Age-Related Macular Degeneration (ARMD)

Age-related macular degeneration (ARMD) or age-related maculopathy (ARM) is the most common cause of legal blindness above the age of fifty-five (55) in the United States. It commonly affects patients in their retirement years. This disease affects the central vision leading to difficulty in driving and reading as well as other near vision tasks.

Background

Age-related macular degeneration is a disease that affects the macular area of the retina. The retina lines the back two-thirds of the eye and is much like the film of a camera. It takes the ‘picture’ for the eye. This ‘picture’ is then transmitted back to the brain via the optic nerve. In the brain this image is processed resulting in what we call sight. The central area of the retina is called the macula. This area is responsible for the detailed vision that enables us to read this paragraph. In ARMD the layers of the retina are damaged.

Cause of ARMD

At this time, no one knows the cause. Many ideas have been proposed and none proven. There appears to be some families in which ARMD occurs later in life.

Types of Age-Related Macular Degeneration

ARMD is divided into two categories: dry and wet. The dry type is caused by a generalized degeneration of the macular area and not associated with growth of new blood vessels and/or bleeding. This type of degeneration usually leads to a slow, gradual loss of central vision over many years. The dry type may advance to the wet type.

The wet type of macular degeneration usually involves rather rapid loss of vision. The wet type of macular degeneration is associated with abnormal vessels that have grown underneath the retina. This growth leads to bleeding and scarring which destroys the overlying retina. This destructive process can lead to distortion of central vision as well as loss of central vision.

Symptoms of Macular Degeneration

The most common symptoms of macular degeneration are loss of vision and blurriness. Since the visual loss can affect one eye at a time, it is important to check each eye individually. Other symptoms include distortion of straight lines and objects. Color vision may seem to be washed out or dimmed.

Detection and Diagnosis

The diagnosis of macular degeneration is made by a dilated examination by a qualified professional. Early detection is important, if there is growth of abnormal blood vessels this can be detected and treated at the earliest possible time. This may help decrease the chance of profound visual loss. Additional tests may be utilized to determine whether macular degeneration is dry or wet. These tests may include fluorescein angiography. There is no clear evidence (in 1999) that the addition of a indocyanine green angiogram (ICG) allows patients to have a better final visual outcome.

Treatment

There is some evidence but no proof that vitamins, minerals, and other dietary supplements may be beneficial in patients with macular degeneration. There are some significant studies that show patients may benefit from eating dark, green, leafy vegetables.

Although there is no ‘true cure’ for macular degeneration, we are able to help some people with laser photocoagulation. Laser photocoagulation can be used to stabilize the wet type of macular degeneration by destroying the abnormal blood vessels that are noted on examination. Unfortunately, even with laser photocoagulation, there is no guarantee of maintaining central vision. Other treatments are experimental, including surgical macular translocation and photodynamic dye treatments.

Summary

Age-related macular degeneration involves the deterioration or degeneration of the macular area of the retina. This disease is quite common in the retired age population. Full, careful, retinal examination is indicated as well as possible fluorescein angiography to best follow and treat this disease. We recommend patients eat dark green, leafy vegetables at least four times a week, take a daily multi-vitamin with minerals, and observe an Amsler grid daily.

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