Age-Related Macular Degeneration

The leading cause of visual loss in the United States' senior population is age-related macular degeneration. This condition causes deterioration and possible eventual loss of central vision. There are several risk factors for macular degeneration. Some of these risk factors cannot be modified, such as age or genetics. Other risk factors can be reduced, such as smoking, poor diet, and sunlight exposure.

The most common type of macular degeneration is the "dry" form. In this type of macular degeneration, there is progressive thinning (atrophy) and deposition of waste products (drusen) in the retina. Although vision loss can occur, it is usually minimal and only slowly progressive.

The "wet" form of macular degeneration is fortunately only responsible for 10% of macular degeneration cases. In this condition, abnormal blood vessels are stimulated to grow beneath the retina. Leakage and bleeding from these abnormal vessels can destroy central vision.

Because the wet form of macular degeneration is often devastating, we have been searching for ways to prevent it from occurring. The Age Related Eye Disease Study (AREDS) has now shown that vitamin supplementation is important in slowing the progression of macular degeneration in patients with moderate dry macular degeneration or patients with more advanced disease in one eye only. The most benefit was derived from a combination of antioxidants and zinc, in the following daily doses: 

Consult with your physician, however, before taking such supplements.

Metamorphopsia (distortion) is the usual presenting first symptom when wet macular degeneration begins and thus this symptom should be evaluated promptly. Fluorescein or ICG angiography is used to identify the presence and location of any abnormal new blood vessels.

Research and treatment of AMD

We are proud of our leadership in the clinical trials that have led to many of the drugs currently used to treat advanced AMD. We now routinely use drugs called anti-VEGF therapies, which we actively researched, such as Lucentis, Avastin, and Macugen in the treatment of AMD. However, tailoring the use of the drugs, and combining these agents with Photodynamic therapy and thermal laser treatments can achieve significant benefits in certain patients. In addition, many patients can achieve excellent results with a treatment schedule of anti-VEGF agents given at reduced intervals. Tailoring the dosing regiment to achieve the best combination of efficacy and safety is key, and we complete this process for all of our patients.

Despite our best efforts, many patients with macular degeneration and other retinal diseases are left with poor vision. For those patients, evaluation by a Low Vision specialist, such as the Low Vision Center at Robert Wood Johnson, conveniently located at our New Brunswick office, may be necessary. Special lenses and optical devices can be adapted to enable the patient to optimize their visual abilities.

Macular Hole

Macular Hole

Macular hole is an abnormal defect in the central part of the retina. Unlike retinal tears which occur in the peripheral retina, macular holes are usually not precursors to retinal detachment. A macular hole looks like a round punched-out defect. Because of its location, this type of retinal hole can cause severe central vision loss. The normal retinal tissue which should fill the hole is usually not missing, though; it is merely spread out to the edge of the hole. Surgery can close the hole, and allow that tissue to return to a normal position, improving vision. Imagine pushing a pencil through a screen; the wires making up the screen are pushed aside, not punched out. The wires may be pushed back into their normal position to repair the screen. Although trauma or disease can cause macular holes, they are usually seen as an age-related manifestation of an abnormality of the vitreous-retinal interface. For unknown reasons, they occur more frequently in women than in men.

Surgery is necessary for the treatment of most macular holes. Macular hole surgery consists of a vitrectomy (removal of the vitreous gel) and filling of the vitreous cavity with a mixture of air and gas. The patient is then asked to remain in a face-down position for 1-2 weeks following this surgery, to allow maximum air/gas contact with the macula. Usually, the intravitreal air/gas spontaneously absorbs from the eye within 6-8 weeks following the operation. In most cases, a macular hole can be closed in this fashion with at least partial restoration of central vision.

Macular Pucker

Macular Pucker

Macular pucker is caused by a transparent membrane of scar tissue that grows over the surface of the central retina. The eventual contraction and shrinkage of this membrane can wrinkle and distort the underlying macula, impairing central vision. Macular puckers usually arise from age-related changes in the vitreous gel but can result from any type of eye injury, inflammation, disease, or surgery.

Treatment is not necessary if symptoms are mild. However, if there is significant metamorphopsia or visual loss, vitrectomy may be performed. During this procedure, after the vitreous gel is removed, the membranous tissue that is causing the macular distortion is peeled off the retinal surface and removed from the eye.