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This condition is the most common cause of poor vision in people over 50 years of age. It is a degenerative condition affecting the central area of the retina called the macula, which is responsible for our central sight used for reading, watching TV, driving and fine vision tasks (e.g. computer work and craft).
Macular degeneration also known as age related macular degeneration (ARMD) generally occurs in both eyes but one eye can show degenerative changes months or even years before the other eye. In early stages of the disease there is a loss of sharpness or distortion in fine detail. In advanced cases, the eye loses central vision but still sees the objects to the side (peripheral vision). For this reason, macular degeneration, even in advanced cases does not result in total blindness. However it can make reading, watching TV and recognizing peoples faces difficult without the use of special low vision optical aids.
There are two types of ARMD, dry or atrophic and wet or exudative. Dry ARMD is more common and can cause slow progressive vision loss. The wet form is characterized by the development of abnormal blood vessels beneath the retina which may leak fluid or bleed. These develop rapidly and vision can worsen in a matter of days or weeks. The dry form has no effective treatment at present although ceasing smoking and maintaining a healthy well balanced diet may slow the progression. Several studies suggest that there may be a benefit in taking anti-oxidants, supplements (e.g. Macuvision) to reduce the risk of progression of ARMD. Your consultant Ophthalmologist can discuss if these supplements are necessary on an individual basis.
Advances in Treatment of Wet ARMD
Many forms of treatment for ARMD have been used in the past including various types of laser treatment most of which have been disappointing in the long term treatment of ARMD. Recent advances in technology have introduced the use of various drugs that can be injected into the back of the eye. Currently the use of these anti-vegf agents (Avastin/Lucentis) are showing promising results in the treatment of the wet form of ARMD. The Lucentis has recently been PBS listed. This treatment does not cure the ARMD but has the effect of slowing down the proliferation or drying out of the new blood vessels that have developed. The treatment involves injections into the vitreous, (jelly type substance between the lens of the eye and the wallpaper like lining at the back of the eye called the retina). To date, most patients require more than one injection over time in an attempt to stabilise and sometimes improve the vision. Numerous studies around the world are presently being conducted into the benefits of this treatment. This condition requires ongoing management over a lifetime.
What does macular degeneration have to do with cataract surgery?
Both cataract and macular degeneration are common findings as we get older and it is not unusual to have both problems occurring together in the eye. During the assessment for cataract surgery, the back of the eye will be examined to detect signs of macular degeneration and other retinal and optic nerve problems. In some cases when macular problems are detected particularly wet ARMD or macular holes, it may be necessary to have these treated before considering cataract surgery.
The natural lens and the cornea act as filters and appear to protect the macula from UV and blue light that may contribute to macular degeneration. Modern intraocular lens implants contain UV blocking and/or blue light filters to protect the macula after cataract surgery, however it is still important to wear sunglasses when outside after cataract surgery.
In patients who have very advanced cataracts, the view of the retina may be blocked by the cataract so it may not be able to determine before surgery if there is any evidence of macular or other retinal problems. In these cases it is important to understand that the ultimate visual outcome after cataract surgery will depend on the health of the back of the eye.
In patients with very advanced macular degeneration and advanced cataracts, the cataract surgery will improve general vision but will not restore central vision.