Macula Degeneration

The eye is shaped just like a ball. The pupil, close to the front, is the opening, which allows light to enter the eye. Just behind the pupil is the lens, which focuses the light on the retina at the back of the eye. The retina is made up of a delicate tissue, which converts the light into images, and sends them to the brain. The macula is a small area at the very centre of the retina. The macula is very important and is responsible for what we see straight in front of us, allowing us to see fine detail for activities such as reading and writing, as well as our ability to see colour.What is macula degeneration?Sometimes the delicate cells of the macula become damaged and stop working, and there are many different conditions, which can cause this. If it occurs later in life, it is called the ‘ age-related macula degeneration’. Unfortunately we do not yet know why this happens. There are two main types of macula degeneration, usually referred to as ‘wet’ and ‘dry’.

This is not a description of what the eye feels like, but what the eye specialist can see when looking at the macula. Only 10% of people with macula degeneration have the ‘wet’ type, all others are affected by the ‘dry’ type. ‘Wet’ macula degeneration results in a build up of fluid under the retina. This causes bleeding and scarring which leads to sight loss. It can progress rapidly, normally within a few months, and sometimes responds to laser treatment in the early stages. ‘Dry’ macula degeneration usually develops slowly, often over years, and there is as yet no treatment. Many people find that the visual cells simply cease to function, like colours fading in an old photograph. Macula degeneration usually involves both eyes, although one may be affected long before the other.

This sometimes, makes the condition difficult to notice at first because the sight in the ‘good’ eye is compensating for the loss of the sight in the affected eye. You cannot wear out your sight, so do not be afraid to continue to use the ‘good’ eye as normal. The good news is that macula degeneration is not painful, and almost never leads to total blindness. It is the most common cause of poor sight in people over 60 but rarely leads to complete sight loss as only the central vision is affected. Macula degeneration never affects vision at the outer edges of the eye. This means that almost everyone with macula degeneration will have enough side (peripheral) vision to get around and keep his or her independence.What are the symptoms?In the early stages your central vision may be blurred or distorted, with objects looking an unusual size or shape and straight line appearing wavy or fuzzy.

This may happen quickly or develop over several months. You may be very sensitive to light or actually see lights, shapes and occasional discomfort but otherwise macula degeneration is not painful. Because macula degeneration affects the centre of the retina, people with the advanced condition will often notice a blank patch or dark spot in the centre of their sight. This makes reading; writing and recognising small objects or faces very difficult.

What should I do if I think I have macula degeneration?

If you suspect that you may have macula degeneration but there are no sudden symptoms, you should see your optician or GP who will refer you to an eye specialist if necessary. If there is a rapid, significant change in vision, then you should consult your doctor or local hospital’s Accident and Emergency department immediately.

If you have macula degeneration in one eye, and you start getting symptoms in your other eye, then you should go to the hospital that usually looks after you, or ask your GP to arrange an emergency appointment, as soon as possible. This will ensure that if treatment can be done, you will get it within a few days.

What does an eye examination involve?

Firstly there will be an assessment of your vision in both eyes. Then you will be given eye drops which enlarge your pupil so that the eye specialist can look into your eye. The drops take about 30 minutes to work although their effect may last for several hours.

Your vision will become blurred for a while and your eyes will become sensitive to light, but this is nothing to worry about. Many patients with macula degeneration do not meet the visual requirements for driving and it is preferable that you do not drive to the hospital and if you could bring someone with you to help you home.

What is fluorescein angiography?

In some cases your eye specialist may decide that a fluorescein angiogram will also be needed. This involves taking rapid series of photographs of your retina with bright flashes of blue light. These photographs give an accurate map of the changes occurring in the macula and help your eye specialist to decide what is the best treatment for you.

For the angiogram you will be given a small injection of special dye in your arm, which then works its way around to your eye. This is not painful but you may feel a bit sick.

There are a few side effects, although some people find that they are dazzled for a while afterwards. You may also notice that the injection has left your skin with a faint yellow tinge from the flourescein dye but this soon passes into your urine.

Your Feelings

A natural reaction to being diagnosed with macula degeneration is to feel upset and angry. Other people may not understand the problem with your vision because you will not look as though you have a sight problem, and they may ask tactless questions such as ‘why don’t you just get better glasses?’

Adjusting to any major change in life is not easy, and it may help to talk to a social worker, telephone the RINB helpline on 0845 766 9999 or talk to someone from a local society for people with sight problems. Your family doctor or social worker will be able to find a counsellor if you feel that would be helpful. Talking about and sharing experiences can be a good way of learning to cope with feelings and problems that other people with the same condition may have come across before.

Can I be helped to see better?

Your sight is one of your most important senses. Your eye uses a very delicate mechanism to ensure that vision is transmitted correctly to the brain. Like all delicate apparatus, it needs constant care and attention.

Macula Degeneration

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