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Macular Problems / Central Vision Distortion Problems
What are macular problems?
The centre of the light-sensitive retina at the back of the eye is called the macula, this area is important for seeing colour, detail and things directly in front of you. With age the macula can develop aging changes (age related macular degeneration) or blood vessel changes (diabetic retinopathy, vascular occlusion).
Age Related Macular Degeneration (AMD)
What causes it?
The exact cause for AMD is not known. Some things are thought to increase your chances of developing AMD:
- Age – although AMD can develop in people who are in their 40s and 50s it is most often seen in those over the age of 65.
- Gender – AMD is more common in women than it is in men, this is probably because women tend to live longer than men.
- Genes –have been identified which appear to be linked to the development of AMD in some people. Not all AMD is thought to be inherited.
- Smoking – greatly increases your risk of developing AMD. Stopping smoking has been shown to reduce your risk of developing AMD.
- Sunlight – in some studies it is suggested that exposure to high levels of UV sunlight throughout your life may increase your risk of developing AMD. This has not yet been proven. It is a good idea to protect your eyes by wearing sunglasses.
- Diet – Some evidence suggests that vitamins A, C, E and zinc may help to slow the progression of AMD in those who already have the condition.
As the exact cause of AMD is not yet known, you may develop the condition even if you don’t have any of these risk factors. To help keep your eyes as healthy as possible, current advice would be to eat a balanced diet which includes plenty of fresh fruits and vegetables, protect your eyes from the sun and stop smoking.
What you may experience:
You may experience visual problems with distortion, reduced central vision and an inability to see detail when looking directly at something, for example when you are reading, looking at photographs or watching television even when wearing your usual reading glasses.
You may also find you become sensitive to bright light, some people also see shapes and lights that are not actually there. These changes may be noticed in both eyes or only one eye.
If you notice any difficulty when reading small print using your reading glasses, straight lines (such as the edge of a wall) looking wavy or distorted or you vision does not seem as clear as it used to be contact your optometrist to arrange an eye examination. They will examine the back of the eye and measure any changes in your vision. Should they have any cause for concern they can refer you to one of our Medical Retina Specialists for further tests.
Types of AMD
The two main types of AMD are “wet” AMD and “dry” AMD. Both wet and dry AMD usually affect both eyes although one eye may be affected long before the other. Both types will not affect the vision around the edge of your sight (peripheral vision), therefore will not cause you to lose all your sight.
It is possible for people diagnosed with dry AMD to develop wet AMD over time. Any sudden changes in your sight should always be checked by an ophthalmologists.
It is also possible for someone to diagnosed with dry AMD in one eye and wet AMD in the other. However, most people will usually have the same type of AMD in both eyes.
AMD is not a painful condition and will not lead to complete loss of your vision.
Dry AMD is the more common. Development is very slow with gradual changes in your central vision. It can take a number of years for dry AMD to get to its final stage. Dry AMD, at its worst, will cause a blank patch in the centre of your vision in both eyes. Your peripheral vision is not affected so dry AMD will never lead to total blindness.
Wet AMD is less common with around 10 – 15% of people with the condition having wet AMD. Wet AMD is caused when the cells of the macular stop working correctly and the body starts to grow new blood vessels to try and fix the problem. These blood vessels unfortunately grow in the wrong place which causes swelling and bleeding underneath the macular. The damage caused by these new blood cells eventually leads to scarring causing a blank patch in the centre of your vision.
Development of wet AMD can be very quick which can result in serious changes to your central vision in a short period of time. Treatment usually needs to be given quickly to prevent too much damage to your macular. The scarring and sight loss is usually permanent if the blood vessels are left to grow. Your peripheral vison is not affected so wet AMD does not lead to total blindness.
What treatment is needed?
As dry AMD does not involve new blood vessel growth, there is currently no treatment for this.
Some evidence suggests that high doses of vitamins A, C and E and minerals zinc and copper may help slow down the progression of dry AMD when they are taken together, particularly in people where changes to vision in one eye have been noticed because of AMD. However, there is no evidence that taking high doses of these vitamins can prevent you from developing AMD in the first place. Eating a healthy balanced diet which includes plenty of fresh fruit and vegetables is good for your general health and may also help your eye health.
It is recommended that treatment for wet AMD is given quickly once the condition is diagnosed. Treatment works mainly by stopping the growth of new blood vessels, if these are allowed to grow for too long they may cause scarring of the retina which cannot be treated.
Treatment of wet AMD includes Lucentis, anti-VEGF and photodynamic therapy.
Who will I see for treatment?
Patients with reduced or distorted vision thought to be due to macular degeneration, diabetic eye disease can be assessed by our Medical Retina Specialists: Mr Kotagiri, Mr Habib.