Our Retina expert Dr Ajay Aurora is amongst the best Retina surgeons of India
Macular degeneration is an age related condition(ARMD) that affects the macula which is the central most sensitive part of the retina. The macula allows us to see fine details such as recognizing faces, reading, watching TV or driving. When the macula gets damaged, central vision is affected and it becomes difficult to perform day to day tasks. However, peripheral vision stays intact, so the patient never becomes blind.
Ageing(> 50 years) is the commonest cause of ARMD. The exact aetiology is not known though smoking,obesity,hereditary, environmental and dietary factors are thought to play a role.
There are 2 types of ARMD- Dry (or Atrophic) & Wet (or Exudative)
In early stages, there is very little impact on vision. It may start in one eye though it eventually affects both eyes. There is gradual painless loss of central vision though side vision remains intact.
The commonest symptom is a progressive blurring of vision. The vision maybe more hazy in bright or low light. Altered perception of colours, glare & sensitivity to bright light, difficulty in night driving, seeing multiple images, frequent changes in the power of glasses are some of the other problems that occur. Cataract usually develops in both eyes, but maybe more in one eye.
Routine eye check
Most people do not realise they have ARMD until vision becomes blurry. Hence it is important to have a dilated retinal examination every 2 years after the age of 40 years.
This is an easy to do self test which is like a graph paper. With one eye closed, you need to look at the central black dot and observe the grid pattern for any wavy lines or black spots.
Optical Coherence Tomography (OCT)
Specialised test which scans your retina and gives a cross sectional image of each layer. It helps in early diagnosis and follow up.
Fundus Fluorescein Angiography
A dye is injected in the vein and photographs are taken with a special camera. This can help to detect leaking blood vessels and choroidal neovascular membranes.
Recently there have been a lot of advancements in the treatment of ARMD. The key is early detection.Although there is no cure, the disease progress can be slowed down by lifestyle modifications, nutritional supplements, laser and antiVEGF injections.
Scientific studies have shown that antioxidants like Lutein, Zeaxanthin, vitamin C, vitamin E, zinc, selenium etc lowered the risk of developing ARMD. They need to be taken on a long term.
These are the latest modality of treatment. They help by blocking the vascular endothelial growth factor, a chemical that is responsible for the growth of abnormal new vessels. The injections need to be given every 4 to 6 weeks till the neovascular membrane regresses. The goal of therapy is to stabilise the vision, it cannot be fully restored. Depending on your requirement,the types of injections are –
The possible side effects of injections could be haemorrhage, raised pressure, infection and inflammation.
This is an OPD procedure that uses a highly focussed beam of light to seal the abnormal blood vessels and prevent them from leaking and bleeding. It results in a scar that can cause a scotoma or blind spot. It is only indicated when the Wet ARMD does not involve the centre of the macula. At Vision Plus Eye Centre we have the latest Micropulse laser that treats without causing retinal damage.
This is rarely indicated for advanced CNVM where injections are not suitable. A special drug Verteporfin (Visudyne) is injected into the vein and a laser is applied to the abnormal vessels to seal them. Repeated therapy may be required. Patient needs to avoid exposure to sunlight for a few days.
These help to improve the quality of life
It's not uncommon to see some small spots or clouds moving in front of our eyes. These appear more prominent when looking at a plain background like a blank wall or the sky. These Floaters as they are called can vary in shape and size ranging from tiny dots to threads, cobwebs or clouds. They are actually clumps of cells or degenerated gel within the Vitreous, the clear jelly-like fluid in front of the Retina. As they float inside the eye, they cast a shadow on the Retina, the sensitive nerve layer of the eye and tend to move as you move your eyes.
If you experience flashes or floaters, you should visit your eye specialist at the earliest. At Vision Plus Eye Centre our experienced doctors will dilate your eyes and thoroughly examine your vitreous and retina to see if there are any tears or bleeding. In most cases no treatment is required as the flashes and floaters tend to decrease with time and are a part of the natural ageing changes. However, if there are retinal tears our Retina specialist may advise a laser to seal them. In case of bleeding you will be advised to avoid strenuous activity and lifting heavy weights.
Rarely Vitrectomy ( surgery to remove the vitreous) is required if the floaters are affecting the vision. You must discuss the pros and cons of surgery as it is not without risks. Laser Floaterectomy can be done to break up a large floater if it is blocking vision. There are no home remedies, best is to ignore them as they gradually fade though may not go away completely