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Home / About disability / Macular degeneration |
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Macular degeneration
Age-related macular degeneration is the commonest cause of blindness in industrialized countries. Visual loss from this condition is uncommon among persons under the age of 50, but its prevalence is likely to increase in absolute numbers globally as a consequence of population ageing. Age-related macular degeneration has two forms, ‘wet’ and ‘dry’. In most populations, the dry form is the more frequent, but it is less likely to lead to severe bilateral visual loss. The wet form is characterized by the development of abnormal new blood vessels deep to the sensory retina, which can leak or bleed, leading to marked loss of central vision; if bilateral, this can be very disabling. Each year after the onset of wet age-related macular degeneration in one eye, 15% of persons develop the wet form in their second eye. Current options for prevention are limited, but new treatments are being developed to preserve or restore vision in some patients with the wet form. Visual loss from this condition is uncommon among persons under the age of 50, but its prevalence is likely to increase in absolute numbers globally as a consequence of population ageing. Age-related macular degeneration has two forms, ‘wet’ and ‘dry’. In most populations, the dry form is the more frequent, but it is less likely to lead to severe bilateral visual loss. The wet form is characterized by the development of abnormal new blood vessels deep to the sensory retina, which can leak or bleed, leading to marked loss of central vision; if bilateral, this can be very disabling. Each year after the onset of wet age-related macular degeneration in one eye, 15% of persons develop the wet form in their second eye. Current options for prevention are limited, but new treatments are being developed to preserve or restore vision in some patients with the wet form.
Current situation
Age-related macular degeneration is responsible for 8.7% of all blindness (3 million persons) due to eye diseases, ranging from close to 0% in sub-Saharan Africa to 50% in industrialized countries.The number affected is expected to double by the year 2020 as a result of the ageing of the world’spopulation. The main risk factors are age, race, smoking, a family history of the condition, hypertension,high cholesterol, high fat intake and high body mass index. The complement factor H gene hasalso been implicated.
There is currently much interest and research into all aspects of age-related macular degeneration, from risk factors to novel interventions and treatments. There is some evidence that antioxidants and zinc can slow the progression of the condition, but there is less evidence that measures such as lutein and zeaxanthin supplementation and dietary modifi cation have a measurable impact on the incidenceof or visual loss from age-related macular degeneration.
Photo-dynamic therapy (i.e. foveal ablation with a low-power laser in combination with a photosensitizingdrug, verteporfin) can be offered to selected patients, but the long-term outcomes are not uniformly good. Sequential intravitreal injections of anti-vascular endothelial growth factor agents can improve vision or stabilize visual loss in selected patients, but this treatment is very expensive and is time-consuming for staff and patients. New anti-vascular endothelial growth factor agents are being investigated, and more research is needed. Surgical translocation of the macula and submacular surgery are indicated only for selected patients, as surgery requires highly experienced vitreo-retinal surgeons, and the results are not always favourable. There is currently no treatment for dry age-related macular degeneration. |
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