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Home » Ophthalmology » Macular Degeneration

Macular Degeneration in Houston, TX

Macular degeneration is the leading cause of vision loss in individuals over the age of 60. A complete medical eye examination by board-certified ophthalmologist Mary T. Green, M.D., Ph.D., F.A.C.S. at Eye Excellence in Houston, and serving Missouri City and the surrounding areas of Texas, can determine if you have it.

What is Age-Related Macular Degeneration (AMD)?

The retina is a thin sheet of nervous tissue that covers the inside of the eye and interprets signals from light. Once light hits the retina, nerve impulses are created and then transmitted to the brain via the optic nerve. The brain interprets the signals into visual images. If you compare your eye to a camera, then the retina would be the ‘film’. There is a small central area of concentrated cells on the retina called the macula. The macula is responsible for central vision and color vision. The unique make-up of the macula allows for us to see finer details, such as words in a book, features of someone’s face or the leaves on a tree.

As we age, the macula is at an increased risk for deterioration. Age-related macular degeneration (AMD) is a medical term used to describe the deterioration of the macula that sometimes happens as we age. AMD can be caused by a combination of genetics, age and environmental factors, such as smoking and high cholesterol. Your doctor can determine if you have AMD.

Dry Age-Related Macular Degeneration (Dry AMD)

Dry AMD accounts for roughly 90 percent of all macular degeneration cases and generally occurs in both eyes. One of the most common early signs on a clinical exam of dry AMD is the presence of drusen, which is the accumulation of extracellular material in Bruch’s membrane in the eye. As the disease progresses, the macular photoreceptor cells slowly degenerate and cause vision loss.

As symptoms of this condition worsen, patients may notice a small blurred spot in their central vision. Over time, patients may experience a complete loss of central vision. The most common symptom of dry AMD is slightly blurry vision and the inability to make out details in faces or words while reading. It is important for people over 50 years old or who have a family history of AMD to undergo an annual dilated eye examination to look for macular degeneration.

Wet Age-Related Macular Degeneration (Wet AMD)

Exudative or wet AMD occurs when blood vessels in the retina grow abnormally behind the macula. When this occurs, these fragile blood vessels can leak fluid and blood. This can cause the macula to rise from its normal position in the eye and damage to the macula occurs rapidly. Bleeding, leaking and scarring associated with wet AMD will ultimately cause irreversible damage to the macula when left untreated.

Different from dry AMD, wet AMD can cause central vision loss very quickly. Early symptoms are often described as seeing “wavy lines” when looking at straight lines. A simple but effective visual tool called an Amsler Grid can be used to help diagnose wet AMD. It is important to know that dry AMD can progress into wet AMD.

There are many new effective treatment options now available to manage wet AMD with the recent use of anti-vascular endothelial growth factors (anti-VEGF), such as EYLEA®, Avastin® and Lucentis®. For this reason, a patient that might be experiencing any symptoms should see an eye specialist immediately.

What are common AMD symptoms?

It is important to know that both dry and wet AMD have no pain associated with them.

Patients that have dry AMD might experience blurred vision, loss of details and a growing blind spot in the center of the field of vision. Patients that have wet AMD often begin seeing straight lines that appear crooked. A blind spot might also occur in the center of the field of vision. These symptoms advance much more quickly than dry AMD.

How is Dry AMD treated?

If dry AMD reaches the most advanced stage known as “geographic atrophy,” nothing can help the patient regain their central vision. However, a doctor might be able to delay and possibly prevent the early and middle stages of AMD from progressing to the advanced stage.

How is Wet AMD treated?

Your surgeon can use laser treatment to remove the fragile, bleeding blood vessels, preventing further vision loss. Some surgeons may prefer not to use laser treatment because it can cause damage to surrounding healthy tissue. This treatment is best for patients that have leaky blood vessels that have formed away from the fovea. Only certain patients will be good candidates for laser treatment, which is typically performed in the office.

Anti-Vascular Endothelial Growth Factors (anti-VEGF) Injections

Intraocular Injections of anti-VEGF medications, such as EYLEA®, Avastin® or Lucentis® slows the growth of abnormal blood vessels. Often, patients will need multiple injections every one to two months. This procedure can slow down wet AMD and improve sight.

What are the Symptoms?

Symptoms are similar to those of AMD. Many patients experience no pain or noticeable symptoms during the early stages of the disease. That is why it is recommended that diabetic patients get annual dilated eye exams before the disease progresses.

With time, patients become more symptomatic. Extreme light sensitivity can occur because of poor ocular blood perfusion. Blurred central vision may be noticed when macular edema or swelling is present. If the disease has progressed to where new blood vessels have grown, then blood can completely block vision.

What are the symptoms of proliferative retinopathy if bleeding occurs?

Patients normally notice specks or spots of blood (that appear gray or black) floating in their vision. If this occurs, see your eye doctor immediately before additional serious bleeding occurs. If treatment is not performed, proliferative retinopathy can cause complete vision loss.

What is a vitrectomy?

A vitrectomy is usually recommended in the advanced stage of proliferative retinopathy. Your doctor may wait several months to see if the blood will dissipate on its own before proceeding with a vitrectomy. This procedure removes the blood-filled vitreous and replaces it with a clear fluid naturally produced by the eye. This procedure is performed under either local or general anesthesia in the operating room.

What is a Macular Hole?

Sometimes, a small circular hole develops in the central retina (macula). Idiopathic macular holes spontaneously occur in elderly patients from traction of the vitreous overlying the macula. Other types of macular holes happen from trauma, high myopia (nearsightedness) and chronic macular edema. When this occurs, patients can notice blurred or distorted central vision. Usually, the size of the hole and its location determines the amount of vision loss.

How is a macular hole treated?

Surgery is often necessary to improve vision and to prevent further damage. Usually, a vitrectomy is performed to remove the vitreous gel and tractional membranes to prevent pulling on the retina. Surgery is usually performed under a general local anesthesia on an outpatient basis. If an air or gas bubble is used, patients must maintain a facedown position for a few days. This allows the air bubble to press against the macular hole as it heals. Although uncomfortable, this is a crucial step to the success of the surgery.

What is a macular pucker?

A macular pucker is caused by contraction of an epiretinal membrane that develops over the macula. The macula is responsible for the central vision. As a result, macular pucker often causes blurred and distorted central vision.

What are the symptoms of a macular pucker?

Symptoms can greatly vary from no visual loss to severe loss of central vision. Some patients may start to notice lines appearing wavy or their vision becoming blurry. Some patients may also notice difficulty seeing fine detail when reading.

How is a macular pucker treated?

In most cases, a macular pucker doesn’t require treatment. In many cases, the symptoms of blurriness or distortion are mild. Most patients can adjust to mild visual distortion, even while reading or driving a car. In some rare cases, the vision can decline to the point that daily activities become impaired. When this happens, retinal surgeons will typically perform a vitrectomy and membrane peel.

What is retinal detachment?

The retina is a thin sheet of nerve tissue that covers the inside part of the eye and interprets signals from the light that focuses on it. Once light hits the retina, nerve impulses are transmitted to the brain which interprets it into visual images. If you compare your eye to a camera, then the retina would be the ‘film’. On rare occasions, the retina can actually detach from the back of the eye. If not promptly treated, retinal detachment can cause permanent vision loss.

Who is at risk for retinal detachment?

A retinal detachment can occur at any age. However, it is more common in people over the age of 40. A retinal detachment is more likely to occur in those who have severe nearsightedness, previous retinal detachment, a family history of retinal detachment, past cataract surgery or prior eye injury.

What are the symptoms of retinal detachment?

The most common symptom is the new onset of flashes and floaters. Floaters can appear as specks or cobwebs floating around in your vision. Flashes appear as flashes of light. Some patients even experience a curtain over their field of vision. IF YOU HAVE ANY OF THESE SYMPTOMS, SEE YOUR OPHTHALMOLOGIST IMMEDIATELY.

How is retinal detachment treated?

When a small tear or hole hasn’t progressed to detachment, your doctor can usually perform an outpatient procedure to preserve your vision. Retinal laser photocoagulation can be used to barricade or make a fire wall around a small or focal retinal detachment. With photocoagulation, your doctor uses a laser beam to coagulate the retinal tear, causing scarring that holds the retina in place.

For a larger retinal detachment, the treatment can be more intense. Sometimes surgeons will use a scleral buckle that acts as a rubber band to gently push the eye wall against the retina. A more severe case would require a vitrectomy. This procedure is performed under either local or general anesthesia in a surgical suite. Often, gas or silicone oil is injected into the eye to hold the retina against the eye wall.

Central and Branch Retinal Vein Occlusion

Retinal vein occlusion occurs when a small vein that carries blood away from the retina becomes blocked. When a retinal vein is obstructed, a hemorrhage in the retina occurs. This causes sudden partial loss of vision. This condition is most common in adults over the age of 60.

How is Retinal Vein Occlusion treated?

Some patients may regain vision without treatment. However, vision rarely returns to normal. Complications from retinal vein occlusion require treatment. Macular edema is treated with focal laser, steroid injections or anti-vascular endothelial growth factor (anti-VEGF) drugs. Laser photocoagulation treatment is performed to prevent abnormal blood vessels from growing in an ischemic retina.

Vitrectomy Surgery

A vitrectomy is usually recommended for advanced retinal complications. This procedure removes the vitreous gel and allows the surgeon to operate on the retina. Conditions sometimes needing a vitrectomy include:

  • Retinal detachment
  • Endophthalmitis
  • Intraocular foreign body removal
  • Lens retrieval after a complication during cataract surgery
  • Epiretinal membranes
  • Macular hole
  • Diabetic vitreous hemorrhage
  • Proliferative vitreoretinopathy

Scleral Buckle

This procedure uses a piece of plastic sponge to push the eye wall toward the retina. This is one of the treatments for retinal detachments.

How Much Does Macular Degeneration Treatment Cost in Houston?

  • Even if your insurance plan doesn’t cover vision correction, you can use cash, a credit card, or approved financing for payment.
  • Choose from no-interest plans, extended payment options up to 48 months and no down payment.

Please visit our financing page for more information.

The eye surgeons at Eye Excellence, located in Houston and serving Missouri City and the surrounding areas of Texas, take an individualized approach to treating macular degeneration and will discuss treatment plans with you at length. Contact us today.