Macular degeneration is a disease that affects the central vision. Wet or dry, it leads to progressive loss of vision. But how useful are regular examinations to detect and prevent damage to your central vision?
But first, some history. Macular degeneration comes in two flavors, exudative (wet ARMD) and non-exudative (dry ARMD). It usually affects both eyes in patients over 55 and is found in patients of northern European descent. There is no cure or treatment for the dry ARMD. Exudative, or wet, ARMD is defined by the presence of abnormal leaky blood vessels that develop within the layers of the retina. Wet ARMD is treated with PDT, Macugen®, Lucentis®, Avastin® and/or steroids, but there is no cure.
Reasons to have regular examination would be to check your vision and examine for signs of progression or development of the wet form. I would like to add that 80-90% of all patients with macular degeneration have the dry form. There is nothing to do for the dry form, nothing. I also think that it is a rare event for a patient to have the dry form and convert to the wet form. (If you feel I am wrong, please feel free to comment.)
Reasons not to have a regular eye examination if you have macular degeneration are the high likelihood there is nothing to do, especially if you have no new symptoms, or you have already lost significant vision in both eyes. This may sound a bit harsh and counter-intuitive, but going to the doctor only to hear me say what you’ve already heard, “you don’t see well and there is nothing to do” starts to be monotonous and depressing. It’s like going to your primary care doctor just for him/her to tell you that you are fat. Who wants to hear this stuff?
What I would do and what I tell my patients is that it is highly unlikely that I (as a doctor) will find anything treatable by scheduling routine examinations. Amsler grid testing is worthwhile (as long as you don’t over do it), but make sure to call or come if you notice a sudden change in vision, including new distortion, that is persistent more than a day. Some slight change that remedies itself after a few minutes doesn’t count, but something that lasts for a day or two straight merits attention. Retinal disease does not fluctuate from minute to minute.
As a physician, I’d like to add a couple of thoughts; 1) AMD is a tough disease, but in many cases, patients with wet AMD can be helped in many cases as especially if we treat you early, 2) AMD is a tough disease because many times there isn’t anything to do and the best we can do is keep status quo. 3) AMD is a tough disease because it ravishes the sight and many times there isn’t anything to do, but we gotta check and make sure.
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist