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Macular Degeneration

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General

Cross Section of the Retina

Dry Macular Degeneration

Fluorescein Angiography

Dry Macular Degeneration

Wet Macular Degeneration

Ocular Wave Length Penetration and Risk

UV Associated Ocular Disorders

General Risk Factors

Normal Photo of the Retina

Histologic Cross Section of the Retina

 

General

 

The macula is the tiny central part of the retina which is responsible for fine detail vision and color perception. It lies directly in the line of vision. Macular degeneration is a disease of this very important portion of the retina. It usually affects both eyes, but often begins in only one.

In many cases, patients are not aware of macular degeneration in one eye, because the other eye compensates for the weaker one. The most common symptoms include difficulty reading, seeing up close or distorted lines. It occurs most often in people over fifty years of age. If you notice a dimness of vision in one or both eyes or if straight lines appear distorted, you should see an eye doctor immediately (not in the middle of the night, however). There is no known cure for macular degeneration, but recent research suggests that certain vitamins and nutrients may slow the progress of the disease in certain patients.

 

Thus far, the results of the randomized portion of the natural history study of the Age-Related Eye Disease Study indeed show a significant beneficial effect of treatment with antioxidant vitamins (vitamin C. 500mg; vitamin E#. 440 IU; beta carotene, 15 mg or 25,000 IU) and minerals (zinc oxide, 80 mg, and cupric oxide, 2 mg) for the treatment of age related macular degeneration. At 5 years of follow-up the risk of developing advanced AMD was reduced by 25% and the risk of vision loss of 15 or more letters on the log MAR visual acuity chare was reduced by 19% by the combination treatment of vitamins and minerals compared with placebo controls. Previous epidemiologic studies showed a strong protective effect of vitamins for lens opacities, but in this randomized, controlled clinical trial, no treatment effect, neither beneficial nor harmful, was found for the treatment of cataracts. This a good example of the power of the controlled clinical trial to evaluate the causal relationship of factors determined in epidemiologic studies. BCSC1 Epidemiology and Statistics.

 

Ref: Age-Related Eye Disease Study Group: Design Paper: The Age-Related Eye Disease (AREDS): Design Implications. AREDS Report No. 1. Control Clin Trials. 1999;20:573-600

Age-Related Eye Disease Study Group. A randomized , placebo-controlled clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration  and vision loss. Arch Ophthalmol 2001;119:1417-1436

 

Age-Related Eye Disease Study Research Group. Risk factors associated with age-related macular degeneration. A case-control study in the Age-Related Eye Disease Study: Age-Related Eye Disease Study Report No. 3. Ophthalmology.2000;107:2224-2232

 

A hereditary basis for macular degeneration has been established, as a result of solving the human genome. It is reported that up to 75% of macular degeneration may be associated with heredity. We don't have the whole story yet but it is being strongly researched. A recent study from the Moran Eye Institute in Salt Lake indicted the HTRA1 gene on chromosome 10 as two to eight times more likely to cause macular degeneration, depending on whether it is present on just one or on both arms of the chromosome.

 

 

If the disease is advancing, sometimes laser surgery can be used to slow the disease. New techniques include verteporfin laser therapy for the wet type (6-10% of macular degeneration patients).

 

Additionally, a new treatment for wet-type macular degeneration called "Macugen" is now approved by the FDA. It involves the injection of a drug into the eye every 4-8 weeks. This has been shown to be beneficial but also increases the possibility of infection.

 

Even newer medications that inhibit vascular endothelial growth factor (FEGF inhibitors) such as Avastin and Lucentis have remarkable results, even improving vision in wet macular degeration. These medications have to be injected into the eye.

 

If you are over fifty, have your eyes examined regularly. If you have symptoms such as blurring or straight lines being crooked, report them to your eye doctor immediately before the disease progresses. We may or may not be able to do something about it, but, if you don't come in neither of us will know. Your sight is too great a gift to risk.

 

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Fluorescein Angiography

 

Fluorescein angiography is a technique of diagnosing a number of retinal disorders. A non-toxic dye (fluorescein) is injected into a vein of the arm. It is allowed to circulate into the retina where sequential pictures are taken with a special camera. In a normal person there is no leakage of the dye. In some, where the retina is gone (dry macular degeneration), there will be no leakage, but will show a white spot from the underlying choroid called window defect. The dye is present from the beginning, but does not spread. In  wet macular degeneration, however, the dye spreads from the leakage as the study progresses.

                                                                                                                      

                                  

Norma Fluroescein Angiogram -(Shatz)

Normal Retina

Cross Section of  Retina

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Dry Macular Degeneration Fluorescein Angiogram (Shatz)

Drusen in the Macula -A Form of Dry Macular Degeneration

Wet Macular Degeneration Fluorescein Angiogram (Only 6-10% have this) (Shatz)

Wet Macular Degeneration with Bleeding

       An Example Of The Fine Detail Digital Fluorescein Angiography

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Penetration of the Human Eye by Various Wavelengths

 

                          

This group of slides was taken from a lecture by Dr. Pfoff on the hazards of various wavelengths regarding the eye. It is intended for the more technically minded visitor. This shows the phenomenon of greater damage potential as the wavelength becomes shorter, and there-by increasing the photon-energy. The chart is not drawn to scale and was only meant to illustrate the increase in retinal damage as the wavelength of 510 nm (beginning of the blue portion of the electromagnetic spectrum compared to green and red) is attained, increasing dramatically as the UV portion of the spectrum is reached. The green and red wavelengths retinal damage potential for the same amount of illuminance is nil. The importance of blue blocking and ultraviolet filtration is apparent. The docosa-hexaneoic acid is a very  prominent long-chain fatty acid found in the cone outer segments of the retina. It illustrates the multitude of double bonds that can be attacked by active oxygen and lipoxy free radicals.

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UV Associated Ocular Disorders

 

       

These pictures illustrates the potential damage of ultraviolet light on the skin. It represents a basal cell carcinoma (shown left). Other disorders of ocular damage relating to ultraviolet light include pterygium (shown here center), pinguecula, and cataract (shown right). The pterygium was nearly covering the cornea and was removed "in-the-nick-of-time" to prevent marked loss of vision from a field worker in Mexico. This cataract was removed from an indigent patient's eye in Mexico and replaced with an intraocular lens implant. It was non-transparent with a black centrally opaque collection of oxidized lens protein.

 

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Risk Factors

 

Positive Risk Factors for ARMD

No Association with ARMD Known

Smoking the most consistent factor. Up to 4x more in smokers
Aspirin use
Carotid Artery Plaques 5x Diabetes
Systemic Hypertension 2X  
Cataract surgery up to 4X more progression if present when cataract removed  
Family History (6.6 odds ratio Rotterdam Study)  
White Race  
Age Reference: AJO 137 489

 

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Click here to read about Blue Blocking Sunglasses, which may reduce your risk for macular degeneration.

 

Click here to read about beneficial vitamins, which may slow down the progression of macular degeneration.

Dangerous Symptoms |  Laser Surgery |  Site Map | Meet Our Doctors  |  Map  | Forms | Photos 

 Home | Patient Education | Patient Instructions | Laser FAQ | Cataract FAQ | About Our Doctors
Pfoff Laser and Eye, 6881 South Yosemite Street | Centennial, Colorado 80112 | 303-588-7900|