Macular degeneration

Macular degeneration is a medical condition that usually affects older adults

and results in a loss of vision in the center of the visual field (the macula)
because of damage to the retina. It is a major cause of blindness and visual
impairment in older adults (>50 years). Macular degeneration can make it
difficult or impossible to read or recognize faces, although enough peripheral
vision remains to allow other activities of daily life.
Signs and symptoms
Pigmentary alterations
Hemorrhages in the eye
Visual acuity drastically decreasing (two levels or more)
Blurred visin
Central scotomas (shadows or missing areas of vision)
A loss in contrast sensitivity
Causes
Aging: over 66 years old
Family history
Macular degeneration gene: The genes for the complement system
proteins factor H (CFH), factor B (CFB) and factor 3 (C3) are strongly
associated with a person's risk for developing macular degeneration.
Specific diseases are associated with mutations in some of these genes
Stargardt's disease (juvenile macular degeneration, STGD)
Hypertension
Cholesterol: Elevated cholesterol may increase the risk of AMD
Obesity: Abdominal obesity is a risk factor, especially among men.
Race: Macular degeneration is more likely to be found in Caucasians
than in people of African descent.
Exposure to sunlight, especially blue light
Vitamin D deficiency
Smoking

Pathophysiology
Dry form. The "dry" form of macular degeneration is characterized by the
presence of yellow deposits, called drusen, in the macula. A few small
drusen may not cause changes in vision; however, as they grow in size
and increase in number, they may lead to a dimming or distortion of
vision that people find most noticeable when they read.
Wet form. The "wet" form of macular degeneration is characterized by
the growth of abnormal blood vessels from the choroid underneath the
macula. This is called choroidal neovascularization. These abnormal
blood vessels eventually scar, leading to permanent loss of central
vision.
Diagnosis
Visual acuity test. This eye chart measures how well you see at
distances.
Dilated eye exam. Your eye care professional places drops in your eyes
to widen or dilate the pupils. This provides a better view of the back of
your eye.
Amsler grid. Your eye care professional also may ask you to look at an
Amsler grid. Changes in your central vision may cause the lines in the
grid to disappear or appear wavy, a sign of AMD.
In dry macular degeneration which occur in 85-90 percent of AMD cases,
drusen spots can be seen in Fundus photography
In wet macular degeneration, using Angiography we can see leakage of
bloodstream behind the macula
Use Electroretinogram, we can know the points in macula which
response weak or absent compared to a normal eye
Fluorescein angiogram
Optical coherence tomography
Treatment
Laser therapy: High-energy laser light can sometimes be used to destroy
actively growing abnormal blood vessels that occur in age-related
macular degeneration.
Photodynamic laser therapy: A two-step treatment in which a light-
sensitive drug is used to damage the abnormal blood vessels.
Vitamins: A large study performed by the National Eye Institute of the
National Institutes of Health, called AREDS -- Age-Related Eye Disease
Study -- showed that for certain individuals, vitamins C, E, beta-carotene,
zinc, and copper can decrease the risk of vision loss in patients with
intermediate to advanced dry age-related macular degeneration.
Low vision aids: Devices that have special lenses or electronic systems
that produce enlarged images of nearby objects