Age-related macular degeneration: Warning signs are clear


Age-related macular degeneration is the leading cause of irreversible vision loss in patients 65 and older and is appearing more often in Vero Beach and elsewhere as the baby boomers keep circling the sun.

“The only cure for age-related macular degeneration is to stop aging,” Dr. Robert M. Reinauer, Vitreoretinal Surgeon at New Vision Eye Center, said facetiously. “Obviously, that is not a viable option, so our goal as retina specialists is to manage the progression of the disease.”

According to the American Macular Degeneration Foundation (AMDF), the degenerative disease is caused by the deterioration of the central portion of the retina, the inside back layer of the eye that records the images we see and sends them via the optic nerve from the eye to the brain.

The retina’s central portion, known as the macula, is responsible for focusing central vision in the eye, and it controls our ability to read, drive a car, recognize faces or colors, and see objects in fine detail. As the cells of the macula deteriorate, people experience wavy or blurred vision.

Dr. Reinauer explained that there are two common types of macular degeneration.

“Dry macular degeneration is caused by the degeneration of the photo receptors through the loss of cells in the back of the eye that receive light and give sight. The good news is that this is a very slow-progressing form of the disease. The bad news is that there is no treatment for it and the only thing a doctor can do is monitor the progression with the hopes of catching an early conversion from dry to wet so that we can stop that progression with medication.

“Wet macular degeneration is caused by an accumulation of blood or fluid deposits in the back of the eye,” Dr. Reinauer continued. “This fluid can damage the photo receptors, which causes loss of vision and we can see changes very quickly from weeks to months. The good news is that there is a treatment – not a cure – for this form of the disease. The bad news is that it progresses very rapidly, so early treatment is imperative.”

Wet eye macular degeneration is treated with injections of anti-vascular growth factor medicines.

“With regular eye injections, 90 percent of those patients will maintain their current vision,” said Dr. Reinauer. “Injection frequency varies upon the individual, with most getting the injections every 4-to-8 weeks. Most of my patients cringe when they hear that injecting medicine into their eye is the only treatment. But I assure them that we numb the eye, so it is literally painless and after the first one their apprehension is gone.”

While there is no preemptive diagnosis for the disease, there are risk factors. Smokers are at a higher risk, so stopping that habit will help deter the disease. Maintaining a healthy lifestyle by eating leafy vegetables, keeping your weight down and your cholesterol in check will also help keep the disease at bay. Age and genetics are uncontrollable risk factors.

Macular degeneration is a bilateral disease, and most people will have it both eyes. Wet presents itself asymmetrically, however, showing up first in one eye and then the other later. Eighty percent of patients with wet macular degeneration in one eye will eventually develop in the other eye.

While the infected eye is treated with injections, the other eye is monitored closely so that it can be treated at the first sign of development. Statistically, patients do better with the second eye because it typically is diagnosed and treated at an earlier stage.

So how would you know you are developing some form of macular degeneration? The top warning signs are:

1.) Blurred vision, usually in the central line of vision. The blurred area may start out very small and grow larger over time, with blank spots developing in the central visual field.
2.) Visual distortions can cause shapes that are not really there. Straight lines can be wavy. If this is happening, see your eye doctor as soon as you can.
3.) Loss of contrast sensitivity, making it difficult to tell the differences in texture, light and shadows. Steps and inclines may be difficult to navigate.
4.) Difficulty in adapting to light, making it hard to transition from a well-lit room to a dark room, or vice versa. Glares from wet roads and glass will impair your vision.
5.) Need for better lighting for everyday activities.
6.) Decreased color intensity, making it hard to differentiate similar colors.
7.) Difficult recognizing faces, even those of family and friends.
8.) Difficulty reading.
10.) Sudden onset and worsening of symptoms indicate wet macular degeneration and require immediate treatment to stop the progression.

Much research is underway and there is hope for improved treatments in the near future – possibly including a treatment to slow the progression of dry macular degeneration coming in the next several years.

At the same time, innovative techniques and technologies are being developed to make the medication for wet macular degeneration last longer so that the injection interval can be extended.

“There is actually a port delivery system that in the FDA approval process right now,” said Dr. Reinauer. “It will essentially create a reservoir in the eye that dispenses the medication over a six-month period. That’s exciting in the sense that a patient would only need two injections a year. We’re still a few years away but it will make the treatment easier.”

“The best thing you can do to ward off macular degeneration is get a yearly eye exam,” Dr. Reinauer said. “You can’t see the inside of your eye like you can a spot on your skin. Only a dilated exam can give a picture of what’s going on behind the retina. If it’s caught early it’s manageable, and in the case of wet macular, it’s treatable.”

Dr. Reinauer joined the staff of New Vision Eye Center in July 2015 after completing a fellowship in Vitreoretinal Surgery at the University of Texas Southwestern in Dallas, Texas. He is board certified and a member of the American Society of Retina Specialists. His core focus is the surgical care of the retina including retinal detachments, medical treatment of dry and wet macular degeneration, and diabetic eye care.

Dr. Robert Reinauer can be reached at New Vision Eye Center, 1055 37th Place, Vero Beach, 772-257-8700.

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