Macular Degeneration

Signs and Symptoms of Macular Degeneration

is the deterioration of the central portion of the retinathe macula, which is the area of the retina that controls visual acuity and color perception. Macular degeneration usually occurs in people over the age of 55 and is more common in people of northern European ancestry.

Symptoms of Macular Degeneration

The most common symptoms of macular degeneration are blurry vision, blind spots, and distortion.  

New distortion should always be examined and can be monitored at home with the use of the Amsler grid.

Blurriness, blind spots, and distortions are also common symptoms in the following eye diseases:

  • macular edema (swelling) from many causes
  • epiretinal membrane
  • macular hole
  • diabetic retinopathy

Distortion is a common symptom of a disease of the macula and is does not signify a particular disease (i.e. get examined).

The Macula

The macula provides our central “20/20” vision.  As you are reading this article, your eyes are moving to keep the text focused on your macula.  When you are staring at an object, you are focusing the object on your macula.

Macular degeneration can be wet or dry and both types progressively affect the central vision causing blurriness, blind spots, and distortions. However, the wet form causes more serious vision loss.

Retinal Degeneration

For reasons yet to be discovered, the macula degenerates with age.  There are probably environmental risk factors, such as smoking, which increases the chances of developing macular degeneration.

The vast majority, 90% of cases, are the dry variety, which causes very slow, yet progressive blurry vision.  Wet ARMD causes the development of abnormal blood vessels within the layers of the macula.  These blood vessels cause destruction of the normal retinal tissue and can leak fluid and bleed.

Regardless of the type of macular degeneration, the initial symptoms are the sameblurriness, blind spots, and distortion.  However, wet macular degeneration can destroy vision rapidlyin days or weeks.  

What Can You Do?

If you have symptoms such as persistent blurry vision, blind spots, and/or distortion, make sure you get a complete dilated eye examination. 

While there are many causes of blurry and distorted vision other than macular degeneration, you want to make sure that you get an early diagnosis so whatever eye condition is causing your visual symptoms, the proper treatment can be initiated early in the process.  

Early diagnosis and treatment of eye diseases may prevent or limit permanent vision loss.


Macular Degeneration

Best Test for Macular Degeneration

When You Need Eye Exam for Macular Degeneration. Randall Wong, M.D., Retina specialist, Fairfax, Virginia.The best test for macular degeneration (ARMD) is a fluorescein angiogram (FA).  The fluorescein angiogram involves the injection of a dye (not iodine based) called fluorescein.  As the fluorescein dye travels through your retina, pictures are taken which may help your doctor diagnose macular degeneration.

Who Performs a Fluorescein Angiogram?

In most instances, a retinal specialist performs an FA.  It is a diagnostic test used mainly for the diagnosis and treatment of retinal diseases.

In addition to macular degeneration, an angiogram may be helpful in cases of retinal vein or retinal artery occlusions, diabetic retinopathy, macular edema, etc.  In cases of macular degeneration, a fluorescein angiogram is integral in distinguishing wet ARMD from dry ARMD.

When to Perform a Fluorescein Angiogram

With respect to macular degeneration, the test should be performed at baseline and then if there there are any changes in vision.  For instance, if a patient has a loss or change in vision including new distortion.

Many patients receive anti-VEGF injections of Avastin, Lucentis or Eylea for control of the wet ARMD.  A fluorescein angiogram is very useful in monitoring treatment for wet ARMD.

Patients with drusen or a questionable case of ARMD should obtain a fluorescein angiogram.  This will help differentiate those patients with “normal” drusen versus patients with early macular disease.

What Does This Mean?

A fluorescein angiogram is integral to the diagnosis macular degeneration.  It is the single best test to make a new diagnosis and to also monitor treatment.

The test is fairly easy to obtain…from a retinal specialist.  In my practice, this test invaluable for the diagnosis and management of ARMD.  It is especially helpful for patients in whom the diagnosis is suspect, or, in patients given the diagnosis, but have perfectly normal vision.



Macular Degeneration

Sophie is 93 and Reads!

Treatment for wet ARMD allows wet ARMD patients to read.  Randall Wong, M.D.This summer I’m celebrating another patient of mine.  SR is also a transplant from Florida, just as my oldest patient “Donald.”  As with Donald, SR also suffers from wet macular degeneration.

SR is now 93 years old and moved from FL to the Washington, D.C. area about 2.5 years ago.  She lives independently, reads daily and has a great daughter who accompanies her to every appointment.


I first met SR 18 months ago when she was diagnosed with wet ARMD in her left eye.  As often is the case, she noted subtle changes in her reading vision in the left eye.  She was examined by a good friend who referred her to me for treatment.

In short, we were successful in treating SR’s wet macular degeneration with a series of intravitreal injections of Avastin.  Vision in her left eye did improve and stabilize after the initial series of 3 Avastin injections.

Right Eye Bleeds

In October, 2012, SR called complaining of acute loss of vision in her right, better eye.  She could not read.  She had sustained a large hemorrhage from wet macular degeneration in her right eye.

While the left eye had been stabilized, she couldn’t read with it due to advanced ARMD.  The right eye was now in jeopardy of the same fate.

Most concerning to SR was the acute loss of vision.  The large hemorrhage occurred underneath the retina, physically blocking light and making it impossible for her to see or read.

My plan was to treat the right eye with Avastin, too.  Blood underneath the retina is benign.  By treating the source of the bleeding with Avastin, the abnormal blood vessels should shrink up and disappear.  The accumulated blood underneath the retina would absorb…but with time.

Fortunately, SR’s reading vision has returned.  We now plan on injections every 3 months to maintain status quo, that is, she’s getting injections to prevent recurrence.  I’ve found that once the ARMD is controlled, so-called “maintenance therapy” works quite well when give 3 months apart.

What Does This Mean?

As with Donald, SR has one good eye and one bad eye.  Both have wet ARMD and each is able to read, albeit with one eye.

It is important to note that our aging population does not have to suffer vision loss, regardless of age.  These are my oldest patients.  Both are able to continue to live rather independently and maintain their visual interests and hobbies.  I’d like to add that my personal observation over the years has been that older patients who remain “sharp” do so by keeping mentally active.  Reading remains just as important for the aged as the younger generation.

Seeing and reading is a huge component to remaining independent, perhaps not physically, but independent thought may indeed be the most important attribute to keeping us going as we age.

I’ve now written about 2 of my oldest patients; Donald and SR.

Each has a tremendous support group, but each also is proof that we needn’t succumb to the blindness from macular degeneration.

If you are reading this and have ARMD, I”d like to hear from you.  If you are a child of someone with ARMD and are fearful about the days ahead, Donald and Sophie should give you great hope and inspiration for your mom or dad.


Macular Degeneration Nutrition Treatments

Vitamin & Diet Recommendations for ARMD

Diet and Vitamin Recommendations for ARMD, Randall Wong, M.D. Retinal SpecialistWith the AREDS 2 study recently published, the recommendations for vitamin supplements have not changed.

AREDS 2 did not change any of the recommendations for changing diet or adding supplements.  While it didn’t lead to any discoveries, it did validate the original AREDS study.

Take the AREDS Formulation!

The original AREDS formulation contains;

  • Vitamin C, 500 milligrams
  • Vitamin E, 400 IU
  • Beta-Carotene, 15 milligrams
  • Zinc Oxide, 80 milligrams
  • Cupric Oxide, 2 milligrams

Note that there is no lutein in the formulation.

Some popular brands containing the AREDS formulation;

There are others made by other vitamin companies but they also sell products for which their is no scientific data on efficacy.  In general, look for the AREDS formulation.  Compare to the ingredient list above.

AREDS and Multivitamins

AREDS vitamins and multivitamins are different.  One is not a substitute for the other.  There are elements found in the AREDS formulation not found in the multivitamin.

Consult your physician if your are considering stopping or starting either vitamin.

You do not need vitamins based upon the AREDS 2 formulation.

What Does this Mean?

The new study confirmed the AREDS study released in 2006.

1.  Take AREDS vitamins, but only if you have intermediate or high risk for developing ARMD.  You’ll have to ask your doctor if you meet the criteria.

2.  Lutein is not necessary.

3.  The vitamins do NOT improve or prevent the development of macular degeneration.   They may, when indicated, prevent severe vision loss from the wet form of the disease.

4.  Omega 3 Fatty Acids have no direct effect on macular degeneration.


Randall V. Wong, M.D.
Retina Specialist
Fairfax, Virginia




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