An exciting development in retina is discovering that age-related macular degeneration (AMD) is a disease that is inherited. The genetics are complex and environment also plays a role. We are now doing the genetic testing at Island Retina. It is an easy test that is obtained by rubbing the inside of the cheek with a cotton stick and sending it to a special lab where I t is analyzed. We receive the information about a month later. The risk of developing the disease is divided into 5 categories- 5 being the highest or most at risk, while 1 means you have genes that protect you against the disease.
You may be asking why anyone would want to know this. There are a few reasons. Number 1, we now have treatments that are extremely successful for the wet form of the disease. We also have treatments for the dry form which slow down the progression. The earlier we detect AMD, the better the results. Also some genes are triggered by environmental factors such as smoking, so we can council you on certain controllable aspects of your life. Furthermore, we can see what the risk might be for the next generation, our children, and provide counseling to them.
If we discover that you have an increased risk- categories 3-5, we will screen you more frequently and watch you closely, so should you develop the wet form of the disease, we will treat in a timely fashion and save vision.
Our understanding of AMD increases yearly. There is a great deal of research going on to develop better treatments and outcomes for the many individuals affected by this disease. At Island Retina, we are frequently enrolling patients in new research protocols to provided patients the opportunity to receive treatments that would not otherwise be able to obtain.
If you have a family history of AMD, you are welcome to come in for screening.
Epiretinal membranes of the macula are a common macular disorder. They can also be referred to as macular gliosis or macular wrinkling. Often they are picked up during OCT scanning. OCT stands for optical coherence tomography and it is a diagnostic test that images the retina. The epiretinal membrane is a fine growth of cells on the surface of the retina. Often epiretinal membranes remain stable and Dr. Weber will just watch it with serial exams, vision testing and OCTs. However, if the membrane starts to get worse causing symptoms of visual distortion and/or a drop in vision,Dr. Weber will recommend surgery. This surgery is done at Suffolk Surgery Center as an ambulatory procedure. It usually takes about 1 hour of surgery. You will be awake, but relaxed. Dr. Weber will perform a vitrectomy and peel the membrane. Sometimes it is necessary to add gas to the eye and place the patient in a face-down head position for 1 week. This helps flatten the retina. The goals of the surgery are to prevent further loss of vision and to reduce the present blurriness and distortion. There is about a 5% risk of the complication of retinal detachment. This could lead to loss of vision and the need for additional surgery. Following the surgery, you will have an eye patch on the eye which will remain on for about 3 days. You will use eye drops and follow-up with Dr. Weber on post-op day 1. After that, you will see Dr. Weber the next week and every few weeks for the next 3 months. After surgery Dr. Weber recommends quiet activities only for 2 weeks. As the eye heals, you will be able to resume normal activities. It is recommended that you take a week off from work.
Most patients with epiretinal membranes will not need surgery, but for those who do, with modern surgical techniques we can improve vision.
Age-related macular degeneration (AMD) is a progressive disease of the retina, and is the most common cause of severe vision loss in older adults. AMD damages the center of the retina called the macula, which provides fine detail for reading and driving. Although we don’t know the cause of AMD, risk factors include family history, smoking, high blood pressure, high cholesterol, obesity, and sun exposure. In addition, women and people with light skin and eye color appear to be at greater risk than others for developing the condition.
There are two forms of AMD: dry and wet. The hallmark of dry AMD is tiny spots in the retina called drusen. A national study called the Age-Related Eye Disease Study (AREDS) showed that high dose antioxidant supplements can reduce progression of dry AMD by 25 percent. The AREDS recommendations include betacarotene 15 mg, vitamin C 500 mg, vitamin E 400 IU, zinc 80 mg, and copper 2 mg. You should discuss vitamin therapy with your medical doctor, as certain vitamins should not be given with particular medical conditions.
The wet form, also known as neovascular AMD, is more serious and occurs when abnormal blood vessels grow in the macula. These vessels leak blood and fluid causing swelling of the retina. The blood vessels quickly progress and impair central vision. The first sign of wet AMD is distorted vision: straight lines look bent, words are crooked, and letters jumble or disappear. As the disease progresses, a central dark spot develops and central vision worsens. If you have these symptoms you must see an eye doctor immediately.
In Suffolk County 17,000 people have wet AMD. However, the good news is that we now have effective, FDA approved medications that halt vision loss in 90 percent of patients and improve vision in 40 percent. The new treatments are Macugen Lucentis, and Avastin. They are sometimes used in combination and require serial treatments with intraocular injections.
