Macular degeneration is a condition that affects the macula, the central part of the retina at the back of the eye, and may lead to a reduction in central vision. Medically known as age-related macular degeneration, this condition is more common, particularly in older age. The macula is involved in functions such as reading, recognising faces, driving, and distinguishing details. Changes in this area may cause blurred vision or a dark area in the centre of the visual field. The condition is classified into two main types, dry and wet. Macular degeneration treatment is planned according to the type and stage of the condition and the results of retinal imaging. Regular follow-up is important for assessing changes in vision and determining the appropriate time for treatment.
What Is Macular Degeneration?
The yellow spot is the name given to the macula, the area at the centre of the retina responsible for sharp vision. Macular degeneration develops when the cells and supporting tissues in this area gradually lose function. The most common form of the condition is age-related macular degeneration. There are also inherited macular conditions that can occur at a younger age, but their causes and assessment processes are different. In age-related disease, central vision is affected, while peripheral vision is generally preserved. Therefore, macular degeneration does not always mean that vision will be lost completely. However, reduced central vision may make daily activities, particularly reading and recognising faces, more difficult.
What Causes Macular Degeneration?
Structural and functional changes that develop in retinal tissue with ageing play a role in the development of the condition. Over time, the retinal pigment epithelium that supports the macula and the tissues beneath it may have difficulty clearing metabolic waste. Small deposits called drusen may form during this process. The size and number of drusen and the accompanying retinal changes provide information about the stage of the condition. The presence of drusen does not always indicate advanced disease, and the findings are assessed together with the examination results. In later stages, thinning or damage may develop in the macular cells. In some cases, abnormal blood vessels may form beneath the retina, causing fluid leakage or bleeding.
Ageing alone does not mean that the condition will develop. Genetic predisposition, a family history of macular degeneration, and smoking may increase the likelihood of developing it. High blood pressure, cholesterol abnormalities, and certain problems related to the circulatory system are also considered during the assessment. Dietary habits and levels of physical activity may be associated with the course of the condition through their effects on general vascular health. The condition may affect one or both eyes, and the rate of progression may differ between the eyes. In most cases, the exact cause cannot be attributed to a single factor. Personal risk is therefore assessed by considering the examination findings together with the medical history.
How Common Is Macular Degeneration?
Age-related macular degeneration is one of the important causes of reduced central vision in older people. The likelihood of developing it increases particularly after the age of 50 and becomes more pronounced with advancing age. As early-stage changes do not always cause symptoms, some people learn that they have the condition during a routine eye examination. Reduced vision in one eye may not be noticed initially because the other eye sees well. The prevalence of the condition varies according to age distribution, genetic characteristics, and risk factors such as smoking. It is therefore not accurate to assign the same level of risk to everyone within a particular age group. Regular assessment is important for people with a family history of the condition or those who notice changes in their vision.
How Does Macular Degeneration Develop?
Dry macular degeneration develops in association with drusen deposits in the macula and changes in the retinal support cells. There may be no noticeable symptoms in the early stages, or mild blurred vision may occur. As the condition progresses, reduced central vision, difficulty reading, and a need for more light may develop. Some people develop an advanced stage called geographic atrophy, in which the loss of retinal cells becomes more pronounced. The rate of progression varies from person to person, and not every case of dry macular degeneration reaches an advanced stage. The dry form may also convert to the wet form during follow-up. Changes in symptoms or the development of a new central vision problem therefore require reassessment.
Wet macular degeneration develops when abnormal blood vessels beneath the retina leak fluid or bleed. The formation of these blood vessels is called neovascularisation. Fluid accumulating in the centre of the retina may cause blurred vision and make straight lines appear distorted. Changes may become noticeable more quickly than in the dry form. In untreated cases, permanent tissue damage in the macula and loss of central vision may occur. However, the course of wet macular degeneration varies according to the structure of the blood vessels and the response to treatment. If a sudden deterioration in vision is noticed, prompt assessment is important.
What Are the Symptoms of Macular Degeneration?
The symptoms of macular degeneration vary according to the type of the condition and the extent to which the macula is affected. One of the most common symptoms is blurring or loss of clarity in the centre of the visual field. Straight lines appearing bent, broken, or wavy may be particularly noticeable in wet macular degeneration. Letters may appear faint while reading, parts of words may disappear, or stronger lighting may be needed. Colours may appear less vivid, and recognising faces may become difficult. In advanced stages, a dark or empty area may develop in the central visual field. Because peripheral vision is generally less affected than central vision, symptoms may initially go unnoticed.
When symptoms begin in one eye, vision in the other eye may partially compensate. Assessing each eye separately therefore makes symptoms easier to recognise. The grid known as the Amsler grid may help monitor whether lines appear distorted or whether there is a missing area in the centre. However, this check at home does not replace an eye examination or retinal imaging. Sudden loss of vision, newly developed distortion, or the appearance of a dark spot in the centre of the visual field should not be left unassessed. Such a change may require evaluation for wet macular degeneration or another retinal condition.
How Is Macular Degeneration Diagnosed?
Diagnosis begins with measuring visual acuity and examining the retina in detail after dilating the pupil. During the examination, drusen, pigment changes, fluid accumulation, or signs of bleeding in the macular area are assessed. Optical coherence tomography helps examine the layers of the macula by creating cross-sectional images of the retina. This method can reveal fluid within or beneath the retina, tissue thinning, and structural changes. The findings are used to determine whether the condition is dry or wet. Both eyes are assessed during diagnosis. Imaging results are interpreted together with the symptoms and eye examination findings, not in isolation.
When required, abnormal vascular networks can be examined using optical coherence tomography angiography. In some cases, methods such as fluorescein angiography or indocyanine green angiography may be used to assess vascular leakage and the characteristics of the lesion. Fundus photographs and fundus autofluorescence imaging may help monitor the progression of certain retinal changes over time. Not every test is required for every patient. The imaging method is selected according to the findings detected during the initial examination and the suspected type of the condition. When planning macular degeneration treatment in İzmir, the stage of the condition, visual acuity, and imaging results are also assessed together.
How Is Macular Degeneration Treated?
The treatment approach varies according to whether the condition is dry or wet and the changes observed in the retina. In the wet form, the main objective is to control fluid leakage and bleeding from abnormal blood vessels. In the dry form, the stage of the condition is determined and a follow-up plan aimed at reducing the risk of progression is prepared. Current treatments do not restore all lost vision in every patient. The outcome that can be achieved depends on the stage of the condition, the damage to the macula, and the response to treatment. The treatment decision is therefore based on individual examination and imaging findings. In suitable cases of wet macular degeneration, planning treatment without delay is important for preserving central vision.
In wet macular degeneration, anti-VEGF medicines administered into the eye aim to reduce abnormal blood vessel growth and vascular permeability. The eye injection is performed after antiseptic preparation and the application of anaesthetic eye drops. The frequency of treatment varies according to the medicine used, the amount of fluid seen on retinal imaging, and the response to treatment. Some people may initially require more frequent treatment, while in suitable cases, the intervals between injections may be extended according to follow-up results. After each injection, the need for the next treatment is assessed according to the established follow-up plan. As the response to treatment varies from person to person, it cannot be stated that a fixed number of injections will provide a definitive result. Regular retinal examinations are continued because the condition may become active again despite the injections.
For dry macular degeneration, the treatment and follow-up plan is prepared according to whether the findings are at an early, intermediate, or advanced stage. Supplements containing the AREDS2 formulation may be considered for some people with intermediate-stage disease or advanced disease in one eye. These supplements are used in suitable patients to help reduce the risk of progression to an advanced stage. They are not routinely recommended for everyone with early-stage disease, healthy individuals, or every patient with visual symptoms. Their formulation and use are determined by taking accompanying conditions and current medicines into account. There is no treatment that completely eliminates dry macular degeneration or restores lost vision. Although medicines aimed at slowing the rate of progression of geographic atrophy are being considered in some countries, their availability and suitability vary by country.
Photodynamic therapy may be considered in selected cases involving particular vascular structures. It is not used as a standard treatment for every patient with wet macular degeneration. In suitable cases, its use together with eye injection treatment may be considered. The use of conventional laser treatments is also limited depending on the location and structure of the lesion. Surgery is not a routine treatment option for typical age-related macular degeneration. The method is selected according to the characteristics of the abnormal blood vessel formation and the extent of retinal damage. It is therefore not appropriate to compare the treatment plans of different patients directly.
What Are the Risk Factors for Macular Degeneration?
Advanced age is one of the prominent risk factors for the development of macular degeneration. A family history of age-related macular degeneration may be important in terms of genetic predisposition. Smoking is among the modifiable risk factors associated with the likelihood of the condition developing and progressing. High blood pressure, cholesterol abnormalities, excess weight, and a sedentary lifestyle are also considered in the overall health assessment. Not including enough green leafy vegetables, fish, and balanced meals in the diet may indicate an unfavourable lifestyle. Advanced disease in one eye requires regular monitoring of the other eye. The presence of risk factors does not mean that the condition will definitely develop, just as the absence of risk factors does not completely rule it out.
When Can Macular Degeneration Be Treated?
The timing of treatment is determined according to the type of the condition and the active findings detected during the eye examination. If new blood vessel formation, fluid accumulation, or bleeding is observed in the wet form, eye injection treatment may be considered. Sudden deterioration in vision or newly developed distortion of straight lines are among the findings that require early assessment. In the dry form, the treatment approach consists of regular monitoring according to the stage of the condition, controlling risk factors, and supportive treatments where appropriate. Whether supplements are required is determined by assessing the eye examination findings together with the patient's general health. As the condition may not be the same in both eyes during treatment, each eye is considered separately. The frequency of follow-up may vary according to the activity of the condition and the response to previous treatments.
When Can Macular Degeneration Treatment Not Be Performed?
An eye injection is generally postponed until the infection has been brought under control if there is an active infection in or around the eye. Significant inflammation within the eye may also require the procedure to be reassessed. If there is a known serious allergy to an ingredient in the planned medicine, alternative options are considered. In situations such as a recent stroke or heart attack, the treatment decision is made by assessing the general health status and potential risks together. Pregnancy, breastfeeding, and certain uncontrolled systemic conditions may also require an individual assessment. None of these situations necessarily means that treatment can never be performed in every patient. The decision to postpone the procedure or modify the treatment plan is made after considering the eye findings together with the potential benefits and risks.
What Is the Recovery Process Like After Treatment?
Mild stinging, watering, or a small area of redness on the white part of the eye may occur after an eye injection. Temporary discomfort caused by the antiseptic solution may also occur. The duration and severity of these symptoms vary from person to person. After treatment, the care recommendations should be followed, and scheduled follow-up appointments should not be missed. Changes in visual acuity are assessed not only through daily perception but also together with examination and retinal imaging results. Urgent assessment is required if severe pain, increasing redness, a marked reduction in vision, sensitivity to light, or discharge develops. These symptoms may be associated with a rare infection or another complication.
Follow-up for macular degeneration is not limited to a short recovery period after a single treatment. In the wet form, the retina is assessed at specified intervals because disease activity may recur. In the dry form, monitoring continues for changes in drusen, the development of geographic atrophy, or conversion to the wet form. Magnifiers, brighter lighting, high-contrast screen settings, and visual aids may be considered for people with a permanent reduction in central vision. Low-vision rehabilitation may help adapt daily activities to the existing level of vision. The frequency of follow-up is determined according to the condition of both eyes and the course of the disease. The aim of treatment is to control disease activity according to individual circumstances and help preserve existing vision.
How Can Macular Degeneration Be Prevented?
It is not possible to prevent macular degeneration completely in every case. However, controlling modifiable risk factors may help manage the risk of developing the condition. Stopping smoking, monitoring blood pressure and cholesterol levels, regular physical activity, and a balanced diet are parts of this approach. Green leafy vegetables, vegetables and fruit of different colours, and an appropriate amount of fish may contribute to a diet that supports general eye and vascular health. Although sunglasses help protect the eyes from sunlight, they cannot be said to prevent macular degeneration on their own. Regular eye examinations are important for people with a family history, those who smoke, or those in older age groups. If a change in vision is noticed, assessment may be required without waiting for the scheduled follow-up date.
AREDS2 supplements are not standard vitamins used preventively by everyone. Their suitability is assessed mainly in people with intermediate-stage disease or advanced changes in one eye. Older formulations containing beta-carotene are not preferred for people who smoke or have smoked in the past. The AREDS2 formulation containing lutein and zeaxanthin is a different option in this respect for suitable patients. Foods containing omega-3 may form part of a balanced diet, but omega-3 supplements have not been conclusively shown to prevent the progression of the condition. Vitamin and mineral supplements do not replace regular retinal follow-up or necessary eye injections. Before starting any supplement, the eye findings, current medicines, and general health should be assessed together.
