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What is Macular Degeneration?
Macular degeneration is a common, painless eye condition in which the central portion of the retina deteriorates and does not function adequately.
Retina - the retina is the light sensitive tissue located in the back of the eye. It is like the film in a camera, recording the images we see and sending them via the optic nerve from the eye to the brain. The retina instantly converts light images into electrical impulses through a chemical reaction. The retina then sends these impulses or signal, to the brain, where we interpret what we see, process the visual information, and relate what we see to the rest of our environment.
Macula - the macula is a small portion of the retina located in the central portion of the retina. The macula is responsible for central vision (straight-ahead vision) and provides the ability to see fine detail in your direct line of sight. We use the macula of each eye to have the clear vision that allows us to read, drive a car, and recognize faces or colors. The non-macular areas of the retina provide us with our side vision and best night vision.
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Age Related Macular Degeneration (AMD)
There are two types of AMD (dry AMD and wet AMD).
Smoking, high blood pressure, obesity, a diet high in unsaturated fats and simple carbohydrates and lack of exercise all increase the risk of AMD.
Early symptoms of dry AMD include slightly blurred vision, the need for more light for reading, and difficulty recognizing faces until very close to the person. A symptom of more advanced dry AMD is the presence of a blurred spot in the center of vision. An early symptom of wet AMD is the wavy appearance of straight lines.
Dry AMD - Dry AMD develops when the cells of the macula become damaged as a result of a build-up of waste products called drusen. It is the most common and least serious type of AMD, accounting for around nine out of 10 cases. The loss of vision is gradual, occurring over many years. However, an estimated one in 10 people with dry AMD will then go on to develop wet AMD.
Wet AMD - Wet AMD develops when abnormal blood vessels form underneath the macula and damage its cells (doctors sometimes refer to wet AMD as neovascular AMD). Wet AMD is more serious and without treatment, vision can deteriorate within days.
Symptoms of Age Related Macular Degeneration
The main early symptom is blurring of central vision despite using your usual glasses. In the early stages of the condition you may notice that -
One specific early symptom to be aware of is visual distortion. Typically, straight lines appear wavy or crooked. For example, the lines on a piece of graph paper, or the lines between tiles in a bathroom, or the border of any other straight object, etc.
A 'blind spot' then develops in the middle of your visual field. This tends to become larger over time as more and more rods and cones degenerate in the macula.
Visual hallucinations are common in people with severe visual loss of any cause. Visual hallucinations (also called Charles Bonnet syndrome) can occur if you have severe AMD. People see different images, from simple patterns to more detailed pictures. The experience can be upsetting but is less frightening if you are aware that it can happen in AMD. Importantly, it does not mean you are developing a serious mental illness. If you do develop visual hallucinations they typically improve by 18 months but in some people they last for years.
AMD is painless. Symptoms of dry AMD tend to take 5-10 years to become severe. However, severe visual loss due to wet AMD can develop more quickly.
Causes of Age Related Macular Degeneration
Causes of macular degeneration include the formation of deposits called drusen under the retina, and in some cases, the growth of abnormal blood vessels under the retina. With or without treatment, macular degeneration alone almost never causes total blindness. People with more advanced cases of macular degeneration continue to have useful vision using their side, or peripheral vision. In many cases, macular degeneration’s impact on your vision can be minimal.
When macular degeneration does lead to loss of vision, it usually begins in just one eye, though it may affect the other eye later.
Many people are not aware that they have macular degeneration until they have a noticeable vision problem or until it is detected during an eye examination.
Stages of AMD?
There are three stages of AMD defined in part by the size and number of drusen under the retina. It is possible to have AMD in one eye only, or to have one eye with a later stage of AMD than the other.
Early AMD - early AMD is diagnosed by the presence of medium-sized drusen, which are about the width of an average human hair. People with early AMD typically do not have vision loss.
Intermediate AMD - people with intermediate AMD typically have large drusen, pigment changes in the retina, or both. Again, these changes can only be detected during an eye exam. Intermediate AMD may cause some vision loss, but most people will not experience any symptoms.
Late AMD - in addition to drusen, people with late AMD have vision loss from damage to the macula. There are two types of late AMD -
In geographic atrophy (also called dry AMD), there is a gradual breakdown of the light-sensitive cells in the macula that convey visual information to the brain, and of the supporting tissue beneath the macula. These changes cause vision loss.
In neovascular AMD (also called wet AMD), abnormal blood vessels grow underneath the retina. ("Neovascular" literally means "new vessels.") These vessels can leak fluid and blood, which may lead to swelling and damage of the macula. The damage may be rapid and severe, unlike the more gradual course of geographic atrophy. It is possible to have both geographic atrophy and neovascular AMD in the same eye, and either condition can appear first.
AMD has few symptoms in the early stages, so it is important to have your eyes examined regularly. If you are at risk for AMD because of age, family history, lifestyle, or some combination of these factors, you should not wait to experience changes in vision before getting checked for AMD.
Not everyone with early AMD will develop late AMD. For people who have early AMD in one eye and no signs of AMD in the other eye, about five percent will develop advanced AMD after 10 years. For people who have early AMD in both eyes, about 14 percent will develop late AMD in at least one eye after 10 years. With prompt detection of AMD, there are steps you can take to further reduce your risk of vision loss from late AMD.
If you have late AMD in one eye only, you may not notice any changes in your overall vision. With the other eye seeing clearly, you may still be able to drive, read, and see fine details. However, having late AMD in one eye means you are at increased risk for late AMD in your other eye. If you notice distortion or blurred vision, even if it doesn’t have much effect on your daily life, consult an eye care professional.
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