Macular Degeneration attacks the central vision of those with the eye disease and macular translocation surgery can be used to lift the macula away from the underlying blood vessels and attach it to a new and more healthier portion.  This will restore the central vision that is damaged by macular degeneration.

Macular translocation surgery is only meant to treat patients with wet macular degeneration.  In this form of macular degeneration leaking blood vessels have formed beneath the retina and moving the macula to a more healthier spot will improve central vision.  This eye surgery is not recommended for every patient who has macular degeneration and best results have been shown for those people who are in the early stages of the eye disease.

In macular translocation surgery, the eye surgeon will pinch the outer part of the eye called the sclera.  With the sclera pinched, the surgeon will place a suture into the wall of the eye to keep it pinched.  This will shorten its length as well as buckle the retina.

Once the suture is in place, the eye surgeon will inject a saline solution into the eye under the retina, causing it to lift up, allowing it to be moved approximately 0.3 and 0.4 mm without detaching it.  After the retina is moved, a gas bubble is injected into the eye to hold the retina in location until it heals.

Another side benefit of relocating the retina during macular translocation surgery is it provides access to the previously covered blood vessels thus allowing treatment without harming the retina.

Duke Eye Center have refined macular translocation surgery into a technique called macular translocation surgery with 360 degree peripheral retinectomy (MT360).  This is a two-stage surgery that involves rotating the retina to move the macula away from the abnormal blood vessels associated with macular degeneration and then correcting the tilted visual field by rotating the eye.

Macular translocation surgery does have some risks associated with it including retinal detachment, bleeding, double vision, and residual tilting of vision.  All of these risks can be either corrected surgically or with special glasses.

While here at Macular Degeneration Support Canada we have blogged about the symptoms of AMD, we thought we would do another quick blog post.

Dry macular degeneration generally develops over a period of time, resulting in the gradual loss of central vision and as a result of this vision loss, you may notice changes in your vision.  If you are over 50 years old or in a high risk category associated with macular degeneration the following symptoms may indicate loss of vision associated with macular degeneration.

•  The need for increased light when reading
• Increased difficulty adapting to low light levels when entering a dimly lit room
• Increased blurriness when reading printed words
• Difficulty recognizing faces
• Decrease in the intensity of colors
• Gradual “fog” or “haziness” that shrouds overall vision
• Blind spot at the centre of your vision

With dry macular degeneration the symptoms may develop slowly over a period of time and patients with the eye disease may have been affected several years before being diagnosed.  It is also possible to have macular degeneration in one eye, resulting in no symptoms in a the other eye.

Wet macular degeneration is generally the faster progression version of the eye disease.  Symptoms of wet macular degeneration are similar to that of dry macular degeneration but changes in vision may progress much faster.  With wet macular degeneration symptoms tend to appear suddenly and get worse rapidly.

Should you experience any symptoms of macular degeneration and be in a high risk category of developing macular degeneration or be over the age of 50, it is recommended that you seek advice from an eye care professional.

With age-related macular degeneration, the eye disease attacks the macula of the eye resulting in the progressive degeneration of this portion of the retina. This results in the loss of central vision, while peripheral vision generally remains normal.

Wet macular degeneration is characterized by choroidal neovascularization (CNV). This is the development of abnormal blood vessels developing beneath the retina. These blood vessels bleed and cause scarring on the macula which results in the loss of central vision. Wet macular degeneration progresses relatively fast and should be treated as soon as diagnosed.

With wet macular degeneration, there are some signs and symptoms of macular degeneration that may appear and progress quickly. THese include:

• visual distortions where straight lines appear wavey or crooked;
• loss of central vision;
• requiring more light to read;
• blurry or blind spot in the field of vision

It is important to have regular eye examinations after the age of 50 or if you are subject to many of the risk factors associated with wet macular degeneration.

While there is no cure for wet macular degeneration, there are several viable treatments for the eye disease. These include: 

• laser therapy;
• photodynamic therapy;
• macular translocation surgery;
• Anti-VEGF drugs such as Macugen, lucentis and Avastin;
• implantable optical devices

It is imperative to have regular eye examinations, especially if you have had a family member diagnosed with macular degeneration. The key to effective treatment of wet macular degeneration is early detection of the eye disease.

People diagnosed with dry macular degeneration do have drusen deposits.  Drusen is described as white or yellow deposits that have built up on the macula.  What causes these deposits is not really known but these deposits are present in all people diagnosed with dry macular degeneration.

Does the presence of drusen mean that you have macular degeneration?

Drusen deposits on your macula does not mean you have macular degeneration.  Most people over the age of 40 have some small deposits of drusen.  This is normal as the eye ages.

If you are told that you do have drusen deposits, it can mean that you have a higher risk of developing macular degeneration.  Because of this it is important that you have your eyes monitored on a regular basis by an eye care professional.  If you are then diagnosed with dry macular degeneration, the eye disease has to be monitored closely to ensure that it does not progress into the more serious form wet macular degeneration.

The Amsler Grid is a simple screening test that is used to assess the macula (the center of the retina).  The Amsler Grid consists of evenly spaced horizontal and vertical lines printed on black or white paper with a small dot is located in the center of the grid for fixation.

The eye test is quite simple.  While staring at the dot in the centre of the Amsler Grid, the patient looks for wavy lines and missing areas of the grid.   This simplicity of this test makes it an effective and inexpensive diagnostic test for diagnosing things such as age related macular degeneration and is especially helpful for monitoring vision at home.

This simple screening test is used to assess the macula (the center of the retina).  The Amsler Grid consists of evenly spaced horizontal and vertical lines printed on black or white paper.  A small dot is located in the center of the grid for fixation.  While staring at the dot, the patient looks for wavy lines and missing areas of the grid.   This test is especially helpful for monitoring vision at home.

If you are at risk for macular degeneration or other eye diseases, you can use the Amsler Grid at home to monitor your vision.  However, using an Amsler Grid is not a substitute for regular eye exams and doctor visits.  Only trained professionals can detect signs of eye disease that can be missed by self-diagnosis using an Amsler Grid.

It is simple to test yourself with the Amsler Grid

If you wear glasses it is important that you wear them while you use the Amsler grid.  The Amsler Grid should be at about the same distance from your eyes as any other reading material would be.

• Cover one eye, then focus on the dot in the center of the Amsler Grid. Do any of the lines look wavy, blurred or distorted? (All lines should be straight, all intersections should form right angles and all the squares should be the same size.)
• Are there any missing areas or dark areas in the grid?
• Can you see all corners and sides of the grid?

If the lines of grid do not appear straight and parallel or there are missing areas, notify your doctor.  This does not necessarily mean that you have macular degeneration, but it is a warning sign that something is wrong.  The doctor will examine the back of the eye (macula) very closely.

This test is frequently given to patients for home use to monitor macular degeneration.

When using the test at home, notify the doctor if any changes in the appearance of the Amsler Grid are detected.

What is OCT and how is it used to battle eye diseases such as macular degeneration?

Optical Coherence Tomography or OCT, is a non-invasive technolgy used for imaging the retina.  It can determine if there are any vision related problems without touching the eye.  It has the ability to detect problems in the eye prior to any symptoms being present in the patient.

The retina is composed of layers of light sensitive tissues.  With an OCT, doctors are able to see a cross section of the retina and detect the early onset of a variety of eye conditions and eye diseases such as macular degeneration.  The OCT allows for detection of things such as macular holes, diabetic retinopathy and even optic nerve damage.  Using an OCT allows for early treatment in patients and dramatically improves the success of these treatments, especially in diseases such as wet macular degeneration – where the eye disease progresses rapidly.

The OCT is similar to a CT scan which is used to image internal organs inside the body.  The OCT uses an array of light to rapidly scan the eye.  These scans are interpreted and the OCT then presents an image of the tissue layers within the retina.  These layers can be differentiated and their thickness measured.  By comparing the thickness of the layers measured by the OCT scan against the normal thickness of healthy retinal layers, eye doctors can determine which retinal disease or eye condition exists in the eye, even before the patient is aware of any symptoms.

The OCT test is not only non-invasive, it allows for early detection.  Using an OCT test to help detect macular degeneration is critical when fighting this eye disease.

Dry macular degeneration occurs when the light sensitive cells in the retina gradually break down.  This causes damage in the macula of the eye, which is responsible for central vision.  The loss of vision with dry macular degeneration is progressive but gradual.  Dry macular degeneration accounts for approximately 90 percent of the diagnosed cases of this eye disease and only 10 percent of the blindness.

Wet macular degeneration occurs when abnormal blood vessels behind the retina start to grow under the macula.  These new blood vessels tend to be very fragile and often leak blood and fluid. The blood and fluid raise the macula from its normal place at the back of the eye. Damage to the macula occurs rapidly.  Wet macular degeneration accounts for only 10 percent of the diagnosed cases of this eye disease and 90 percent of the blindness contributed to macular degeneration.

Because of the nature of this eye disease and its two distinct forms, it is important to recognize the early symptoms that may be associated with macular degeneration.

First, it is imporant to note that with both forms of macular degeneration, there is no pain.

Some of the more common symptoms of dry macular degeneration are:

• Blurry vision – As a few cells start to die in the macula, the clarity of objects begins to decline.  This blurry vision will go away in bright light.
• As dry macular degeneration progresses, people generally notice a small but growing blindspot in the centre of their vision.
• As dry macular degneration enters the late stages, the blindspot has generally become large enough to obscure the entire centre vision

Some of the more common symptoms of wet macular degeneration are:

• Straight lines appear to be wavy or crooked as the fluid leaking in the retina lifts the macula and distorts vision.
• A small blindspot may appear as it does in dry macular degeneration.
• The blindspont may grow rapidly as more fluid and blood leaks.  The continued bleeding and fluid leakage is what causes the rapid loss of vision in people diagnosed with wet macular degeneration.

There is no known cure for either form of macular degeneration.  Several drugs are now available to treat and slow the progression of wet macular degeneration, and in some cases, these drugs have been known to reverse the damage caused by the leakage.  There is no known treatment for dry macular degeneration, but it has been shown that antioxidant supplements may slow the progression of the disease.

It is imperative that people have regular yearly eye examinations, especially if there is a history of macular degeneration in their family.  Early detection of this eye disease leads to early treatment and therefore improves the chances of maintaining ones vision.

Macular degeneration can affect anyone at anytime.  Ensuring proper eye health, maintaining a healthy diet and reducing the risk factors associated with the eye disease can reduce the risk of macular degeneration developing.

The Age Related Eye Disease Study (AREDS) was a controlled clinical study that involved approximately 3,600 patients.  Each participant in the study was diagnosed with age related macular degeneration and each patient was at various stages of the disease.  Throughout the course of the study it was shown that antioxidant and zinc supplements introduced into the diet of patients could help slow the progression of age-related macular degeneration (AMD), thus preventing the disease from progressing into the advanced stages.  This would aid in saving the patient’s vision.

AREDS found that taking high levels of antioxidants and zinc can reduce the risk of developing advanced age-related macular degeneration (AMD) by about 25 percent.

During the course of the clinical study it was determined that the following would be the mixture of supplements added to the diets of those participating:

• 500 milligrams of vitamin C;
• 400 milligrams of vitamin E;
• 15 milligrams of beta-carotene;
• 80 milligrams of zinc; and
• 2 milligrams of copper

Copper was added to the supplement to counter a condition commonly known as copper deficiency anemia that is associated with high levels of zinc intake.

It should be noted that the AREDS formulation is not a cure for age related macular degeneration.  This is just a treatment that was shown to reduce the risk of developing advanced macular degeneration by about 25 percent over the course of a six (6) year study.  The effects of this formulation beyond six-years in unknown but a second study is underway to determine the longterm viability of antioxidants and dietary supplements in preventing the advancement of age-related macular degeneration.  It should also be noted that this forumulation will not prevent anyone from developing age-related macular degeneration.

For more information on the Age-Related Eye Disease Study you can visit the National Eye Institute website.

Age related macular degeneration is a progressive eye disease that attacks the central vision.  With dry macular degeneration, the most common form of this eye disease affecting approximately 90 percent of those diagnosed, the loss of vision is associated with the accumulation of drusen in the retina.  Drusen deposits on the macula cause atrophy which halts the functioning retinal cells resulting in vision loss.

Drusen is thought to be associated with the metabolic processes occurring throughout the body.  As cells perform their tasks they produce by-products which are carried throughout the body.  Most of these by-products are disgarded, it is thought that some deposit and accumulate in the eye forming drusen.

Drusen deposits may be scattered or concentrated, depending on the stage of dry macular degeneration a person is at.  In the early stages of dry macular degeneration, the accumulation and deposits of drusen may be small.  There is little or no impact on vision and the person typically will not have any symptoms indicating a problem or signaling the beginnings of macular degeneration.  As the deposits of drusen grow in accumulation, medium size deposits form and symptoms develop such as blurred vision.  People will generally require more light and will often indicate a loss of vision that is more pronounced in the centre of the eye.  This is typically when most patients are diagnosed with dry macular degeneration.

Once the eye disease progresses to where it is considered advanced dry macular degeneration, retinal damage has occurred and there is an inability of the light sensitive cells in the retina to process light.  The drusen deposits at this stage may be very large and very concentrated, resulting in more blurry vision which gets larger and larger and darker with time.

There is no known treatment for macular degeneration but the progression of drusen deposits have been shown to be slowed with antioxidants and zinc supplements in the diet.

A controversial treatment called rheopheresis is being explored for a treatment of dry macular degeneration.  Rheophersis is a treatment that is similar to kidney dialysis where teh blood is filtered to remove the by-products associated with the metabolic processes of the body.  This treatment hopes to remove the elements thought to be depositing in the eye and forming drusen.  Clinical trials are currently underway to determine if this treatment is a viable option for treating dry macular degeneration and for removing the drusen deposits.

Rheopheresis has been shown to be effective in slowing the progression of dry macular degeneration in limited trials.  However, this treatment for dry macular degeneration is only currently available in Canada and Germany.

Laser treatment for the removal of drusen has been shown to be ineffective.  This is partially due to the fact that atrophy has already occured and the function of the cell has already been loss prior to the removal of the drusen.

People diagnosed with dry macular degeneration must have regular eye exams to monitor the drusen deposits and the progression of the eye disease.  Dry macular degeneration can progress into the more serious form of wet macular degeneration.

Wet macular degeneration is the leading cause of vision loss in people over 60 years of age, accounting for more than 90 percent of the blindness associated to the eye disease.  The damage caused to the eye with this form of macular degeneration occurs rapidly as abnormal blood vessels grow and leak, causing scarring on the macula.

The Foresee PHP test significantly improves the detection of macular degeneration and provides eye care specialists with early detection, allowing treatments through anti-VEGF macular degeneration drugs such as Lucentis, Macugen or Avastin.  Early detection of the eye disease means preventing damage to the eye.

The new non-invasive test for wet macular degeneration has the patients touching a touch-sensitive screen indicating where distortion occurs in a series of onscreen linear dots.  Patients use a pointer similar to a pen and are required to simply indicate where the dots are out of line.  The entire eye test takes approximately 20 minutes to perform and is non-invasive.

Early detection using the Forsee PHP test means halting the progression of the eye disease before damage becomes permanent.  Early detection means early treatment, a critical component for providing eye care to those patients with wet macular degeneration.