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Macular Degeneration
 
The macula is the most central part of the retina and is where light is focused when looking at an object. It is where detailed vision takes place and is responsible for sight in the centre of the field of vision. The rest of the retina (peripheral) is responsible for side and night vision. Macular degeneration affects the macula and impairs central vision.

It accounts for almost 50% of all visual impairment in the developed world. It usually affects people over 50 years of age and is known as Age-related Macular Degeneration (ARMD or AMD). There are other forms of macular disease affecting younger people, often termed 'macular dystrophy', that may run in families - this type of macular degeneration is rare. Macular degeneration can also be caused by eye injury, infection or inflammation. Diabetes can cause macular disease (known as diabetic retinopathy).

If detected early enough laser treatment can be effective in arresting AMD in a minority of patients. For the majority of patients it remains untreatable. Initially only one eye may be affected and symptoms in the early stages may not be noticed since one good eye can mask the sight problem of the other eye.
You may notice:
The central part of your vision is 'reduced'. You may see the outline of a face but not the features Straight lines may appear wavy or misshapen.
Judging distances and heights becomes difficult.
You may find it difficult to match similar shades of the same colour
You may constantly need better lighting
In general you will have little problem walking from one place to another although crossing busy roads may be more difficult. However, you are likely to have difficulty reading, watching television and other activities where detailed vision is required.
AMD alone does not result in total blindness. Only the central (reading) vision is affected and the surrounding vision remains normal. Useful side vision that allows you to see to get around is retained in both forms of AMD.
DIAGNOSIS:
If your optometrist or general physician suspects that you have age-related macular degeneration (AMD), you will be referred to an ophthalmic clinic for diagnosis.
When you attend for an outpatient appointment, you will be examined by one of our ophthalmologists to confirm the diagnosis andthe type of AMD present. There are 2 types - 'dry type' and 'wet type'. Dry AMD develops gradually, over a number of years, causing fading in the central areas of vision, while wet AMD progresses more rapidly. You will have a sight test and then a full eye examination. You should always avoid driving on the day of your appointment as your pupils will need to be dilated on each appointment.

TREATMENT:

There is as yet no available treatment for dry type AMD. For wet type, laser treatment may occasionally halt the progress of the disease if diagnosed very early.
Before the laser is applied local anesthetic drops are put on the eye to numb it and drops instilled to dilate the pupil. This allows a contact lens held by the doctor to be placed against the eye. The contact lens helps keep the lids open while allowing the doctor to view the back of the eye in greater detail.

The laser (photocoagulation) focuses a high energy light beam in small bursts onto the damaged retina. The purpose of the laser is to seal the leaking blood vessels. Treatment takes only a few minutes. Sometimes a dull thud sensation or occasionally a sharp pain is felt. Any discomfort experienced that day can be relieved by rest and a mild painkiller. If pain persist after 24 hours you must report to an eye casualty department.

Immediately after the treatment you will be completely dazzled by light and vision may be temporarily blurred. There will be a small blind patch at the site of the laser treatment but this will not interfere with your vision unless it is very close to the middle. Changes may occur in colour vision, night vision and in the field of vision. On very rare occasions vision can be made worse. It is rare for an effect on colour vision to be a problem.