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Macular Degeneration

  • A condition that causes damage to the retina and leads to blurred vision
  • Symptoms uncommon in early stages; warped vision, loss of central vision may occur in later stages
  • Treatment includes intravitreal injection
  • Involves macular degeneration program

Overview

As we age, it's important to get regular eye exams to check for a condition called macular degeneration. It's the leading cause of loss of visual acuity or sharpness and the most common cause of legal blindness for people over age 65 in the United States. 

Macular degeneration can negatively impact your life by affecting your ability to drive, read, do computer work and even recognize faces.

Yale Medicine eye specialists are at the forefront of developing better therapies for age-related macular degeneration, and they have improved their success in treating it to as high as 90 percent with some retinal therapies. 

“At Yale Medicine, our center of attention is on the patient and the best outcome for patients and their families,” says Ron Adelman, MD, director of the Yale Medicine Retina & Macula Center.

What are the symptoms of macular degeneration?

The condition affects a spot at the center of the retina called the macula. You may not notice symptoms of macular degeneration for awhile. The first indicator of macular degeneration may be that you don't see colors as brightly or intensely or that straight lines seem warped. As the condition progresses, symptoms can include a gradual or even sudden loss of central vision. You might also perceive dark, blurry areas in the center of your vision.

What are the risk factors for macular degeneration?

The biggest risk factor for macular degeneration is age. The condition also has higher incidence rates among people with a family history of it, Caucasians and smokers. Age-related macular degeneration is also more common among women. Additional risk factors include high blood pressure, high cholesterol, heart disease, light iris color, sun exposure, farsightedness and a low dietary fish intake.

How does macular degeneration progress?

When the cells of the macula deteriorate, images aren’t received correctly. Still, early stage age-related macular degeneration doesn’t affect vision. Later, if the disease progresses, it can cause wavy or blurred vision, and, if the condition continues to worsen, central vision may be completely lost.

How is macular degeneration diagnosed?

After discussing your vision issues, an ophthalmologist will do a clinical examination with a slit lamp, a low-power microscope combined with a high-intensity light source that can be focused as a thin beam to help look at the front of the eye. The doctor may also use several types of imaging (such as fluorescein angiography, indocyanine green angiography or optical coherence tomography) to determine if age-related macular degeneration is in the retina and in the layers beneath it.

According to those findings, the disease is classified as “dry” or “wet.”

“If ‘wet macular degeneration’ (which is also known as neovascular age-related macular degeneration) is untreated, the central vision would be significantly affected, causing a legal blindness,” says Dr. Adelman. 

With "dry age-related macular degeneration,” there is a gradual breakdown of the light-sensitive cells in the macula that convey visual information to the brain, and degeneration of the supporting tissue beneath the macula. Those changes can cause vision loss, which is why, Dr. Adelman says, the conditions “need to be treated in a timely manner.”

How is macular degeneration treated?

The ophthalmologist may suggest a common retinal procedure called “intravitreal injection,” which means injection into the eye. This particular injection is likely to combat vascular endothelial growth factor, a protein that promotes the growth of new abnormal blood vessels in the eyes.

“Although that seems to be painful, patients tolerate it very well,” says Dr. Adelman. “With some topical anesthetics, like eye drops, patients feel relatively comfortable a minute or two after the procedure.” Patients may need several of those injections to treat the affected eye or eyes.

Intravitreal injection is commonly used as a very effective treatment for wet macular degeneration, although the condition can’t be cured. “With those injections of medications, 95 percent of the time, patients can have stable vision again and do not lose vision,” Dr. Adelman says.

Can macular degeneration be prevented?

The National Eye Institute conducted testing and found that daily intake of some high-dose vitamins and minerals can slow progression of the disease in people who have intermediate age-related macular degeneration, and those who have advanced cases in one eye.

One trial found that vitamins C and E, and beta-carotene, zinc and copper, could reduce the risk of late advanced macular degeneration by 25 percent. Another trial found that adding two carotenoids, lutein and zeaxanthin, may help reduce the risk of late-stage disease.

What makes Yale Medicine’s approach to macular degeneration unique?

Retinal therapies are commonly performed at Yale Medicine, and the success rate has significantly improved in recent years.

The team is also at the forefront of developing new therapeutics for the condition. “We have participated in a large number of clinical trials that resulted in some of the new treatments for retinal diseases,” Dr. Adelman says. “In addition, our researchers have helped to develop new approaches in the lab for retinal conditions that are slowly going to be introduced to clinical medicine.”