS2: http://www.nei.nih.gov/areds2.
The AREDS2 formula added omega-3 fatty acids, as well as the antioxidants lutein and zeaxanthin, which are in the same family of nutrients as beta-carotene. The researchers also tried substituting lutein and zeaxanthin for beta-carotene, which prior studies had associated with an increased risk of lung cancer in smokers. The study found that while omega-3 fatty acids had no effect on the formulation for AMD, lutein and zeaxanthin together appeared to be a safe and effective alternative to beta-carotene.
There are also many investigational treatments for macular degeneration, including transplantation of pigmented cells, transposing the macula to another portion of the eye where the pigmented cells are healthier, electronic chips that implant in the retina, as well as genetic and stem cell research. However none of these treatments are proven; nor are they ready for general clinical use.
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Coping with AMD
The impact of developing AMD can be devastating to those who were independent and active prior to the onset of this impairment. Their visual world gradually diminishes into a vague blur, making ordinary daily activities challenging. Vision rehabilitation and assistive devices can help people use their remaining vision effectively. The Eye Associates recommends that visually impaired patients contact the following organizations that can make their daily life experience better and safer:
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If you have a diagnosed retinal condition and would like to be evaluated by one of our Fellowship Trained Retina Specialist, Katia E. Taba, M.D., Todd A. Berger, M.D., F.A.C.S. or Jeffrey Kasper, M.D., please call us at (941) 792-2020 or toll free 1-866-865-2020 or contact The Eye Associates to schedule an appointment.