How to Give | Find a Disease/Condition | Employment | Contact Us | Site Map |

Retinal Diseases, Age-related Macular Degeneration

The Retina Service represents the major consultative facility in New England for diseases of the retina and vitreous. Our seven retinal specialists see patients with common retinal conditions and are also world experts in age related macular degeneration, choroidal melanoma, diabetic retinopathy and complicated retinal detachment. We provide services such as fluorescein angiography, optical coherence tomography, ultrasonography, electroretinogram ("ERG") testing, laser treatment (including photodynamic therapy) vitroeretinal surgery, and immunologic diagnosis and follow-up therapy for retina patients.

In cooperation with Harvard Medical School and the Massachusetts General Hospital, the Retina Service provides proton beam irradiation therapy for certain malignant eye tumors to arrest the development of such tumors and prevent removal of the patient's eye whenever possible. This treatment is available in the United States only through the Massachusetts Eye and Ear Infirmary and one other facility in California.

Age-related Macular Degeneration

What is age-related macular degeneration (AMD or ARMD)?

Age-related macular degeneration is a disease of the macula that results in loss of central vision. It is estimated that there are 1.7 million people with age-related macular degeneration in the United States.

How is age-related macular degeneration classified?

There are two forms of macular degeneration: dry and wet. In the dry form, loss of vision usually occurs gradually but in the wet form, a rapid distortion and loss of central vision can occur as new, fragile blood vessels leak fluid or blood. Severe loss of vision is more commonly associated with the wet type. FUNDUS PHOTO OF WET AND DRY AMD DIAGRAM OF RETINA/EYE

Who is at risk for age-related macular degeneration?

As the name implies, the biggest risk factor for age-related macular degeneration is age. Other risk factors include: -being Caucasian -smoking -having a blood relative with age-related macular degeneration

What are the symptoms?

Distortions in central vision may be an early indicator of age-related macular degeneration.  Straight lines may appear curved or broken (e.g. the lines dividing the lanes on a road may appear crooked).  Blurry vision (e.g. difficulty reading) is another common symptom.  In advanced disease, there is complete loss of central vision.  Peripheral or “side” vision is rarely impaired.

How do I know if my age-related macular degeneration is getting worse?

An Amsler grid should be used at home to monitor for any progression. As age-related macular degeneration is painless and often asymmetric, patients may not be aware of any visual changes unless they check each eye separately with an Amsler grid. However, regular follow ups with an ophthalmologist are recommended.

What can I expect during my visit to the ophthalmologist?

Your eyes will be dilated so that the doctor can examine your retinas. Your doctor may also decide to take photographs of your retinas. Sometimes they will use a special test called “fluorescein angiography” to examine whether you have leaking blood vessels in your eyes. A dye is injected into your arm and a special camera is used to photograph your eyes. This test helps to establish whether the wet form of the disease is present and helps to determine which treatment would be best.

What treatments are available?

There is a great deal of ongoing research in treatment of age-related macular degeneration.  Currently, the treatment of the dry form is to take nutritional supplements (AREDS formula).  There have been recent advances in treatment for the wet form, especially injectable medicines.  The goal of treatment for the wet form has involved stopping the fragile blood vessels from leaking.

Macugen is an FDA approved drug that is injected into the eye to decrease the signal for new blood vessels to form.  The injection is repeated every six weeks as needed. 

Photodynamic therapy (PDT) is another available treatment.  It is a “cold” laser that is applied at the leaking blood vessels in the eye after an injection (into the arm) of a medicine responsive to certain wavelengths of light.  This is repeated every three months as necessary.  Some doctors combine this therapy with an intravitreal steroid injection.

Lucentis is an investigational drug injected into the eye that suppresses fragile blood vessel formation.  Lucentis was approved by the FDA in July 2006..

The specific therapy used depends on the characteristics of the leaking blood vessels.  You should discuss the options with your retina specialist.

What steps can I take to maximize my chances for vision?

1. Don’t smoke.
2. Eat green/leafy vegetables
3. Wear sunglasses
4. Take AREDS (Age-Related Eye Disease Study) supplements

Link to MEEI AREDS vitamins page.

If reading has become difficult, a consultation with a low-vision specialist may be appropriate.  They can offer various tools such as magnifiers, talking-watches, telescopes, closed-caption televisions, large-font books and bingo cards, etc.  For those who qualify, they can also help arrange various services such as transportation, mobility training, and tax benefits. 

Link to low vision services at MEEI.

page updated: 3/14/07