Macular degeneration

What causes Macular Degeneration?

Age-Related Macular Degeneration (ARMD) is a complex disease and is influenced by several factors:

1. Genetics and inflammation Mutations in one or more of at least 12 genes have been shown to have a role in at least 70% of MD cases. Most of these mutations involve a part of the immune system known as 'complement' and reduce one's ability to fight inflammation of the retina.

2. Oxidative damage The eye is a very active organ, requiring significant energy and producing large amounts of waste products. These waste products are normally removed from the eye, but in some people, waste products remain, causing oxidative damage. Certain foods and supplements (anti-oxidants) or drugs help reduce this damage.

3. Response to injury or tissue damage An organ or tissue normally responds to damage by trying to heal. This response may actually make things worse. In Wet ARMD, the new, leaky blood vessels that form may be an example of the retina trying to heal itself in a process that has gone wrong.

Causes

The exact cause of macular degeneration is not known. What is known, however, is that as the eye ages certain structural and functional changes occur in the retina that are important to the development of macular degeneration. Genetic and environmental factors may be involved.  There are two types of macular degeneration: dry and wet.

Dry macular degeneration is the more common and less severe of the two types. It may progress to the wet form over time. Dry macular degeneration has three stages, which may occur in one or both eyes.

Wet macular degeneration is characterised by sudden onset and more severe loss of vision. Wet macular degeneration occurs when abnormal blood vessels grow under the retina and leak fluid or blood into the macula region.

Eye examination equipment
An eye examination at Shattky Optometrists

Treatments

Currently, there are no medical treatments available for dry macular degeneration. However, because it usually progresses slowly, many people with the dry form can live relatively normal and productive lives, especially if only one eye is affected.

Several medical treatments are available for wet macular degeneration, although none can cure the condition. The aim of these treatments is to stabilise and maintain existing vision for as long as possible. In some cases, vision can improve. Treatments for wet macular degeneration include:

Medications
Drugs called anti-vascular endothelial growth factor (anti-VEGF) agents can help stop the growth and leaking of new blood vessels in the retina. These drugs are injected directly into the eye. Anti-VEGF drugs available in New Zealand include bevacizumab (Avastin), ranibizumab (Lucentis), and aflibercept (Eylea).

Photodynamic therapy
This procedure involves using light to activate a medication that is injected into the arm and travels to blood vessels in the eye. Once activated the medication causes abnormal blood vessels in the eye to close and stop leaking.

Photocoagulation
In certain situations, a high-energy laser beam can be used to destroy and seal leaking blood vessels under the macula.

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