Wet & Dry Age-Related Macular Degeneration in the Elderly
Macular Degeneration: Symptoms and TreatmentsAge-related macular degeneration (AMD) is a long term process that slowly affects the sharpness of something called central vision. Central vision just refers to the ability to see objects well enough to function in day-to-day life. AMD is common in the elderly; as such, senior citizens and those caring for the elderly should understand the condition and how to prevent, identify, and treat it.
The macular part of the eye is specifically responsible for focusing images so that you can see fine detail. The back of the eye is comprised of tissue that interprets light into images (this tissue is the retina), and the central part of this tissue is called the macula. The degradation of this area in the eye happens slowly, doesn’t cause pain, and can potentially lead to loss of vision in one or both eyes. It can take the form of what physicians call wet and dry AMD.
Wet macular degeneration
Wet AMD refers to a condition characterized by the growth of fragile blood vessels underneath the macula in the eye which leak fluid and elevate the macular tissue. This kind of damage is more rapid, often called rapid AMD, and one may see straight lines as wavy in the early stages before loss of vision.Dry macular degeneration
Dry AMD refers to the degradation of cells that make up the tissue responsible for translating light into neural signals to be interpreted by the brain. While some common symptoms of dry AMD include blurry vision, more light required when reading, and difficulty recognizing faces, sometimes senior citizens see a blurred spot in the center of their visual field. People detect dry AMD early on because of the common presence of drusen.Senior citizens are more prone to drusen which are yellow spots that appear underneath the retina. These spots can be detected during dilated eye exam, and although doctors are unsure of how the presence of drusen affects the eye, they know that larger amounts of drusen contributes to developing and advancing dry and wet AMD.
Age Related Macular Degeneration AMD Symptoms
90% of people with AMD experience the dry form progression, but some are able to function normally if degeneration only occurs in one eye. However, blurriness and dark spots like in the picture above will surface when degeneration affects both eyes. If AMD is advanced in one eye, there is a high risk that the other eye will also be affected by AMD. While dry macular degeneration is more common, advanced ADM or vision loss is largely due to wet macular degeneration. Sometimes the dry form will develop into a wet form, leading to more rapid sight degeneration. All symptoms of wet ADM are considered advanced macular degeneration while dry AMD occurs more slowly and can have less severe early stages associated with the type of breakdown.Age Related Macular Degeneration AMD Risk Factors
While senior citizens are more at risk for developing AMD, middle aged individuals are at less risk. People who are more prone to developing ADM tend to smoke, be overweight, and have family histories of AMD. AMD develops more typically in Caucasians and females.Senior citizens can reduce their risk for developing AMD by following a healthy eating plan, avoiding unhealthy habits like smoking, maintaining normal blood pressure, maintaining a healthy weights, and getting physical activity in. Those providing elder care should encourage a healthy lifestyle.
Detecting and Diagnosing Age Related Macular Degeneration
Physicians can detect AMD by using a visual acuity test which measures sharpness of sight at varying distances, dilated eye exams which allow the doctor to see the retina more clearly and drusen that could be there, and tonometry which measures the pressure inside of the eye. There is a more specific test which involves staring at a Amsler grid and describing what you see. The Amsler grid looks like any grid with a black circle in the center. If one looks at this grid through one eye and notices wavy or missing lines, it can indicate the presence of AMD. If it is suspected that you have more advanced ADM like the wet form, doctors can perform a procedure called flourescin angiogram where dye is injected into the blood vessels in order for doctors to see the extent of growth of blood vessels and leakage in the retina at the back of the eye.Treatment & Surgery for Wet Age Related Macular Degeneration AMD
Like most long term degradation that occurs with age, macular degeneration cannot be reversed or stopped, but there are a few procedures for correcting the damage caused in order to relieve immediate symptoms that affect vision.Treatment for Dry Age Related Macular Degeneration AMD
- Laser surgery: This procedure involves aiming a highly focused beam of light into the retina in order to destroy the blood vessels that leak and cause wet macular degeneration. There is, however, a risk of also damaging healthy normal tissue around the macular region or blood vessels simply growing back after surgery. This usually involves repeating the procedure a few times, and eyesight can continue to degrade during this process.
- Photodynamic therapy: This procedure involves injecting a drug called verteporfin into the arm so that when it circulates, it binds to the newly formed leaky blood vessels in the retina. The physician than exposes the retina to a light source which activates the drug and destroys the blood vessels. This does not damage other tissue in the eye and can slow degeneration processes associated with wet AMD. Eyes or skin should not be exposed to direct sunlight for about five days after this procedure.
- Injections: Anti-VEGF therapy involve injecting drugs that block the growth of blood vessels due to large amounts of a specific growth factor in the eye. This therapy is given multiple times over a period of time.
- Nutrients (AREDS formulation): Taking a high dosage of specific antioxidants and zinc can slow the progression of macular degeneration and increase the resiliency of cells to this type of damage (500 mg Vitamin C, 400 International units of Vitamin E, 15 mg of beta-carotene (Vitamin A), 80 mg of zinc oxide, 2 mg of cupric oxide. Copper is ingested because a deficiency can occur with increased intake of zinc. This treatment can be taken for either intermediate to advanced stages of dry AMD or wet AMD.
- Diet: Although effects are minimal by the time AMD is more advanced, people who consume many green leafy vegetables over a long period of time are less at risk for developing AMD.
Living with AMD at All Stages
Senior citizens who develop AMD should have regular eye exams at least once a year, while seniors with more advanced conditions should consider an AREDS formulation to slow progression. Obtaining an Amsler grid for daily self-exams can be beneficial for determining rate of degradation that is harder to determine from day-to-day activities which involve sight. If someone detects an irregularity of sight occurring when looking at the Amsler grid before they experience more dramatic effects on vision when reading or driving, they can see their physician immediately before degradation worsens. Those assisting with the senior citizen’s elder care should drive them.Senior citizens who have significant degradation or vision loss can still use their eyes as they usually would without increased risk of worsening damage. Again, AMD is an irreversible process, but normal usage of the eyes is not related to increasing the rate of degradation. There are plenty of resources that are willing to help senior citizens with vision loss. Community organizations or other health care agencies can help these individuals adapt to a lifestyle with compromised vision.
