Brief Explanation of AMD

Age-Related Macular Degeneration

 

Age-Releyeated Macular Degeneration is a medical condition that usually affects older adults and results in a loss of vision in the center of the visual field (the macula) because of damage to the retina. It is a major cause of blindness and visual impairment in older adults (over 50), affecting 30-50 million individuals globally.

Macular Degeneration makes it difficult or impossible to read or recognize faces, although enough peripheral vision remains to allow  limited activities of daily life.

In the dry form (nonexudative, approximately 90% of AMD patients), cellular debris called drusen accumulates between the retina and the choroid, causing atrophy and scarring to the retina.

In the wet form (exudative, dry type progresses to wet type in approximately 10% of AMD patients), which is more severe, blood vessels grow up from the choroid behind the retina, which can leak exudate and fluid and also cause hemorrhaging. Wet type is associated with the development of abnormal blood vessels (choroidal neovascularization) under the retina, in which abnormal vessels leak fluid or blood under the macula, resulting in hemorrhagic detachment of the RPE and, eventually, fibrous scarring (disciform scar). Visual acuity for individuals with disciform scar ranges from 20/200 to 20/400, or worse, in one or both eyes.

There are currently no accepted therapies for dry form AMD. Some vitamin supplements along with high doses of antioxidants have shown benefits such as slow progression of the disease. Visual acuity for individuals with moderate to severe geographic atrophy commonly ranges from 20/80 to 20/200, or worse, in one or both eyes.

 

For bookwet type patients, due to the involvement by vascular endothelial growth factor (VEGF) in the development of new blood vessels, antiangiogenics or anti-VEGF agents can cause regression of the abnormal blood vessels and improve vision when injected directly into the vitreous humor of the eye. Several antiangiogenic drugs have been approved for use in the eye by the FDA and regulatory agencies in other countries.

About 10% of persons 66 to 74 years of age will have findings of macular degeneration. The prevalence increases to 30% in patients 75 to 85 years of age.

Other macular diseases include diabetic maculopathy, Stargardt’s disease, macular holes, solar retinitis and other toxic maculopathies.

Patients with moderate to severe central vision impairment are often referred to as “low vision patients.”  They generally respond well to magnification for distance and near vision and are often prescribed external low vision appliances such as handheld and spectacle mounted telescopes. However, those are seldom used due to the very small field of vision and the need to scan by head-movements when using them.

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