Diagnosis & Treatment of Macular Degeneration (ARMD) at
Brass Eye Center in Albany New York

Macular Degeneration or Age Related Macular Degeneration (ARMD) is a disease of the retina that in which the central portion of the retina, called the Macula, is damaged. Central vision is the sharpest or clearest area of your vision and is required for activities such as reading, driving and anything that is visually demanding, whether at far or at near. Macular Degeneration is extremely common and affects more people in the United States than either cataracts or glaucoma. In fact, Macular Disease is the most frequent cause of legal blindness for patients aged 55 and above in the United States and is estimated to affect over 10 million Americans (http://www.macular.org/disease.html) in some fashion.

As you would expect from the name Macular Degeneration, this eye disease affects the Macula. As mentioned above, the Macula is the area of the retina that allows you to see fine detail of faces, reading material, colors and precise vision required for driving a car and is responsible for central or “straight ahead” vision.

There are a number of different types of Macular Degeneration. Age Related Macular Degeneration (ARMD) is the most common type of Macular Degeneration. Your chances of developing Age Related Macular Degeneration (ARMD) are directly related to you age. The older you are, the greater the chance that Macular Degeneration will affect you. It is estimated that at least 30% of the Caucasian population over the age of 75 has Macular Degeneration.

Causes of Age Related Macular Degeneration

 Age Related Macular Degeneration (ARMD) is a degenerative condition of the Macula that is caused by hardening of the small arteries supplying oxygen and nutrients to the retina. The hardening and narrowing of these arteries deprives the Macula of oxygen and nutrition. This results in a slow but progressive loss of function. The visual effects of Macular Degeneration can be relatively minimal with a mild “dimming” or “distortion” of your central vision, or very profound resulting in a complete loss of your central vision. However, Macular Degeneration DOES NOT cause total blindness. Since the effect of Macular Degeneration is limited to the central retina, its effects are limited to central vision and thus it does not cause any loss of your peripheral vision.

Types of Age Related Macular Degeneration

There are actually two types of Age Related Macular Degeneration: “Dry” Macular Degeneration and “Wet” Macular Degeneration.

• Dry Macular Degeneration is the most common type of Age Related Macular Degeneration. Dry Macular Degeneration makes up approximately 85-90% of cases of Macular Degeneration. If you have Dry Macular Degeneration, during the examination of your retina, Dr. Brass will see small, yellow colored deposits between the retinal layers, which are called Drusen. Dry Macular Degeneration results in a slow, gradual progressive “dimming” of your central vision. Many people 50 years of age or older begin to display some Drusen as they age. Drusen are not a problem or a risk to your vision unless they are large or confluent. If you have Drusen, Dr. Brass may ask you to schedule eye examinations more frequently in order to monitor them as there is some possibility that Dry Macular Degeneration will progress to Wet Macular Degeneration over a period of time. Thus people with Dry Macular Degeneration, even without any noticeable change in vision, need to be followed closely as Wet Macular Degeneration has far more serious consequences for vision loss. 

• Wet Macular Degeneration only accounts for about 10-15% of cases of Macular Degeneration but is likely to cause far more serious vision loss than Dry Macular Degeneration. Wet Macular Degeneration is characterized by an abnormal growth of new blood vessel under the retina. These new blood vessels are called “neovascularization”. Neovacularization is not made up of “normal” blood vessels in that they are unusually weak in their structure. In fact, they are quite fragile and are prone to be leaky and can easily break and bleed. If leakage occurs, the Macula may actually begin to swell. If the new blood vessels break and bleeding occurs, it can result in scarring as it heals. Scarring of the Macula can cause a sudden, rapid and severe loss of central vision, which is irreversible.

Diagnosis of Macular Degeneration

First and foremost, it is important to have routine eye examinations. By scheduling regular eye exams, you are giving yourself the advantage of allowing Dr. Brass to make an early diagnosis of Macular Degeneration. In addition, if you experience any “distortion” or “twisting”, “shadowing” or “bending” of objects in your vision, you should schedule an appointment at Brass Eye Center immediately. Be sure to let the receptionist know that you are experiencing these symptoms.

If you are over the age of 40-45 and anyone in your family has been told that they have Macular Degeneration, it is a good idea to have a complete eye examination each year. Make certain that you tell the eye doctors and staff at Brass eye Center if you have a family history of Macular Degeneration.

During your eye examination, eye drops will be put in your eyes to dilate your pupils in order to carefully examine the Macula and retina using various types of instruments and sources of high magnification.

Additional tests that Dr. Brass may perform to further evaluate the Macula during your eye examination can include checking your color vision and an Amsler Grid Test, which helps identify distortion of your central vision, and may be an indication of swelling or fluid under the Macula.

Amsler Grid

While it may appear simple, the Amsler Grid Test is actually a very significant test. By using the Amsler Grid, it is possible to detect very small changes in your vision that can result from the accumulation of just a small amount of fluid under your Macula. Dr. Brass may actually recommend that you take an Amsler Grid home and use it each day to check for slight changes in your vision. If this is necessary, Dr. Brass and the staff at Brass Eye Center will supply you with an Amsler Grid and detailed instructions on how to use it.

If Dr. Brass detects any signs of Macular Degeneration or he believes that you may be at risk for Macular Degeneration, it may be necessary for you to have some specialized color pictures of the Macula and retina taken. It may also be necessary for you to have an Intravenous Fluorescein Angiogram (IVF) performed in order to study the health and circulation of the Macula and retina. During an IVF a special fluorescent dye is injected into a vein in your arm. By using a high speed digital camera a series of photographs will be taken in rapid succession as the dye passes throughout the retinal blood vessels. From these pictures, if present, Dr. Brass will be able to see any fluid leakage or new blood vessel growth beneath the retina. The IVF will also show any changes or damage to the Macula and retina and the extent of the changes. Most important, Intravenous Flourescein Angiography gives Dr, Brass a considerable amount of information regarding whether certain types of treatments such as laser treatment for macular degeneration, Visudyne Photodynamic Therapy, Macugen Injections or Lucentis Injections might help stabilize your vision and prevent vision loss. Today, thanks to the advances in treating Wet Macular Degeneration, if caught early, it may be possible to avoid suffering significant vision loss.

Treatment Options for Macular Degeneration

Today, if Macular Degeneration is diagnosed early enough, we are very fortunate to have a number of possible treatment options that may help to slow or even halt the progression of vision loss from Macular Degeneration. However, patients must understand that once the Macula has been damaged, there is no treatment that currently can reverse that damage and the associated loss of vision. Early diagnosis and treatment to prevent or halt vision loss must be the approach that we take.

Macular Laser Photocoagulation

Some time ago, The Macular Photocoagulation Study Group, a group of eye surgeons consisting of macular disease specialists, conducted several well controlled international clinical studies in order to determine what particular macular conditions should be treated with lasers, what types of lasers should be used, which patients might get the best results and to try and establish the best ways to use lasers to treat macular degeneration. As a result of these studies, Dr. Brass was able to obtain access to and establish a set of useful clinical guidelines for the Laser Treatment of Macular Degeneration.

Brass Eye Center uses the following guidelines for Macular Laser Photocoagulation:

Laser treatment of the Macula is ONLY useful for the EARLIEST stages of Wet Macular Degeneration. There is NO application for Dry Macular Degeneration.

Laser treatment of Macular Degeneration is ONLY applicable if the growth of new blood vessels or neovascularization is outside the direct center of the Macula-called the Fovea, adjacent to the Fovea, or well below the Fovea.

Very few areas of neovascularization were clearly enough defined to be treated effectively. We can ONLY treat those areas where the definition of the neovascularization is clearly outlined.

Even in cases where a successful laser treatment was performed, leakage returned in 50% of the cases within 2 years.

Thus, laser photocoagulation for Macular Degeneration is limited in its effectiveness and may also lead to scarring of the macula and additional vision loss.

Visudyne Photodynamic Laser Therapy

In 2000, the Food and Drug Administration (FDA) approved a new laser treatment option for Wet Macular Degeneration, which uses a light-activated drug called Visudyne^TM. The approval of Visudyne was a promising therapeutic approach for patients with Wet Macular Degeneration. Visudyne works through a “cool” process that produces a selective destruction of the weak leaky neovascularization. The purpose of the Visudyne Photodynamic Laser Treatment is to seal off leaking vessels while leaving healthy ones intact. This was believed to offer improved results over Macular Laser Photocoagulation. Unfortunately, what we know today is that even when successful, Visudyne Photodynamic Laser therapy does not always prevent recurrence of the new blood vessel growth. This means that it is often necessary to have repeated treatments in order to slow the progression of vision loss, and that even with repeated treatments a recurrence of neovascularization is possible and must be carefully monitored to preserve vision.

Macugen Injections and Lucentis Injections

As a result of basic research in cancer therapy in the area of “angiogenesis” or new blood vessel growth, a large base of knowledge has been developed in the treatment of Wet Macular Degeneration. Researchers discovered that a specific protein called “Vascular Endothelial Growth Factor” (VEGF) causes the growth of new blood vessels or “neovascularization” to occur in the eye. From this work, two drugs that can be injected into the eye have been developed, FDA approved and are now available for our clinical use to treat Wet Macular Degeneration. These drugs work by inhibiting Vascular Endothelial Growth Factor (VEGF) so that there is little or no stimulus to grow new blood vessels in the retina.

The most publicized anti-VEGF drugs are the Macugen Injection and the Lucentis Injection. The Food and Drug Administration approved Macugen Injections, in 2004 for treating all types of Wet Macular Degeneration. Macugen is an intravitreal injection, an injection that is placed directly into the vitreous of the eye. Generally it needs to be repeated every six weeks. Another type of anti-VEGF drug is the Lucentis Injection, which was approved  by the Food and Drug Administration in the summer of 2006. Lucentis Injections can be given to patients who have evidence of new blood vessel formation monthly with the clinical studies showing that over 90% of patients will maintain their vision (http://www.fda.gov/).

The Macugen Injection and Lucentis Injection is by prescription and injected only by an Ophthalmologist or Retinal Specialist. Should you have or be at risk for Wet Macular Degeneration, Dr. Brass will discuss more about the results with you. He will also be able to tell you more about the length of your actual treatment program, as it varies for each patient. If Macugen Injection or Lucentis Injection is a possible option for you, Dr. Brass will spend the time necessary to thoroughly review the possible risks, benefits and side effects with you before you decide to proceed.

Nutrition and Age Related Macular Degeneration

Over the past several years a number of clinical trials have demonstrated a relationship between the role of nutrition and the likelihood of developing Macular Degeneration. Simply stated, it appears that people who have a diet that is rich in fruits and vegetables-particularly green leafy vegetables-have a considerably lower incidence of Macular Degeneration. It is not yet clear whether taking dietary supplements can prevent progression in patients with existing macular disease, but it does seem clear that supplements can reduce your risk of Macular Degeneration. The Age Related Eye Disease Study (AREDS), which was sponsored by the National Eye Institute (http://www.nei.nih.gov/amd/summary.asp), showed that taking high levels of antioxidants and Zinc could reduce the risk of developing Age Related Macular Degeneration by about 25%. This is not a cure, but we need to consider this information as a possible way to help patients who are at risk for ARMD prevent vision loss.

A VERY SPECIFIC FORMULATION WAS USED IN THIS STUDY

BEFORE patients begin taking any course of vitamin or antioxidant supplements, you should fully discuss the risks and benefits with Dr. Brass, who in consultation with your family physician or Internist, will determine whether this is safe and effective for you to try.

As you can see, Macular Degeneration is a complex eye disease. Fortunately with early diagnosis it is possible to have a number of treatment options available to help preserve your vision. If you, a family member of friend have not had a recent eye examination or if you feel that you may be at risk for Macular Degeneration, please schedule an appointment at Brass Eye Center by calling 518.687.6872 or sending us an e-mail request.

Brass Eye Center is conveniently located for patients seeking diagnosis and treatment of Macula Degeneration (ARMD) from Albany, Troy, Schenectady, Saratoga Springs, Clifton Park, Cohoes, East Glenville, Loudonville, Mechanicsville, Niskyuna, Rexford, Westmere, Colonie, Half Moon and Delmar New York. Please phone 518.782.7827 to schedule an appointment for a Consultation for Macula Degeneration (ARMD).