What is the macula?

The macula is the specialized portion of the retina where the center of vision is located. Sensitive light receptors in the macula are responsible for reading, perception of color, and fine discrimination of details. If there is a problem in the macula, there is, by definition, a problem with the retina. If there is a problem in the retina, however, it may or may not be affecting the macula.

Why is the macula important?

Given the high concentration of nerve structures important for fine vision in the macula, any swelling, bleeding, leakage or injury to the macula can lead to significant changes in the central vision. Also, since the macula is so metabolically active, it is more likely to have degenerative problems than other areas of the retina.

How do I know if my macula is having problems?

Macular problems are usually associated with a combination of any or all of these 4 main complaints: 1) decreased central vision 2) decrease color vision 3) distortion 4) central blind spots If you notice a CHANGE in any of these symptoms, it could represent “active” disease and warrants a prompt visit to your eye care specialist.

Is macular degeneration the same as macular hole?

No. The macula is a location and can be afflicted by a number of different diseases (like the heart, lungs, liver, etc). If there is a hole in the central macula, we logically refer to it as a macular hole. If there is swelling, this is called macular edema, while if there is a hemorrhage, we call it a macular hemorrhage. Macular degeneration is a specific “degenerative” disease that selectively affects the macular portion of the retina.

Is macular degeneration called wet and dry only?

Technically, we divide all macular degeneration into wet and dry forms, but this can serve as a large source of confusion. In general, this broad classification has implications regarding the prognosis of the disease at a given time, as well as potential treatment options. To further confuse matters, a patient can show “wet” and “dry” changes at the same time. One way to think about this is that there are probably 100 or more different types of “macular degeneration,” of which 80 are wet and 20 are dry. Retina specialists can agree on the different types of macular degeneration (most of the time) and use terms like “retinal angiomatous proliferation” and “late leakage of undetermined origin” to describe them. However, patients understandably do not necessarily remember these terms as easily, and most physicians and patients are more concerned with determining the prognosis and treatment options. To make things even more complicated, sometimes even retina specialists will disagree on which “type” of wet macular degeneration you may have. That said, it is usually not difficult to identify an active case of wet macular degeneration that would potentially benefit from current treatments. In this case, whenever there is evidence of leakage of fluid and/or blood in the macula, we logically refer to this as a form of “wet” or “neovascular” macular degeneration. Often times, these specific cases are offered treatment when indicated, as they carry the highest risk for more rapid, progressive visual loss when left untreated.

What are Drusen?

Drusen are yellow flecks in the outer layers of the retina. The word comes from a German derivation that refers to the refractile changes seen on the cut surface of a rock that is split in two. From a clinical standpoint, drusen come in a number of different shapes and sizes. We know that some drusen, typically the smaller ones, are NOT of clinical concern and are generally associated with a good visual prognosis. Larger drusen are more ominous and can be associated with development of leakage, or wet macular degeneration, in the future. Simply stated, larger drusen merely put you at increased risk of leakage and are generally not associated with loss of vision per se. Your doctor can tell you what type of drusen you have and what your risks are. In general, the presence of drusen does not necessarily imply the presence of macular degeneration, whereas the presence of macular degeneration is often associated with the development of drusen.

Then what exactly is dry macular degeneration?

This is a little controversial. Some clinicians will use the term “dry” to include any macular degeneration patient without active “wet” disease. In the strictest terms, certain changes in the macula (i.e. drusen, pigmentation, atrophy) without the presence of leakage (blood, fluid, fats/proteins from the bloodstream) are considered “dry.” Leakage is the hallmark of “wet” disease, and often leads to more rapid, progressive visual loss (especially when left untreated or not brought to the physician’s attention promptly). In contrast, patients can technically have “dry macular degeneration” and maintain excellent central vision for long periods of time. Sometimes, drusen that patients have are smaller and not associated with an increased risk of vision loss at all (see above answer). These patients are also not at increased risk of developing wet macular degeneration compared to the general population.

Will vitamins make my vision better if I have macular degeneration?

The short answer is no. The vitamins in and of themselves do not have a beneficial effect on lost vision, as the underlying damage is often irreversible. However, for those at high risk of developing advanced macular degeneration, vitamin supplementation can potentially decrease the risk of future visual loss or possibly at least delay visual loss.

Why do people encourage me to take vitamins? A large clinical trial sponsored by the National Eye Institute referred to as AREDS (Age Related Eye Disease Study) demonstrated that certain patients who were given a combination of anti-oxidants and zinc had a reduced rate of vision loss as compared to those who were not on these supplements over an extended period of time. The vitamins were felt to be protective against vision loss from both wet and dry macular degeneration.

Who should take vitamins?

The complete answer to this is unclear because the AREDS study (above) really only looked at patients at “high risk” of developing macular degeneration. This same protective effect may not be present for people with low risk findings, and these supplements have no proven benefit in those with no signs of macular degeneration. Your doctor can discuss this with you in more detail, and you should ask specifically if your drusen are associated with an increased risk.

Who should NOT take vitamins?

If you are a smoker, your risk of developing lung cancer is greater if you take high-dose beta carotene as found in the AREDS formulation. For this reason, the AREDS supplement is not recommended for patients who currently smoke or are recent ex-smokers. Some companies offer a “smoker’s formula” that eliminates the beta carotene, or replaces it with a different nutrient such as lutein. The best advice for any macular degeneration patient who smokes is to quit smoking. Also, patients in the AREDS evaluation who were taking zinc had a higher rate of urinary tract infections. If urinary tract infections are a recurrent problem for you, it may be advisable to not take zinc.

What is macular degeneration? Explain in simple details?

Macular degeneration is a group of conditions that affects individuals over the age of 50. Two broad categories are used: Wet (neovascular) and Dry (non-neovascular). In Wet AMD, blood vessels grow under the retina through breaks in a normally intact barrier (Bruchs’ membrane/Retinal Pigment Epithelium) and begin to leak both fluid and blood. The body’s healing response to this leakage eventually leads to scarring and ultimately irreversible loss of vision. The best way to imagine this is to consider the eye to be like a room. We are on the outside looking in through the bay window. The iris is akin to the drapes (and can be blue, brown etc) with the hole in the middle representing the pupil. The retina is the wallpaper and lines the walls, ceiling and floor. The macula is the part of the retina that lines the center back wall of the room. In short, the macula is the capital city of the retina. The drywall is the choroid (which consists of a meshwork of blood vessels) and a thin sheet of “waterproofing” is represented by the retinal pigment epithelium (RPE). The RPE is responsible for supporting and nourishing the overlying retina. The white of the eye, or sclera, is akin to the siding outside of the “house.” This is the protective outer coating of the eye. In “wet” AMD, an analogous situation occurs when a pipe breaks in the drywall layer of the wall and fluid is seen on the wall-paper (except in this case the pipes are blood vessels and the fluid consists of blood products). All of our attempts to fix AMD are based on our ability to treat this leakage without damaging the wallpaper (macula). In the dry form, blood vessels that normally supply nutrients to the macula atrophy or deteriorate, ultimately resulting in loss of function in that part of the macula.