Articles from prior issues of The Advocate

November/December 1998

Macular Degeneration Prevalence In The Elderly
by Dean Crawford, Texas DDS

DO YOU KNOW THE LEADING cause of sight loss in elderly individuals?

As Dr. Prema Abraham told NADE conference attendees, the answer is Age Related Macular Degeneration (ARMD). This condition is caused by pigmentary disturbances in the macular region or by the formation of an ecudative mound. ARMD affects 64 percent of individuals age 65-74 and 19.78 percent of those 75 and older.

There are three forms of ARMD which can be caused by heredity, light exposure, zinc, smoking, hypertension, lipid metabolism, scleral rigidity, and free radicals.

The three forms are Dry, Wet, and pigment epithelial detachment (PED).

The dry (atrophic) form affects 85-95 percent of patients. It is characterized by drusen lesions and pigment alterations. The end stage process of the dry form is atrophy and there is no cure. This form may progress to the next form which is Wet.

The wet (exudative) form of macular degeneration affects 10 percent of patients. It is characterized by abnormal blood vessels. If one eye is affected, the other is at increased risk of being affected and the risk increases 10 percent per year. Dr. Abraham suggested individuals should see their doctor immediately if their vision is disturbed. Laser treatment is available for this form of ARMD and the end stage process is discoform scars.

The PED form affects five percent of patients and is characterized by blisters developing in the macula. Laser treatment is also available for PED. Laser treatment for this disease is accomplished by a process called fluorescein angiography. Dye is injected into the veins, specialized cameras take photos, and the laser treatment is guided by the photos. The advantages of laser treatment are it destroys abnormal blood vessels and it preserves central vision. The disadvantages of laser treatment include developing scars, the presence of a blind spot, and persisting and/or recurring abnormal blood vessels.

There are new treatments available for macular degeneration. These include digital IVG, thalidomide, submacular surgery, and low dose radiation. Dr. Abraham is an International Rotary Foundation Scholar. She continues her work on Age Related Macular Degeneration at the Blackhills Regional Eye Institute.