A patient came into the office complaining of new onset distortion in the right eye. My patient, JG, is a 64 year old male, caucasian, and has a long history of smoking. JG started noticing changes in his central vision about 6 weeks ago. At first, there was some distortion in the central vision. When looking out his front window, he noticed that the telephone wires developed an extra “wiggle.” This has been getting worse. He noticed that even small print has become hard to read. Now, when he closes his left eye, he can’t see people’s faces well; they are “missing” an eye and a nose.
What is happening? This is a typical “story” or history of a patient developing wet macular degeneration. The “wet” part means that abnormal blood vessels have developed within the layers of the retina. More specifically, the abnormal blood vessels, aka neovascularization, have developed underneath the macula. These blood vessels can physically damage some of the vital layers within the retina, leak and cause fluid to accumulate and often bleed, although the blood doesn’t really cause any harm.
The macula is the functional center of the retina. It gives us our central vision and this is where we have the best color vision. The rest of the retina gives us our peripheral or “side” vision. The macula is only about 2 X 2 mm large! Any small perturbation in this area may have dramatic consequences to our central vision.
What to do? The first thing to do is to make the proper diagnosis. While this may be a typical scenario, there are a few other conditions that may cause the same or similar complaints. If you can, see a retina specialist and have a flourescein angiogram performed. This dye test is very sensitive and specific for demonstrating neovascularization and estimating macular edema (fluid collection).
What can be done? Treatments these days consist of intraocular injections of Vascular Endothelial Growth Factors (VEFG). These injections neutralize the effects of this hormone which causes growth of the abnormal blood vessels. Avastin®, Lucentis® and Macugen® are commonly used. Your doctor should explain which therapies are available and why. Other treatments may include laser photocoagulation and photodynamic therapy.
In general, the earlier we institute treatment, the better the visual prognosis.
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist