Blurred or Wavy Vision? It could be Macular Degeneration!

Dry macular degeneration and Wet macular degeneration.

In Hong Kong, 90% of macular degeneration patients are dry type. There is degeneration of retinal pigment epithelial cells in the macular area and formation of accumulated metabolic waste. These form drusen (yellow deposits) under the retina, which eventually leads to atrophy of the retinal pigment epithelium.

Most patients have no obvious symptoms in the early stage. As more photoreceptor cells are being damaged, one's vision gradually gets blurred. However, there is a chance that dry macular degeneration can become wet macular degeneration, which can lead to sudden and severe vision loss. Up to now, there is no cure for dry macular degeneration. Regular follow-up of the disease is required early intervention when needed.

There are 10% of macular degenerations are wet AMD. Patients have abnormal blood vessels under the macula. If these blood vessels have leakage (fluid or blood), they can cause subretinal bleeding and subsequent scarring, which cause permanent damage to the retina.

The deterioration of wet AMD can be rapid, and it can lead to central visual field defect. If one of the eyes experiences sudden blurred or distorted vision, wet AMD would be suspected. On the other hand, the fellow eye is also needed to be checked because it may be in the early stage of wet macular degeneration or may carry the risk of suffering from the disease. Wet AMD can lead to severe visual loss in a short period of time, can be a few days. Therefore, you should contact an ophthalmologist immediately when suspected symptoms happen.

• Avoid smoking: Smoking increases the chance of developing macular degeneration by 3–4 times.
• Control weight, blood pressure, lipids, glucose: Studies found that obesity, hyperglycemia, hyperlipidemia and hypertension may cause microvascular damage, resulting in the development of macular degeneration.
• Prevent high myopia: People with high myopia (600 degrees or more) have a higher chance of developing macular degeneration.
• Schedule annual eye checking: The risk of developing macular degeneration increase with age. It is recommended to arrange a comprehensive eye examination every year.
• Maintain a balanced diet: High saturated fat and cholesterol foods should be reduced, and nutrients such as lutein, zeaxanthin, Omega-3, and vitamins C and E should be taken.
• Wear sunglasses to avoid strong sunlight: Prolonged exposure to sunlight may increase the chance of developing macular degeneration.

Prolonged blue light exposure is reported to be harmful to the macula. Our pupil will be more dilated in dark and therefore theoretically we may intake more blue light from the screens in the dark. Some studies have shown that prolonged exposure to high-energy visible light can cause damage to the macula, which is similar to macular degeneration.

The older you are, the higher risk of developing age-related macular degeneration you have. However, these are other risk factors we also need to pay attention to, such as smoking, eating lots of high saturated fat or cholesterol food, excessive sun exposure, having vascular disease or high blood pressure, already having macular degeneration in one eye or genetic factors.

Patients suffering from dry macular degeneration have no obvious symptoms in the early stage and deterioration in vision is relatively slow. Drusen or geographic atrophy can be seen in the patient's fundus. But it may develop into wet subtype during its natural disease course. Wet AMD tends to be more severe in term of the visual damage. It has abnormal growth of vessels which lead to leakage beneath macula and the leakage may affect vision significantly. Exudation, edema, or hemorrhage can be seen during eye examination. If wet macular degeneration is not treated properly, photoreceptor cells can be damaged and permanent loss of center vision can be caused.

Yes, injection of drugs (anti-VFGF or steroids, etc.) into the vitreous cavity is one of the effective treatments for macular degeneration. Medical reports show that this method has a good efficacy on treating the macular edema caused by wet AMD and it also has a role to promote visual improvement. Timely treatment is important, the earlier the macular degeneration is treated, the better result one may have. Injection of medicine can also be given along with PDT or other treatment (named as combined treatment in clinical practice) to obtain better treatment outcomes. For further details, you should discuss with your eye doctor so as to come up with a tailor-made treatment regimen for you.

Macular degeneration cannot be fully reversed. However, receiving treatment early can help slow down the progression of the condition. Delaying medical intervention may lead to permanent vision loss.

No, macular degeneration will not heal spontaneously. Medical intervention is required to manage and control the disease. The primary goals of treatment are to delay deterioration and reduce the risk of vision loss, rather than providing a complete cure.

There is a close relationship between the two. Chronic high blood sugar can damage the capillaries in the retina, leading to Diabetic Macular Edema (DME). This condition is one of the leading causes of vision loss in diabetic patients.