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The macula is a small spot in the center of the retina at the back of the eye. It is responsible for clarifying objects, perceiving color, and distinguishing fine details. The macula controls the ability to read, drive, recognize faces, and see objects directly in front of the viewer.
When the macula becomes damaged, the vision in the center of the eye is affected rather than the periphery. People with macular degeneration (usually known as age-related macular degeneration or AMD) are not blind, but they don’t have a full range of vision either. They are somewhere in between – as the former National Association for Visually Handicapped’s founding director, Dr. Lorraine Marchi, coined the phrase for AMD as being “hard of seeing.”
A loved-one with AMD may not see the eyes of the person they are looking at, but they can usually see the general shape of the face. Since they know where the eyes are generally located, they can look at the eyes without seeing them.
In America, AMD — usually in the form of age-related macular degeneration— is the leading cause of vision loss for those who are over the age of 60. Studies show that exposure to UV rays, obesity, and smoking may increase the risk of AMD, and it seems to be more prevalent in Caucasians than in African-Americans. It has hereditary links and is also more common among women than men.
Though there are two forms of AMD (wet and dry), 90% of those suffering from AMD have the dry, less severe form. No cure has been found yet for AMD. With early detection, there are treatments that slow the progress of the disease, extending full vision longer.
There are two types of AMD. The first type is dry AMD, which is characterized by a breakdown of the macular tissues which causes a buildup to form underneath the retinal layers, called drusen. If the yellow deposits of drusen increase in size, then the tissue at the back of the eye may be cut off from its blood supply. If this occurs, new blood vessels form and tend to leak.
This leads to the second type of macular degeneration, which is wet or exudative AMD. Both of these types of macular degeneration can lead to devastating loss of vision, although it's more common with wet AMD.
In this first stage, vision loss is rare. During an eye exam the doctor will notice yellow deposits, called drusen, in the macula. Drusen is believed to be cholesterol deposits that cause deterioration and are damaging to the macula. For this stage (also known as dry AMD), there are no FDA-approved therapies, although clinical trials are currently underway.
80-90 percent of patients diagnosed with AMD fall into the dry category. This is the best time to take action to protect yourself against further macular damage and keep good vision as long as possible.
At the intermediate stage, the drusen might have become larger, causing more damage and possibly some vision loss. Even during this stage, the recommendations we'll discuss in this article may help to slow the progression. The recent Age-Related Eye Disease Study (AREDS2) found that daily supplementation with certain vitamins and minerals may slow the progression of the disease when in the intermediate stage, and we'll get into more of the treatment later on.
The later stage is known as wet or exudative AMD because the area has tried to grow new blood vessels to deliver oxygen and nutrients to the deteriorating macula, but there is scarring which causes the vessels to leak blood and fluid. In this stage, several medical treatments are available and can be very effective if applied early.
There is also a late stage AMD called geographic atrophy. This form of AMD is actually considered to be dry AMD, and this causes progressive, irreversible damage to the retina. Extensive vision loss is usually noted with this condition even though there is no new blood vessel growth.
Symptoms of degrading vision often build slowly and go unnoticed for a long period of time until they reach a degree of severity that may no longer be ignored. One may notice that he or she now needs glasses to read the text of a favorite book or magazine. Headaches grow more frequent - the result of constantly strained eye muscles. Once bright and vibrant colors may even take on more dull and muted hues.
While many conditions may result in impaired vision, wet macular degeneration is one of the most common culprits. According to AMD.org, when one is afflicted with wet macular degeneration the membrane beneath the retina thickens and eventually breaks, disrupting the supply of critical oxygen to the macula. In response to this assault, the body forms new, abnormal blood vessels which grow up from beneath the retina toward the macula. These new blood vessels are quite delicate and are prone to leaking.
This causes damage to both the retina and macula and often results in a rapid degradation of vision that, once lost, cannot be restored.
As is often the case with illness, catching macular degeneration early is key so one may take action to minimize its negative effects. Here's what to watch out for for AMD in general:
Unfortunately, the older you get, the more at risk you are for macular degeneration. This disease is most likely to occur after age 60, but it can occur at younger ages as well. Other risk factors to note:
This DOUBLES the risk of AMD! That's right...I said DOUBLES! Smokers are two to five times more likely to develop macular degeneration than non-smokers. This is due to the fact that smoking reduces the amount of oxygen delivered to the retina. This lack of proper oxygen most likely contributes to both the development and progression of the disease.
Caucasians are far more likely to develop macular degeneration than other ethnicities, which may have something to do with genetic background as well as with lower pigmentation found in the retina. Individuals with light-colored eyes (think blue and light gray) are more likely to develop macular degeneration due to lack of pigmentation protecting them from UV light.
Someone is more likely to develop macular degeneration if someone in their immediate family has or had it as well. Closer relationships, like a sister or mother with the disease, mean greater risk.
Women are more likely to develop macular degeneration than men, most likely because their life expectancy is longer.
Like smoking, high blood pressure leads to the narrowing of the tiny blood vessels of the retina, restricting oxygen. In addition, people with a BMI (body mass index) higher than 30 are 2.5 times more likely to develop the disease than those with a lower BMI.
The loss of sight induces a sense of fear that almost feels primal. When one of our most frequently used senses fails to function, we feel threatened and we are forced to acclimate by relying more heavily on our senses of hearing and touch.
Perhaps this natural association of vision loss with danger accounts for the fear that we experience when diagnosed with a condition like age-related macular degeneration (AMD).
Although there is no cure for this disease, I'm here to let you in on some things YOU can do to prevent this awful condition from taking your sight. Summed up, here's what you can do to help prevent it:
Smoking contributes to the rapid progression of macular degeneration. In a study conducted at the University of Manchester, smokers were found to be more likely to reach the advanced stages than non-smokers. The chemicals in cigarette smoke greatly affect the process of advancement. Experts say that it would be best never to have started smoking, but if you do, stopping now will slow the process.
As is the case with most health afflictions, a proper diet can do wonders to reduce the symptoms of this condition and, according to some doctors, diet may even be able to heal wet macular degeneration in some people.
A key study conducted by the National Eye Institute - titled the long-term Age-Related Eye Disease Study (AREDS) - discovered that when supplementing a diet with a few critical nutrients, the risk of developing macular degeneration was reduced. “Let food be thy medicine” and incorporate the following research-supported foods and nutrients into an anti-AMD diet. Make sure to eat these DAILY.
Maintaining a healthy weight and exercising are also good for your eyes. People who exercise on a regular basis -- three or more times a week, like walking two miles a day, are 70% less likely to develop age-related macular degeneration. Eating fruits and veggies is important and also reduces the refined carbs you eat. Refined carbs are to be avoided and include white bread, pretzels, potatoes, donuts and other baked goods. Instead, try eating more low-glycemic foods such as multigrain or whole wheat breads.
Cholesterol is that fatty material that builds up in blood vessels and makes it harder for the blood to flow freely. Cholesterol that builds up can make it harder for your eyes to maintain the health they deserve, creating added pressure on the delicate veins in the eyes. Hypertension must also be controlled to prevent macular changes from worsening. For both of these conditions, leading a healthy lifestyle with proper diet and exercise can often do more for you than taking medications. If you suffer from either of these conditions, speak with your primary care doctor about your options.
Although the role of UV light in macular degeneration is unclear, we do know that overexposure to UV light can lead to cataracts and other eye issues. The short wavelengths and blue light, in particular, are known to put stress on the cells of the retinal pigment epithelium. Exposure to more UV light over a lifetime will put you at a higher risk of developing mild AMD, so wearing your sunglasses any time you're outdoors is a great way to prevent this.
We believe that everyone should have a comprehensive eye exam yearly, but as you age this becomes more essential. It is recommended that between the ages of 40 to 60 you have an eye exam at least every two years. After age 60, eye exams should be done yearly. If you already suffer from AMD, it's likely that your eye doctor will recommend an exam schedule that meets your individual needs.
By now, you've likely heard about lutein, but you may be wondering what it is and why it's so important for you. Lutein is a type of carotenoid, which is a fat soluble yellow to red pigment found in many vegetables and plants. Carotenoids give brightly colored vegetables and autumn leaves their color.
Lutein is known to be a yellow pigment, but it appears orange-red in higher concentrations. Within plants, lutein works to dispel damaging light rays that release increased levels of energy that can harm plants. In the same way, it is thought that high concentrations of lutein in the eyes may help prevent damage from ultraviolet radiation and especially blue light.
As was previously stated, lutein is thought to be incredibly beneficial for the eyes because it concentrates in the macula. There, it helps to prevent damaging blue light rays from wreaking havoc on the cells of the macula, the area of the retina (in the back of the eye) responsible for seeing in fine detail.
The macula allows us to read, drive, recognize faces, and function during any other small detail task. Because of the high concentration of lutein in the macula, it actually appears a bit yellow to the eye of your optometrist. Joining lutein in the macula are carotenoids zeaxanthin and meso-zeaxanthin as well, and all function in much the same way.
These carotenoids appear to function as antioxidants in the eye and in the rest of the body, acting alongside other antioxidants like Vitamins C, E, and beta-carotene. These antioxidants work to guard the eyes against oxidative damage from free radicals that can build up and destroy the cells of the eye, leading to diseases like age-related macular degeneration (AMD).
Multiple studies have shown that lutein can be beneficial in preventing the development of AMD. The most significant one to note is the AREDS2 study which demonstrated that those with early macular degeneration who took the studied supplement containing 10mg lutein and 2mg zeaxanthin daily for 5 years saw a 10-25 percent reduction in the risk of AMD progression.
The best food sources of lutein include those with bright color. Green leafy vegetables such as kale, collard greens and spinach are wonderful sources (put them in your breakfast smoothie or make a big salad for lunch!)
Other great foods containing lutein include squash, green peas, brussel sprouts, broccoli, pumpkin, sweet potatoes, and peppers. These can easily be incorporated into a big salad or a dinner with roasted vegetables. Organic eggs are also a great source of lutein that give you loads of protein, and eggs are a great staple for any meal! Don't be afraid of the cholesterol in eggs, as this is a healthy form of cholesterol and eggs contain so many great nutrients our bodies thrive on (like lutein).
There is no recommended daily allowance or intake of lutein. The AREDS studies looked at 10 mg lutein, and at least this amount is often found in supplements. There are no known toxic effects of taking too much lutein (or any of the other carotenoids).
The most notable side effect of eating too many carotenoids is a yellowing of the skin, known as carotenemia, so if you love carrots, you might want to watch out for that! This condition can also occur due to taking too high of a dose of carotenoids in supplement form, but the condition is reversible by cutting back on the amount you're consuming.
Zeaxanthin is one of three primary carotenoids found in the macula of the eye. Carotenoids are fat soluble yellow to red pigments found in many vegetables and plants, and they give brightly colored vegetables their color. This potent substance is what gives paprika and saffron their characteristic colors!
Zeaxanthin is the primary carotenoid within the central macula, while lutein hangs out around the perimeter. Within plants, zeaxanthin works to dispel damaging light rays that release increased levels of energy that can harm delicate plants. In the same way, it is thought that high concentrations of zeaxanthin and lutein in the eyes may help prevent damage from blue light exposure.
Zeaxanthin is thought to be incredibly beneficial for the eyes because it concentrates in the macula, specifically in the very center. There, it helps to prevent damaging blue light rays from wreaking havoc on the cells of the macula. Zeaxanthin is joined by carotenoids lutein and meso-zeaxanthin as well, and all function in much the same way to protect the cells of the eye.
These carotenoids appear to function as antioxidants in the body, acting alongside other antioxidants like Vitamins C, E, and beta-carotene. These antioxidants work to guard the eyes against oxidative damage from free radicals that can build up and destroy the cells of the eye, leading to diseases like age-related macular degeneration (AMD) and others.
There have been many studies showing that zeaxanthin, when partnered with lutein and a few select vitamins and minerals, can be beneficial in preventing the development of AMD.
Just like lutein, the best food sources of zeaxanthin include those with bright color. Green leafy vegetables such as kale, collard greens and spinach are perfect sources that pack a big punch and are easy to incorporate into a smoothie or salad.
Paprika, saffron, and spirulina are also rich sources of zeaxanthin and can easily be added to various dishes.
Other great foods containing zeaxanthin include corn, orange pepper, kiwi fruit, zucchini, and other types of squash.
A critical factor in the formation of new, unhealthy blood vessels in the macula is vascular endothelial growth factor (VEGF). Those with wet macular degeneration have been found to benefit from the injection of VEGF inhibitors. These therapies have been found to greatly reduce vision loss, and new VEGF medications are hitting the market often.
One of these medications was presented to the Food and Drug Administration (FDA), and they approved it after a lengthy testing period. The day they received the good news was in 2006. This injection was a step into the technology age, and it was one of the first VEGF inhibitors used for AMD.
If you have received a diagnosis of macular degeneration (AMD), you may be well aware of the most common VEGF inhibitors. Both are injected into the eye in order to slow vision loss in people who have wet AMD. These are part of a class of drugs that block the growth of abnormal blood vessels, which are the cause of wet AMD.
They are also used to treat macular edema, swelling of the macula, which is often associated with diabetic retinopathy. Some of these medications are considered “off-label” use, but this is permissible if a drug is demonstrated to be effective for treating other diseases. Studies on these medications are ongoing, and we're sure to see newer and better VEGF medications in the near future.
Like any treatment plan, you should investigate not only the available options but the risks and side effects of each option in order to make the most informed decision. Now that we've discussed injections, here are the surgical options currently available for people with wet macular degeneration:
Photodynamic therapy (PDT) was developed by researchers at the Massachusetts Eye and Ear Infirmary and approved for AMD treatment in April 2000. PDT involves a 10-minute intravenous administration of a light-sensitive drug followed by a low-dose, non-thermal (light only) laser to the affected area of the retina. The drug circulates through the body's blood vessels and is particularly attracted to new blood vessels formed by the diseased macula.
The laser activates the drug, which can selectively seal off the leaking blood vessels without damaging the healthy retinal tissue surrounding them.
Thermal laser photocoagulation is a process used by eye surgeons to treat a number of eye conditions, including the wet form of AMD. A thermal laser is used on the eye, focused on abnormal blood vessels growing beneath the retina. The heat from the laser closes off the unwanted blood vessels, preventing additional leakage and vision loss.
This process of thermal laser photocoagulation does not restore lost vision, however. In the past, it was critical that this treatment was initiated as early as possible in the course of the eye disease. Unlike PDT, thermal laser can also destroy healthy retinal tissue as it seals the leakage from abnormal blood vessel growth. Presently, thermal laser is rarely used in clinical practice to treat wet AMD.
Because stem cells are so amazing for treating many different ailments, they've also been studied for use in patients with AMD. The cells that could be transplanted include pluripotent stem cells, embryonic stem cells, and autologous cells. Patients had stem cells inserted into the eye in the hopes that they would grow new, healthy retinal cells. So far, it was found that vision had not worsened in these patients at one year, suggesting a potential treatment option in the future. Studies are ongoing for stem cell therapy.
Later stages of macular degeneration are associated with central vision loss, which may mean eventual legal blindness. Eyesight generally continues to worsen and makes performing daily tasks very difficult. As a result, living with the condition may prove challenging, if not frustrating, for many. Fortunately, there are several coping mechanisms to aid people in the process.
The most important place to start is by seeing a low vision specialist. You can search for one near you by clicking here. Low vision is simply visual impairment that is not correctable through medications, surgery, glasses or contact lenses. Most people with low vision have partial sight, such as blurred vision, tunnel vision or blind spots in their vision.
People who use prescription eyewear should get their eyeglasses checked regularly to make sure their prescription is suitable for them. Magnifiers, also referred to as telescopic lenses in some cases, are a way to enhance reading and similar work that requires close-up vision. Examples include adding telescopic lenses to prescription glasses, and using hand-held magnifying glasses.
Since the central field of vision is lost with macular degeneration, magnification extends images outward from that lost central vision, making it possible to see more of what is in front than would be possible without these aids. The problem comes from each device being made for specific tasks. Reading, driving, and watching television all require a different type of magnification.
One way to maneuver around the vision problems of macular degeneration is to enhance the type of lens used. Scientists have used the age-old concepts of binoculars and telescopes to help people see better by enlarging the size of what they see. People have been using this technique to aid their ability to see objects that are far away and to see miniscule things more clearly.
Just as people have used telescopic lenses to see fine details, people may now use telescopic glasses to assist their low vision and be able to see far away objects much better than before. People with AMD can utilize telescopic glasses to improve the visual aspect of watching sports and plays, as well as looking at the small font of computer screens, books, and other important documents. Telescopic lenses can even be used to assist in driving!
Telescopic glasses are made up of a tiny telescope mounted inside the lenses of eyeglasses. They are between half an inch to three inches thick. Larger sizes generally indicate increased power. An excellent quality is that the telescope can be incorporated into the normal glasses prescription and adjusted according to daily needs. Adding telescopes to glasses can improve vision at normal distances and can even help people see things far away in just the way binoculars can.
Another benefit of adding telescopic lenses to glasses is that they can legally be used for driving in most places. After a specialized exam and training with a low vision specialist, people with macular degeneration can use glasses with telescopes to drive around like before. Being able to see clearly is a basic physical necessity that plays a significant role in daily living and social interactions. In that sense, telescopic lenses can help to improve the quality of life for people facing eye complications.
A great way to cope with vision loss is to take advantage of modern day technology and use advanced tools. People can change computer, tablet and phone interfaces by adjusting font size, altering contrast, increasing volume and adding speech-input systems.
Closed-circuit TV (CCTV) setups that project magnified images on a larger screen with a video camera are readily available. Those who enjoy reading can find books, tablets, and cellphones with large print. Some electronic devices have options specifically for people with low vision. A number of them also employ voice recognition systems that can make life so much easier for those who are undergoing vision loss.
In 2010 the FDA approved another device known as the implantable miniature telescope (IMT) for those with end-stage age-related macular degeneration. This implant helps visual acuity by reducing the central “blind spot” of the patient. The implant is a telescope that is about the size of a pea. The procedure is surgical, and the natural lens is removed and replaced with the IMT in the eye capsule. After surgery, as light enters the eye, images are enlarged at three times magnification. This does not repair the damage already done; it’s purpose is to enlarge the remaining field of vision.
Improving the power of home and office lights may facilitate the completion of daily activities while reducing the chance of accidents. Finding a shuttle or other public transport is a convenient option for those who find it hard to see while driving, or for those who no longer drive. Many options for help exist, but the support of family and friends can be priceless for someone who has low vision.
As is the case with numerous health complications, macular degeneration may stem from either environmental or genetic causes, although its development is also known to occasionally derive from a mixture of both. Hereditary diseases occur when a defective gene is incorrectly applied to the standard functioning of the body. Since the flaw is genetic, it can be passed down from one generation to the next and is not transmitted like infections.
The form of macular degeneration that is inherited is most routinely referred to as juvenile macular degeneration, or JMD for short. Other names include hereditary macular degeneration and macular dystrophy. Cases of JMD are less common than age-related macular degeneration and surprisingly different in presentation.
JMD, like age-related macular degeneration, is essentially the breakdown of the eye’s macula, which is the small, light-sensitive tissue in the retina critical for central vision and seeing details. There are also various manifestations of JMD, and all variations are quite rare.
In most circumstances, the disease first becomes apparent during childhood. Central vision either gets blurry or distorted and dark patches cloud eyesight. The symptoms do not always affect both eyes to equal degrees and rarely hinder peripheral vision. Usually, the symptoms of JMD progress rapidly, although there are some people who retain central vision into adulthood, especially in people who have Best’s disease. People with Stargardt’s disease, on the other hand, lose vision early on and may quickly become legally blind.
The most frequently found type of JMD is called Stargardt’s disease, which is a recessive defect and so must be present in the genetic makeup of both parents in order for their child to show symptoms. It is rare to have only one parent with the condition, although this is possible.
Macular degeneration in this category is caused by a mutation in either the ABCA4 or ELOVL4 genes. These genes are in charge of making essential proteins for retinal cells. What the gene specifically does is get rid of toxic substances in the retina. Without the gene, such toxic substances collect in the retina and damage retinal cells.
A child with Stargardt's disease may complain of vision loss, but tests may come back normal. That is why it is often diagnosed later in life, as children are often not the best at relaying their symptoms. Symptoms may include blurred or distorted vision, small blind spots, moving blind spots, difficulty adjusting to different levels of light, and light sensitivity. There may even be a loss of color vision and loss of depth perception.
As it progresses, changes will appear in the choroid (a layer of blood vessels that feed the macula). Later, small yellowish white flecks will appear in their retinal periphery. Unfortunately, not much can be done for treatment of Stargardt’s, although research continues to dive into future options.
Unlike Stargardt's disease, Best’s disease comes from a dominant gene, which means only one of the parents needs to have the gene in order for their child to develop the disease. When one person who carries the gene has a child who does not carry the gene, there is a 50% chance that the child will show symptoms.
People with Best's disease may not have any symptoms at all. The progression of the disease is also unpredictable because each person who has it is a unique case. They usually have it in both eyes, but the progression could even be different in each eye. Best's disease progresses just as Vitelliform Macular Dystrophy does.
Vitelliform Macular Dystrophy presents itself in adults. Less than a quarter of them have the mutated genes thought to be responsible for this dystrophy. The cause for the rest of the cases is unknown.
There are several stages in Vitelliform. They are the same no matter how the disease presents. People can skip stages or never progress beyond the first few. It is different for each sufferer. In the first stage, everything looks normal, but electro-oculography retinal tests begin to register abnormalities.
During stage two, lipofuscin builds up beneath the macula. Lipofuscin is a fatty yellow pigment that resembles an egg yolk, hence the disease having a name that means yolk (vitelline). Lipofuscin damages photoreceptor cells in the macula and can be seen during an eye exam. The rest of the eye looks normal.
In stage three, the lipofuscin can break through the retinal pigment epithelium (RPE) and accumulate in the subretinal space. During stage four, the lipofuscin breaks up and gives the build up and appearance of scrambled eggs. Vision deteriorates at this point. In stage five, the lipofuscin disappears, but the damage to the RPE remains.
In stage six, a yellow cyst forms under the RPE. Vision can remain normal, or as normal as the accumulated damage allows, for years. When the cyst erupts, the fluid deposits in the RPE and macula. It causes further vision loss though the patient retains their peripheral vision.
Will I go blind from macular degernation?
The risk of vision loss is significant, but it’s not absolute and can be prevented with prompt and proper treatment. No one will ever go completely blind from macular degeneration. Wet AMD affects about 10% of people with macular degeneration but is usually the most visually devastating.
How does macular degeneration lead to blindness?
The easy answer? It doesn’t. According to the National Federation for the Blind, nearly 7% of adults over age 65 fit the definition of “visually impaired.” A great many of those cases stem from macular degeneration, which currently impacts 10 million people who either have the condition or are at severe risk of contracting it. For patients over 55 years of age, macular degeneration is the leading cause of severe vision loss.
The macula is the region of the retina most responsive to light stimuli, providing precise focus for sharp, close vision. It’s the part of your eye that functions when you do things like read an analog clock from across a room, sew a button on a shirt, or read a book up close. Damage or deterioration to the macula inhibits this type of vision, while leaving lateral and peripheral vision untouched.
Are injections for macular degeneration painful?
The way injections for AMD are normally given is through an injection directly into the eye at monthly intervals (or as directed by your retinal specialist). Although the actual injection is considered to be painless, there have been scenarios were adverse reactions took place, such as eye inflammation, elevated eye pressure, and cataracts due to trauma. Lucentis, Avastin, Macugen, and Eylea are all examples of these injections.
Can macular degeneration be reversed?
A research study conducted by the National Eye Institute found that supplementation of key nutrients including vitamin C, vitamin E, zinc, and copper helped to slow both vision loss and the progression of intermediate macular degeneration. Additional research took this a step further, looking at the effects of a category of phytochemicals called carotenoids. A proper diet, rich in these key nutrients, can do wonders to improve wellbeing and guard against disease. The vitamins, minerals, phytochemicals, and additional compounds mentioned are particularly beneficial for eye health and preventing the progression of macular degeneration in many people.
What is macular degeneration vs. macular dystrophy?
Macular Degeneration causes more cases of severe vision loss than cataracts and glaucoma combined. It is incurable and the damage done before treatment or surgery cannot be reversed. It happens when the macula, the central portion of the retina, deteriorates over time (usually due to age). Macular dystrophy, on the other hand, is rare. It leads to cell damage in the macula, which in turn leads to vision loss, and it has no cure. Dystrophies tend to be directly inherited conditions.
Can macular degeneration cause visual hallucinations?
An issue sometimes confronting people with advanced macular degeneration, glaucoma, or cataracts is visual hallucinations. These type of hallucinations are due to a condition called Charles Bonnet Syndrome. Charles Bonnet was a Swiss philosopher in the 18th century who recognized that his grandfather’s visual hallucinations were due to his eye disorder, not mental illness.
The brain creates these hallucinations because the normal amount of visual stimulus coming from the eyes is greatly reduced. The images are often complex, including detailed patterns or even fully formed images such as animals, artwork, faces, or scenery. These episodes can last anywhere from a few seconds to hours. People are reluctant to mention the hallucinations because they think it suggests mental illness, but it is really just a common consequence of impaired vision.
Individuals with Charles Bonnet Syndrome are often aware that the images are not real. In contrast, people with psychiatric illnesses may experience delusions in which they completely believe the hallucinations they see are real. These psychiatric delusions may include hearing voices as well.
Charles Bonnet Syndrome is often compared to phantom limb syndrome which is a condition in which amputees still “feel” an amputated limb. This is due to the cells in the brain, responsible for sensing that limb, continuing to fire signals despite the limb’s absence. Also, in Charles Bonnet Syndrome, the part of the brain responsible for visual images creates illusions when it lacks input from the macula in the eye.
What is macular pucker?
A macular pucker is scar tissue that has formed on the eye’s macula. The macula is in the center of the retina. It is one of the components in the eye that makes the eye light-sensitive. When enough scar tissue builds up, it makes the macula less sensitive to the light and may inhibit light filtration. MP (or Epiretinal Membrane) gives the appearance of wrinkled cellophane over the macula, so this condition is sometimes also known as Cellophane Maculopathy.
So now you are likely asking yourself if AMD and MP are related in any way. The answer is no. The two conditions are as different as night and day. So different in fact that they both take two different treatments. Where AMD takes supplements, laser, and injections to treat, macular pucker requires no treatment in the early stages. The blurry effects that the scar tissue has on the macula is minimal in most cases.
What is a macular hole?
Unlike macular degeneration, which starts in the macula, a macular hole actually begins in the vitreous body, which is the “jelly” that fills your eye. As you age, the vitreous body naturally contracts over time, stressing the fibers that connect it to the retina. In addition, these miniscule fibers can break down, allowing the vitreous to move more than it should. The combination of vitreous shrinkage and degradation of the connective fibers can actually pull the vitreous body far enough away from the macula to create a small tear in the macula itself. This tear typically develops first into a macular cyst and then, if left untreated, progresses to a macular hole.
A small fraction of macular holes will actually heal themselves; for the rest, treatment typically involves a surgery called vitrectomy. In this procedure, the vitreous body is actually severed from the eye and replaced with an artificial vitreous “bubble.” This bubble presses against the macula, sealing the macular hole and enabling it to heal. As the macula heals, the eye’s cavity will refill itself with fluid and the bubble will naturally be absorbed by the eye. This process will require the patient to lie face-down for anywhere from two days to three weeks. As you can tell, this is an extensive procedure and will only be performed if vision loss is severe.
What is the difference between retinitis pigmentosa and macular degeneration?
Retinitis pigmentosa, or RP for short, and AMD, are both formidable eye diseases that result in vision loss. More than a singular disease, RP is considered a collection of genetic disorders affecting the eye’s responsiveness to light. The area of the eye most deeply affected is the retina, which is the layer of cells at the back of the eye that detects light and then converts it into signals for the brain to recognize. Once the signals travel through the optic nerve and enter the brain, they are finally formed into images.
What happens with RP is that those very same retinal eye cells, also known as rods and cones, are either damaged or deteriorating. The first main consequence is side vision loss along with decreased night vision. Central vision also gradually worsens. Blindness is the final outcome after an extended period of time passes, and vision loss is permanent.
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