Macular Degeneration for San Francisco, CA | Bart Eye Center

Macular degeneration

Contents:

What is Age-Related Macular Degeneration (AMD)?

Who is at risk for AMD?

What are the types of AMD?

Dry AMD

Vitamins and minerals for AMD

Lifestyle remedies

Wet AMD

Home vision monitoring

How is wet AMD diagnosed?

How is wet AMD treated?

What is AMD?

AMD damages the central part of your vision. The retina is nerve tissue inside the eye that captures light and sends it to the brain for processing into vision. AMD affects the center of the retina, called the macula. When the cells of the macula degenerate, images are not perceived correctly. Symptoms include:

early on, difficulty seeing in low light
later, wavy or blurred vision
in very advanced stages, loss of central vision and legal blindness

Who is at risk for AMD?

While the causes of AMD are not known, there are genetic and environmental factors that contribute to its development.

You are more likely to develop AMD if you:

eat a diet high in saturated fat (found in foods like meat, butter, and cheese)
are overweight
smoke cigarettes
are over 50 years old
have high blood pressure (hypertension) , heart disease, high cholesterol
have a family history of AMD
are caucasian
have had significant ultraviolet (UV) light exposure

What are the types of AMD?

Dry AMD is when tiny clumps of yellow protein called drusen build up under the macula, and parts of the macula get thinner. It accounts for 85-90% of all AMD cases. Central vision loss is slow.
Wet AMD is a more serious form that causes severe, rapid central vision loss. It occurs when abnormal blood vessels grow under the macula, often leaking blood or fluid and causing scarring. Only 10-15% are of the wet form.

Dry AMD

During an eye exam, Dr. Bart will look inside your eye through a magnifying lens to see if there are abnormalities in the macula. Dr. Bart may ask you to look at an Amsler grid which helps you notice any blurry, distorted, or blank spots in your field of vision.

Right now, dry AMD cannot be treated. New medications are on the horizon that may do so in the future. Currently, we focus on preventing dry AMD from getting worse.

Vitamins and minerals for AMD

Many people with intermediate or advanced dry AMD benefit from a specific mix of vitamins and minerals. AREDS 2 (Age-Related Eye Disease Study 2) was a very large research study that showed that taking the following nutritional supplements every day lowers the risk of getting late-stage or wet AMD:

Vitamin C (ascorbic acid) 500 mg
Vitamin E 400 international units (IU)
Lutein 10 mg
Zeaxanthin 2 mg
Zinc (as zinc oxide) 80 mg
Copper (as cupric oxide) 2 mg

Dr. Bart can tell you if vitamins and minerals are recommended for your dry AMD, as not all forms will benefit from the AREDS supplements.

Lifestyle remedies

Eye-healthy foods. Studies show that nutritional supplements alone are not enough to prevent or delay advanced AMD. You should also eat a healthy, balanced diet. This includes dark leafy greens (like spinach and kale) along with yellow, orange, and other colorful fruits and vegetables. Eating fatty fish like salmon may also lower your risk of early or advanced AMD.
Manage your other medical conditions. If you have cardiovascular disease or high blood pressure, for example, take your medicine and follow your health care provider's instructions for controlling the condition.
Smoking cessation. If you smoke, ask your health care provider for help quitting.
Maintain a healthy weight and exercise regularly. If you need to lose weight, reduce the number of calories you eat and increase the amount of exercise you get each day.
Have routine eye exams. Dr. Bart carefully evaluates the macula for the presence of AMD during a comprehensive exam.

Wet AMD

Over 200,000 cases of wet macular degeneration are diagnosed every year in the United States.

Home vision monitoring

Dry AMD can change into wet AMD. Dry AMD causes your vision to change over time. You may not notice these changes when they happen. It is important to catch vision changes as soon as possible because, if wet AMD is beginning, early treatment is important. Dr. Bart may recommend you use an Amsler grid every day to monitor your vision. A PDF of the Amsler grid with instructions on its use can be downloaded at https://amslergrid.org/AmslerGrid.pdf].

Amsler grid:

How to use the Amsler grid:

Wear the eyeglasses you normally wear when reading.
Position the chart 14 inches away from your face.
Cover one eye at a time with your hand.
Stare at the dot in the center. Do not let your eye drift from the center dot.
Contact Dr. Bart immediately if any of the straight lines appear wavy or bent, any of the boxes differ in size or shape from the others, or any of the lines are missing, blurry or discolored. Monitoring your vision every day is important. Print out this grid and keep it in a convenient place.

When testing, it is important to test EACH eye separately. It is not uncommon for AMD to progress in one eye undetected because the vision in the clear eye overrides the irregularities seen with the weaker eye, so test one eye at a time.

Traditionally, patients have been instructed to use an Amsler grid to test their vision. Significant vision changes can also be detected with reading, so we recommend testing your reading vision one eye at a time. If there is a definite change in either your reading vision or with Amsler Grid testing, it is important to contact Dr. Bart right away for evaluation. You should not wait for your next scheduled appointment to be seen.

How is wet AMD diagnosed?

Dr Bart carefully evaluates the macula for the presence of wet AMD during a comprehensive exam.

Optical coherence tomography angiography (OCTA) is a modification of standard OCT that allows visualization of retinal and choroidal vessels in separate layers of the eye. This test takes only a few minutes more than a standard OCT test.

Fluorescein angiography is a test whereby/during which a yellow dye called fluorescein travels through your blood vessels. A special camera takes photos of the retina to see if abnormal new blood vessels are growing.

Optical coherence tomography angiography (OCTA) is a special modification of standard OCT that allows visualization of retinal and choroidal vessels in separate layers of the eye. This test takes only a few minutes more than a standard OCT test.

How is wet AMD treated?

A protein called vascular endothelial growth factor (VEGF) is produced in our body and regulates the growth of blood vessels. In wet AMD, an excess of VEGF causes the formation of abnormal vessels. Several anti-VEGF medications are available to inactivate the excess VEGF. These drugs need to be injected into the eye. This is called an intravitreal injection. Anti-VEGF injections have led to remarkable gains in vision. These treatments are initially done monthly. As the eye improves, treatments become less frequent and in time may be paused. While most patients initially have an aversion to the idea of an injection into the eye, numbing of the eye is carefully done, these injections are comfortable, and patients do very well.

Since intravitreal injections typically provide the best outcomes, it is less common to use other treatments, such as a cold laser (Visudyne Photodynamic Therapy) or thermal laser treatment to seal the leaky blood vessels. Photodynamic treatment uses a medication, Visudyne, that is absorbed by the leaky blood vessels. A laser light activates the drug, causing the blood vessels to close and stop leaking. Thermal laser treatment seals leaky blood vessels but damages the tissue, so it is usually used when the leaky vessels are farther away from the center of vision.

At the SF Vision Center, we provide the highest quality eyecare to help you achieve and maintain optimal vision and ocular health. Call us to arrange a macular degeneration screening at SF Vision Center or request an appointment online today.

Visit MyVisionTest.com to test your vision with an online computerized verion of an Amsler grid.

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For AMD screening and care, see outstanding ophthalmologist Dilys Bart, MD in the Presidio Heights neighborhood of San Francisco, California. Call the office in the Presidio Heights neighborhood of San Francisco, California, or request an appointment online today.

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Macular Degeneration

Macular Degeneration services offered in San Francisco, CA