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Macular Degeneration

Macular Degeneration is the leading cause of vision loss in American senior citizens. MD is named as such because it entails the disintegration of the macula, which is a part of the retina that is responsible for high-acuity and colored vision.

MD is characterized by the loss of visual acuity. Vision loss normally begins in the center at the center of one’s vision field. At this point it may be hard to read or drive. The vision loss slowly extends out from the center, normally becoming a gray or black hole in one’s vision. Color perception also starts to go, as colors become dull and blend together. Spatial perception also decreases, and lines that are straight may appear curved. There are also physical changes to the eye.  The pigment of the iris may change and protein buildups called drusen may appear in the eye.

There are two types of MD:  neovascular and non-neovascular. These are more colloquially referred to as wet and dry MD respectively. Neovascularization is the abnormal growth of new blood vessels (neo- meaning new and -vascular meaning fluid carrying vessels).

Dry Macular Degeneration (DMD) is nine times more common than Wet Macular Degeneration (WMD). DMD occurs in the earlier stages of the disease. The two main causes are the thinning of macular tissues due to aging or due to buildup of pigment in the macula over time. Drusen are often an early indication of DMD. Vision loss is normally less severe than in WMD, but can gradual proceed to severe vision loss.

Wet Macular Degeneration is named as such because it is characterized by exudate leaking into the macula due to an overgrowth of blood cells in the retina. WMD is rarer than DMD but has a much higher chance of causing more severe central vision loss. The cause of WMD is choroidal neovascularization. The choroid is connective tissue in the eye that holds the visible portion of your eye and the inner retina. In an attempt to bring more nutrients to the retina, the eye grows an abnormal amount of blood vessels. Since they are created so quickly, the vessels are very fragile which leads to blood leakage that damages photoreceptors. There are two levels of WMD: Occult and Classic. Occult involves less leakage and thus less severe vision loss. Classic is simply more leakage and fittingly causes more severe vision loss.

MD can be detected early on its development. Vision loss normally occurs in the later stages of the disease and is very gradual. A retinal exam is administered to look for any physical signs of MD. If early signs of MD are found, a fluorescein angiography may be ordered. Angiography is the photography of blood vessels. Fluorescein refers to the fluorescent yellow dye injected into the blood vessels to make them more visible.

MD is most commonly associated with aging, and is often referred to as age-related macular degeneration. Studies have shown that those with specific gene variations have a much higher risk of developing AMD. Because of this, AMD tends to run in the family. White females are the most common demographic. Besides for heredity, smoking is the only other confirmed cause of AMD.

Some studies have shown that obesity and hypertension could be a cause. Other studies have shown that certain drugs and having a lighter eye color could also cause AMD. All of these studies are inconclusive, however.

While there is no cure for AMD, medicines exist that have been shown to slow or reverse the progression of vision loss. Many medicines have been shown to treat wet AMD very effectively, while no effective treatments exist for dry AMD. Improved nutrition, however, has been shown to prevent dry AMD from developing into wet AMD.