Tag: optician

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Two Patients With Macular Degeneration Get Artificial Retinas

LYON, France — A 72-year-old woman with dry age-related macular degeneration (AMD) was the first patient to receive an artificial retina implant as part of the multicenter PRIMAvera clinical trial, which is looking at the safety and efficacy of the PRIMA system.

“Her vision was severely impaired by this condition. We used the ETDRS chart to assess her visual acuity, as this is the current method in ophthalmology. She was able to read only nine letters,” said Laurent Kodjikian, MD, PhD, from Hôpital de la Croix-Rousse in Lyon, who is a former president of the French Society of Ophthalmology. To put that in perspective, a person with normal vision can make out 85 letters, he explained.

“The goal is to get her reading another ten letters,” he told Medscape Medical News.

The hospital where Kodjikian works is one of six centers in France selected to take part in the ongoing AMD clinical trial; other study sites are in Germany, Italy, the Netherlands, and Spain. The 38 study participants will be followed for 12 months after implantation to assess visual acuity and adverse events, and outcomes will be monitored for 3 years. Investigators hope that the findings will lead to the device receiving authorization to enter the market.

The PRIMA artificial retina system has three elements: a tiny wireless retinal implant; a pair of glasses with a camera and digital projector; and a portable processor connected to the projector. The camera captures visual scenes from the surrounding environment. The processor uses algorithms to process and simplify the images, which are then sent back to the glasses. The digital projector uses pulses of infrared light to project the processed images onto the retinal implant’s photovoltaic receptors. These receptors then convert the optical information into electrical stimulation, which excites the nerve cells of the inner retina, allowing them take in the information and transmit it, via the optic nerve, to the brain. This then induces visual perception.

A Delicate Operation

To implant the chip, Kodjikian made a rather large incision — 3.5 mm — and then peeled off the retina, all while looking through a surgical microscope.

“It’s easy to peel off the retina in a healthy eye. However, the procedure becomes more difficult in an eye affected by dry AMD, where the retina tissue is not only very thin and firmly attached to the back wall of the eye, but is also very fragile. A lot can go wrong during this step, so we have to really take our time,” he said. “You can’t go too deep, and if you go too close to the surface, you risk perforating the retina. Like walking on a very thin tightrope, there’s danger all around, and very little room for error.”

After the chip was inserted under the retina, Kodjikian put the retina tissue back into place. “This was the first time I’d ever done this kind of procedure, and it was quite a challenge,” he told Medscape.

The operation took 2.5 hours, which is much less time than the 4 to 5 hours estimated by the manufacturer.

The patient will undergo rehabilitation for 12 months to help her adapt to the system. “Our hope is that this patient will be able to see better with the implant. She probably won’t get to the point of being able to drive a car. And while reading novels in small print may not be possible, it’s quite likely that she’ll be able to read large-print editions,” Kodjikian explained.

Upon activation of the retinal prosthetic, the patient experienced visual impressions that she couldn’t see before the surgery. And 1 month after the procedure, things seem to be on track, according to a press release. “The postoperative result is excellent. There are no complications, the chip is perfectly in place and the vision has not been degraded by the operation. She should now start to improve thanks to rehabilitation,” said Kodjikian.

“Of the various artificial retina systems out there, this one is the most sophisticated because it has the most pixels. The technology will certainly continue to advance. But for the time being, the clinical study should allow us to show that it does work,” he concluded.

In December 2021, he implanted an artificial retina in a second patient, and it took him 50 minutes less than the first one.

This article originally appeared in the French edition of Medscape.

The authors have disclosed no relevant financial relationships.

Eyeupdate Eye-clinic & Optical Supplies, p1, Ajuwon bus stop, Akute/Ajuwon Road, Ajuwon (beside BPNL/MRS Filling station).
Tel: 08107531046, 08034971582.

Our eye-clinic/optical care services cover people from the following locations and near you:
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Computer Vision Problems

Computer vision problems or Digital eye strain is a group of eye and vision problems. The problems can include eyes that itch and tear, and are dry and red. Your eyes may feel tired or uncomfortable. You may not be able to focus normally. These problems are caused by lots of computer or digital device use. Using e-readers and smartphones may also cause these problems.

These problems have been increasing in frequency over the past few decades. Many people have some symptoms if they use a computer or digital device for long periods. Most computer or digital device users have symptoms at least some of the time. Digital eye strain is very common in both children and adults.

What causes digital eye strain?

For many reasons, reading text on a computer screen or digital device is often harder for the eyes than reading printed text. This is why working on a computer for a few hours may cause symptoms of digital eye strain, but reading a book may not.

Several factors help to cause digital eye strain, such as:

  • Screen glare
  • Poor lighting
  • Poor posture while using a computer
  • Viewing a computer at the wrong distance and angle
  • Uncorrected vision problems
  • A combination of many of these factors

People often blink less when using a computer than when reading printed text. This can cause dry eye, This may contribute to digital eye strain.

Who is at risk for getting digital eye strain?

You may be at greater risk for digital eye strain if you:

  • Spend a few hours or more a day at a computer or on a digital device
  • Are too close to your computer or digital device screen
  • View your computer or digital device at the wrong angle
  • Have bad posture while using your computer or digital device
  • Have eye problems (even minor ones) not corrected with glasses or contact lenses
  • Have a pair of glasses that is not suitable for viewing the distance of your computer
  • Don’t take breaks while you are working

You may have an underlying problem with dry eye. This may make digital eye strain worse, or more likely to occur. Dry eye is more common in women than in men. It also becomes more common with age. Some medicines and health problems make dry eye more likely. For example, if you use antihistamines, you may be at greater risk of having dry eye. If you have thyroid disease or certain autoimmune diseases, you are also at greater risk of having dry eye.

What are the symptoms of digital eye strain?

Digital eye strain can cause many symptoms, including:

  • Blurred vision
  • Double vision
  • Dry eye
  • Eye discomfort
  • Eye fatigue
  • Eye itching
  • Eye redness
  • Eye tearing
  • Headaches
  • Neck and shoulder pain

Most of these symptoms are short-term (temporary). They often lessen or go away when you stop using your computer or device. But symptoms may continue for a longer time.

The severity of symptoms may vary depending on:

  • How long you have been using the computer or digital device
  • Your underlying eye problems
  • Other factors that cause digital eye strain.

Symptoms may get worse if you don’t resolve the problem.

Using a computer or digital device for a long time can also lead to other symptoms. This includes neck and shoulder pain. This is often due to poor alignment and posture when using the computer or digital device. Some healthcare providers call these symptoms part of digital eye strain as well.

How is digital eye strain diagnosed?

Your eye care provider will make a diagnosis with a health history and complete eye exam. They will assess if any health problems, medicines, or environmental factors might be adding to your symptoms.

Your eye care provider may test the sharpness of your vision and how well your eyes focus and work together. For a more detailed exam your provider may want to dilate (enlarge) your pupils. Then they will use a device (ophthalmoscope) to look at the back of your eye. In some cases, you may need to get follow-up blood tests for healthcare problems that might be helping to cause your digital eye strain.

How is digital eye strain treated?

Treatment includes creating a better work environment.

  • Rest your eyes at least 15 minutes after each 2 hours of computer or digital device use.
  • Every 20 minutes, look into the distance at least 20 feet away from the computer or digital device. Do this for at least 20 seconds.
  • Enlarge the text on your computer screen or digital device.
  • Reduce glare from the light sources in your environment.
  • Think about using a screen glare filter.
  • Place your screen so that the center of it is about 4 to 5 inches below eye level (about 15 to 20 degrees from the horizontal).
  • Place your screen about 20 to 28 inches from your eye.( About arm’s length.)
  • Remember to blink often.
  • Fix your chair height so your feet can rest comfortably on the floor. Don’t slump over the computer screen.

Making these changes may help eliminate digital eye strain in many people.

Your eye care provider will also need to treat any hidden health problems that may be adding to your digital eye strain. For instance, you might need a new pair of glasses. If you have an underlying dry eye problem, your eye care provider might advise the following:

  • Using lubricating drops
  • Treating allergies, if you have them
  • Creating a more humid work environment
  • Drinking more fluids (staying hydrated)
  • Taking a prescription medicine to increase tear production

What can I do to prevent digital eye strain?

Create a better work environment to help prevent digital eye strain. If you use glasses or corrective lenses, see your eye care provider at least once a year or as advised for a checkup. Also see your healthcare provider regularly. This can help prevent and treat health problems that can help cause digital eye strain.

Key points about digital eye strain

  • Digital eye strain is a group of related eye and vision problems caused by extended computer or digital device use.
  • Symptoms include eye discomfort and fatigue, dry eye, blurry vision, and headaches.
  • Uncorrected vision problems are a major cause.
  • Sometimes hidden health problems help to cause it.
  • Having a better computer work environment may help improve symptoms.
  • Resting your eyes regularly is one of the best ways to prevent and treat digital eye strain.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your healthcare provider if you have questions.
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Prosthetic Contact Lenses

Prosthetic contact lenses are prescribed to mask flaws and improve the appearance of an eye disfigured from a birth defect, trauma, or eye disease.

If certain structures of the injured or disfigured eye also fail to function properly, special prosthetic lenses can be designed to block excess light from reaching the back of the eye to reduce glare and increase comfort.

Your eye care practitioner can match prosthetic contact lenses to the appearance of a healthy eye by using a pre-made trial set or by ordering custom-painted contact lenses.

Like regular contact lenses, prosthetic contacts can be made of gas permeable or soft lens materials. And most prosthetic lenses can be cleaned and disinfected using the same multipurpose contact lens solutions recommended for conventional soft or gas permeable lenses.

Custom prosthetic lenses can be made in a wide variety of lens powers to correct nearsightedness, farsightedness and/or astigmatism, or they can be produced without corrective power to simply provide a more natural appearance to a blind or disfigured eye.

Eye Conditions That May Benefit From Prosthetic Contact Lenses

Many injuries, conditions and infections can lead to disfigurement of an eye and make an individual feel self-conscious about his or her appearance. Prosthetic lenses can be specially designed to match the appearance of the unaffected eye as closely as possible and make the disfigured eye less conspicuous.

Disfiguring conditions frequently treated with prosthetic contact lenses include incomplete formation of the pupil (aniridia), lack of pigment or color in the eye (albinism) and damage to the cornea from trauma.

People with albinism or other eye conditions creating light sensitivity (photophobia) can benefit from prosthetic lenses that reduce the amount of light entering the eye. Prosthetic lenses also are sometimes used to eliminate double vision (diplopia) caused by certain eye conditions.

Special prosthetic colored contact lenses sometimes are used to improve vision in cases of childhood amblyopia. Two identical-appearing colored contacts are worn, but one lens has an opaque pupil painted on it to block (occlude) light from entering the eye. This lens is worn on the eye with normal sight, forcing greater use of the amblyopic eye to improve vision development in the affected eye.

Occlusion therapy with prosthetic contact lenses can be more effective for treating amblyopia than the use of an eye patch, which children often resist or remove due to embarrassment. But amblyopia treatment with contacts is more expensive due to the cost of the prosthetic lenses.

How Prosthetic Contact Lenses Are Prescribed

The first step in being fit with prosthetic contact lenses is to have a comprehensive eye exam. During this exam, your optometrist or ophthalmologist will thoroughly examine your eyes to rule out conditions that might interfere with successful prosthetic contact lens wear.

The second step is to undergo a contact lens fitting. In addition to performing the steps in a normal contact lens exam and fitting, your eye doctor may also take close-up photographs of your eyes. These color photos are sent to the prosthetic contact lens manufacturer to help the company create a prosthetic lens that matches your natural eye color and appearance as closely as possible.

Some eye doctors who specialize in contacts for hard-to-fit eyes also may have fitting sets of sample prosthetic lenses on hand so you can get an immediate idea of how effectively the lenses can restore a natural appearance to your affected eye(s).

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How to Maintain Your Eyeglasses

Though many of us wear glasses, very few of us realize the maintenance they actually need to keep our vision clear. Maintaining your eyewear isn’t difficult, but it does require special care. Read some of our tips for taking care of your eyeglasses

Tips for Maintaining Your Glasses

Avoid Chemical Contact

Your glasses can be very fragile depending on how they were made. Some lenses have films on them to provide UV protection, scratch or shatter resistance, or even to enhance your prescription. These films are the most fragile part of your glasses, and they can easily be destroyed by contact with certain abrasive chemicals.

While it’s obvious that you shouldn’t scrub your glasses with, say, bathroom cleaner, it’s much less obvious that everyday things we put on our skin, like lotions and sunscreen, can be nearly as bad for our sensitive glasses as the bathroom cleaner we all know we should never use.

These products can contain mild abrasives that do not harm (and sometimes can even help!) our skin but may harm the film on our glasses, especially with exposure over time.

Wash Your Hands

The only way to be certain that you are avoiding any chemical contact with your glasses is to wash your hands before handling them. Lotions and sunscreens are just two of the many things we can have on our hands; often our hands have all sorts of random things on them that we don’t notice or can’t see.

A simple hand washing before you handle your glasses can help to keep the abrasives from getting onto your lenses and can help keep everything clean.

Rinse Your Lenses

While you’re at the sink, run your glasses under a gentle stream of warm water. This will help to carefully remove any loose dirt or other debris that could scratch the lenses when you wipe your lenses.

If you were to omit this step, you might end up scratching your lenses with invisible debris. While the damage might not be visible immediately, it will degrade your lenses more quickly.

Use a Lens Cloth

Once your hands are clean and you’ve run your glasses under warm water, you can wipe the lenses off to remove any leftover oils and grime. Back away from that T-shirt and put down the paper towels! You should only use a cloth specially designed for lenses. Your local Eyeglass World will sell these as either lens cloths or microfiber cloths. Using a material that was not intended to clean glasses can and will do more damage than the little bits of dirt you’re trying to remove. 

Use a Cleaning Solution

Usually, a simple rinse and wipe is enough to get your frames back to top condition. However, there are always cases where we end up with grime that just won’t come off easily.

In these cases, you should only use a cleaning solution that you get from your optometrist. These cleaners are specially formulated to be very gentle on your glasses, whereas cleaners that might work on other forms of glass could be harsh and cause damage.

Store Them Correctly

Remember, when you’ve cleaned your eyeglasses, you need to be sure to store them properly to avoid having them collect more dirt, causing you to have to repeat the process more often than necessary.

Use the case your eyewear came in to store them. Hard cases generally provide more protection than soft cases. Even though they tend to be bulkier – they’re the safer choice.

If you have any questions, stop by any of our branches

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Leading causes of broken eyeglasses

After years of working with patients and their broken glasses, my experience has been:

  • Glasses were sat on (usually when put down on a bed while dressing/undressing), or stepped on.
  • Glasses were damaged during a sports or recreational activity.
  • Glasses were “altered” by a family pet…almost always a dog.
  • Glasses were destroyed by a young child. Could be the child’s or the parent’s glasses.
  • Glasses were damaged in luggage, backpack,etc.
  • Glasses were damaged by owner while attempting to do a repair at home.
  • Glasses were damaged by “unknown entity.” Were found destroyed on nightstand upon wakening. “They must have been defective.”
  • Georgio Armani eyeglassesGeorgia Armani eyeglasses t2

Please note that I am not counting loose or missing screws, broken nylon cords for rimless. missing nose pads or temple tips. Those parts are easily fixed and do not constitute damage. Also, home repairs using super glue, toothpicks, standard solder, epoxy resin, acetone, etc. will elevate a low level repair to the need for frame replacement, and will void manufacturers warranties.

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Headaches and your eyes

How a Headache Can Affect Your Eyes and Vision

By Troy Bedinghaus, OD  Medically reviewed by Diana Apetauerova, MD on September 08, 2020

Have you ever had a headache that affected your vision? Sometimes a headache can cause pain around your eyes, even though the headache is not associated with a vision problem. On the other hand, a headache may be a sign that your eyes are changing and that it’s time to schedule an eye exam. Although headaches are rarely a medical emergency, a severe one should not be ignored or minimized.

headaches and vision
Verywell / Luyi Wang

Headaches That Affect Vision

Vision problems can sometimes be the consequence of a headache. This is especially true with migraines and cluster headaches.

Migraine Headache

A migraine headache can cause intense pain in and around your eyes. A migraine aura resembling flashing lights, a prismatic rainbow of lights or a zig-zag pattern of shimmering lights often precedes the actual headache. The aura typically lasts around 20 minutes.

Some people who experience a migraine aura never develop the actual headache, making the diagnosis of the visual disturbances difficult.1 Migraines can also cause tingling or numbness of the skin. People with severe migraines may experience nausea, vomiting, and light sensitivity. Medications, certain foods, smells, loud noises, and bright lights can all trigger a migraine headache.An Overview of Migraine With Aura

Cluster Headache

Cluster headaches are severe headaches that occur in clusters and typically cause pain around the eyes. The pain often radiates down the neck to include the shoulder. Other symptoms include:

Cluster headaches may occur daily for several months at a time followed by a long period with no headaches. It is not known what causes cluster headaches, but they are clearly one of the most severe headaches one can experience.

Vision Problems That Cause Headaches

On the flip side, vision problems can cause headaches when you either overwork the eyes or struggle to maintain focus. By correcting the vision problem, you can often resolve the headache.

Eye Strain

Simply overusing the focusing muscles of your eyes can cause eye strain and headaches. This is an increasing problem in our high tech world

Small-screen texting and web browsing can easily cause eye strain, in part because the words and images on a computer screen are made up of pixels and do not have well-defined edges. The eyes cannot easily focus on pixels, so they must work harder even if an image is in high-resolution.2 When the eye muscles become fatigued, a headache can develop around or behind the eyes.

Farsightedness

Adults and children with uncorrected farsightedness (hypermetropia) will often experience a frontal headache (also known as a “brow ache”). If you are farsighted, you may find it difficult to focus on nearby objects, resulting in eye strain and headaches. As you subconsciously compensate for your farsightedness by focusing harder, the headaches can become worse and more frequent.

Presbyopia

Around the age of 40, people begin to find it difficult to focus on nearby objects. Near point activities, such as reading or threading a needle, are often difficult to perform because of blurring. This is an unavoidable condition known as presbyopia that affects everyone at some point. Headaches develop as you try to compensate for the lack of focusing power. Reading glasses can often relieve the underlying eye strain.

Occupations requiring close-up work, exposure to sunlight for longer periods of time, and farsightedness were the most common risk factors for presbyopia.3Presbyopia: Close-Up Vision Loss and What to Do About It

Giant Cell Arteritis

Also known as temporal arteritis, giant cell arteritis (GCA) is an inflammation of the lining of the arteries that run along the temple. GCA usually creates a headache that causes constant, throbbing pain in the temples. Vision symptoms occur as a result of a loss of blood supply to the optic nerve and retina. Other symptoms include:

  • Fever, fatigue and muscle aches
  • Scalp tenderness
  • Pain while chewing
  • Decreased vision​

GCA is considered a medical emergency. If left untreated, the condition may cause vision loss in one or both eyes. A delayed diagnosis is the most common cause of GCA-associated vision loss.42:18

What Is a Retinal Migraine?

Acute Angle-Closure Glaucoma 

Acute angle-closure glaucoma (AACG) is a rare type of glaucoma that causes a sudden onset of symptoms, including headaches. Eye pressure rises quickly in AACG causing increased eye redness, eye pain, and cloudy vision. A mid-dilated pupil (in which pupil dilation is sluggish and incomplete) is one of the most important diagnostic features of AACG.5

Ocular Ischemic Syndrome

Ocular ischemic syndrome (OIS) is a condition that develops due to a chronic lack of blood flow to the eye. This condition often causes a headache, decreased vision, and a host of other signs, including cataracts, glaucoma, iris neovascularization (the development of new weak blood vessels in the iris), and retinal hemorrhage. White spots on the retina indicate a lack of blood flow and oxygen to the retinal tissue.2:18

What Is a Retinal Migraine?

Herpes Zoster

Also known as shingles, herpes zoster is known for causing headaches, vision changes and severe pain around the head and eye. Herpes zoster is a reactivation of the chickenpox virus and affects a single side of the body. A headache usually precedes an outbreak of painful skin blisters.

Herpes zoster around the eyes is serious and requires immediate medical attention (including antiviral medication) to prevent damage to the ocular nerves and eyes. Complications include corneal clouding, glaucoma, and optic nerve atrophy (deterioration).6

Pseudotumor Cerebri

Pseudotumor cerebri is a condition that occurs when the pressure within the skull increases for no apparent reason. For this reason, pseudotumor cerebri is also referred to as Idiopathic Intracranial hypertension (“idiopathic” meaning of unknown origin and “hypertension” meaning high blood pressure).

Pseudotumor cerebri often causes a headache and changes in vision. If left untreated, pseudotumor cerebri can lead to vision loss as the pressure places strain on the optic nerves. Fortunately, while 65% to 85% of people with pseudotumor cerebri will experience visual impairment, the condition is usually transient and will normalize when the hypertension is controlled.

About Us

 

Our Mission

To Be the Region’s Leading Eye Care Provider, Delivering the Most Advanced, Specialized Eye Care Services in a Compassionate, Patient-Centered Approach.

Our Commitment

Above all other principles, we affirm patients are the basis for our existence as an organization. We continuously strive to exceed the expectations and needs of each patient at every visit, or encounter. Our commitment to our patients is reflected in our employee’s attitude and respect towards others. We are committed to providing the highest quality of service and meeting our patients’ needs with the utmost care and courtesy. This commitment must be reflected in our behavior.

The Team

Eyes are among our most precious tools. Much of our quality of life depends on these windows to the world. Eyupdate Eye clinic lives by our mission by providing the newest technologies, treatments and surgical techniques as a team.

Eyeupdate Clinic is the region’s leading eye care center with experienced Eye-Doctors improving the quality of life for people like you. Our Board certified Eye-Doctors are among the most highly educated and trained specialists practicing in the World today. Our Ophthalmologists and Optometrists at Eyeupdate Eye Clinic are committed to delivering expert eye care to patients including general vision and specialty eye care, disease diagnosis, treatment, and surgical options.

At Eyeupdate Eye Clinic, we focus on quality, patient-centered eye care and are able to triage and treat many urgent and emergency situations right in the clinic.

Our Pediatric Ophthalmologists/Optometrists have the tremendous privilege of caring for kids to help them achieve their best vision. We understand, as parents, nothing is more important to you than your children, and like you, we want them to have a lifetime of excellent vision. Working with you, in a patient-centered approach, we treat your child’s eyes all the way from infancy through high school.

Outpatient surgical procedures, corrective lenses, and diagnostic and surgical treatment of eye diseases are available onsite. In addition, we offer a full-service Optical shop and Contact Lens department at each location.

To schedule an appointment, call: 07030000001

 

LOCATIONS

Eyeupdate Clinic & Optical Supplies, 01, Ajuwon junction, Ajuwon bus stop, Akute/Ajuwon Road, beside BPNL Filling Station, Ajuwon, Ifo, Ogun State. Tel: 07030000001.

 

Eyeupdate Clinic & Optical Supplies 222 Iju road, Balogun bus stop, Iju-Ishaga, Lagos, Nigeria. Tel: 08107531046

Eyeupdate Clinic & Optical Supplies, 20 Akute/Ajuwon Road, Akute, Ifo, Ogun State.Tel: 08034971582

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Have an eye check within Omole Akiode Ojodu Berger for detection of Age Related Macular Degeneration (ARMD)

Age-related macular degeneration (AMD) is the most common cause of irreversible central vision loss in older patients. Dilated funduscopic findings are diagnostic; color photographs, fluorescein angiography, and optical coherence tomography assist in confirming the diagnosis and in directing treatment. Treatment is with dietary supplements, intravitreal injection of antivascular endothelial growth factor drugs, laser photocoagulation, photodynamic therapy, and low-vision devices.

Risk factors include the following:

  • Age

  • Genetic variants (eg, abnormal complement factor H)

  • Family history

  • Smoking

  • Cardiovascular disease

  • Hypertension

  • Obesity

  • Sun exposure

  • A diet low in omega-3 fatty acids and dark green leafy vegetables

     

    PROFESSIONAL /
    … /
    AGE-RELATED MACULAR DEGENERATION (AMD OR ARMD)

    Age-Related Macular Degeneration (AMD or ARMD)

    (Senile Macular Degeneration)

    By

    Sonia Mehta

    , MD, Vitreoretinal Diseases and Surgery Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University

    Professional.Manuals.TopicPage.LastRevisionDate| Content last modified Jun 2019
    CLICK HERE FOR PATIENT EDUCATION

     

    Age-related macular degeneration (AMD) is the most common cause of irreversible central vision loss in older patients. Dilated funduscopic findings are diagnostic; color photographs, fluorescein angiography, and optical coherence tomography assist in confirming the diagnosis and in directing treatment. Treatment is with dietary supplements, intravitreal injection of antivascular endothelial growth factor drugs, laser photocoagulation, photodynamic therapy, and low-vision devices.

     

    AMD is the leading cause of permanent, irreversible vision loss in older adults. It is more common among whites.

     

    Two different forms occur:

    • Dry (nonexudative or atrophic): All AMD starts as the dry form. About 85% of people with AMD have only dry AMD.

    • Wet (exudative or neovascular): Wet AMD occurs in about 15% of people.

    Normal Retina
    Normal Retina
    IMAGE PROVIDED BY SUNIR GARG, MD.

    Although only 15% of patients with AMD have the wet form, 80 to 90% of the severe vision loss caused by AMD results from wet AMD.

    Age-Related Macular Degeneration (Wet)
    Age-Related Macular Degeneration (Wet)
    PAUL WHITTEN/SCIENCE PHOTO LIBRARY

    Dry AMD causes changes of the retinal pigment epithelium, typically visible as dark pinpoint areas. The retinal pigment epithelium plays a critical role in keeping the cones and rods healthy and functioning well. Accumulation of waste products from the rods and cones can result in drusen, which appear as yellow spots. Areas of chorioretinal atrophy (referred to as geographic atrophy) occur in more advanced cases of dry AMD. There is no elevated macular scar (disciform scar), edema, hemorrhage, or exudation.

     

    Wet AMD occurs when new abnormal blood vessels develop under the retina in a process called choroidal neovascularization (abnormal new vessel formation). Localized macular edema or hemorrhage may elevate an area of the macula or cause a localized retinal pigment epithelial detachment. Eventually, untreated neovascularization causes a disciform scar under the macula.

    Dry AMD

     

    The loss of central vision occurs over years and is painless, and most patients retain enough vision to read and drive. Central blind spots (scotomas) usually occur late in the disease and can sometimes become severe. Symptoms are usually bilateral.

     

    Funduscopic changes include the following:

    • Changes in the retinal pigment epithelium

    • Drusen

    • Areas of chorioretinal atrophy

    Wet AMD

     

    Rapid vision loss, usually over days to weeks, is more typical of wet AMD. The first symptom is usually visual distortion, such as a central blind spot (scotoma) or curving of straight lines (metamorphopsia). Peripheral vision and color vision are generally unaffected; however, the patient may become legally blind (< 20/200 vision) in the affected eye, particularly if AMD is not treated. Wet AMD usually affects one eye at a time; thus, symptoms of wet AMD are often unilateral.

     

    Funduscopic changes include the following:

    • Subretinal fluid, appearing as localized retinal elevation

    • Retinal edema

    • Gray-green discoloration under the macula

    • Exudates in or around the macula

    • Detachment of retinal pigment epithelium (visible as an area of retinal elevation)

    • Subretinal hemorrhage in or around the macula

    Age-Related Macular Degeneration (Drusen)
    Age-Related Macular Degeneration (Drusen)
    PAUL PARKER/SCIENCE PHOTO LIBRARY

    • Funduscopic examination

    • Color fundus photography

    • Fluorescein angiography

    • Optical coherence tomography

     

    Both forms of AMD are diagnosed by funduscopic examination. Visual changes can often be detected with an Amsler grid. Color

    • Dietary supplements for high-risk dry or unilateral wet AMD

    • Intravitreal antivascular endothelial growth factor drugs or laser treatments for wet AMD

    • Supportive measures

    Dry AMD

     

    There is no way to reverse damage caused by dry AMD. Patients with extensive drusen, pigment changes, and/or geographic atrophy can reduce the risk of developing advanced AMD by 25% by taking daily supplements of the following:

    • Zinc oxide 80 mg

    • Copper 2 mg

    • Vitamin C 500 mg

    • Vitamin E 400 units

    • Lutein 10 mg/zeaxanthin 2 mg (or beta-carotene 15 mg or vitamin A 28,000 units for patients who have not smoked)

     

    In current and former smokers, beta-carotene can increase the risk of lung cancer. Recently, substitution of beta-carotene with lutein plus zeaxanthin has been shown to have comparable efficacy (1). Therefore, such a substitution should be considered in current or former smokers. The zinc component of these supplements increases risk of hospitalization for genitourinary tract disorders. Some patients taking beta-carotene also have yellowing of the skin. Reducing cardiovascular risk factors as well as regularly eating foods high in omega-3 fatty acids and dark green leafy vegetables may help slow disease progression; however, recent large trials have not shown that taking supplements of omega-3 fatty acids reduces disease progression.

    Wet AMD

     

    Patients with unilateral wet AMD should take the daily nutritional supplements that are recommended for dry AMD to reduce the risk of AMD-induced vision loss in the other eye. The choice of other treatments depends on the size, location, and type of neovascularization. Intravitreal injection of antivascular endothelial growth factor (anti-VEGF) drugs (usually ranibizumab, bevacizumab, or aflibercept) can substantially reduce the risk of vision loss and can help restore reading vision in up to one third of patients. In a small subset of patients, thermal laser photocoagulation of neovascularization outside the fovea may prevent severe vision loss. Photodynamic therapy, a type of laser treatment, also helps under specific circumstances. Corticosteroids (eg, triamcinolone) are sometimes injected intraocularly along with an anti-VEGF drug. Other treatments, including transpupillary thermotherapy, subretinal surgery, and macular translocation surgery, are seldom used.

    Treatment reference

    • 1. Age-Related Eye Disease Study 2 Research Group: Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: The age-related eye disease study 2 (AREDS2) randomized clinical trial. JAMA 309(19):2005-15, 2013. doi: 10.1001/jama.2013.4997. Clarification and additional information. JAMA 310(2):208, 2013. doi:10.1001/jama.2013.6403.

    Supportive measures

     

    For patients who have lost central vision, low-vision devices such as magnifiers, high-power reading glasses, large computer monitors, and telescopic lenses are available. Also, certain types of software can display computer data in large print or read information aloud in a synthetic voice. Low-vision counseling is advised

    • AMD is more common among whites and is the leading cause of permanent vision loss in older adults.

    • AMD can be dry (nonexudative or atrophic) or wet (exudative or neovascular).

    • Although 85% of AMD is dry, 80 to 90% of severe vision loss caused by AMD results from the wet type.

    • Funduscopic changes in dry AMD include drusen, areas of chorioretinal atrophy, and changes to the retinal pigment epithelium.

    • Funduscopic changes in wet AMD include retinal edema and localized elevation, detachment of the retinal pigment epithelium, a gray-green discoloration under the macula, and exudates in and around the macula.

    • If patients have AMD on funduscopy, do color fundus photography, fluorescein angiography, and optical coherence tomography.

    • Prescribe dietary supplements for unilateral wet or high-risk dry AMD.

    • Treat wet AMD with intravitreal antivascular endothelial growth factor drugs or laser therapy.

Contact us

Eye clinic locations:

Eye centre Akute Ajuwon Fagba Alagbole Agege Alagbado Matogun Olambe Lambe Obawole Giwa Okearo abule Egba Ogba

01, Ajuwon junction, Ajuwon bus stop, beside BPNL filling station, Akute/Ajuwon road, off Elliot bus stop, Iju-Ishagah. Tel: 08034971582

222, Iju road, Balogun, Ifako Ijaye, Lagos. Tel: 08107531046

01, Itshekiri street, beside M. R. S. Petrol station, Ajuwon, Ifo, Ogun state. Tel: 08068084591.