Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "

Case study ( 13121 views as of December 21, 2024 )

Betty, a 75-year-old female, presents with sudden onset of central vision loss in her right eye. She has had ‘perfect’ vision since her cataract surgery 15 years ago. The vision loss has affected her ability to thread needles and read small print. Her sister, a heavy smoker, lost vision in her late 60s due to age-related macular degeneration. When she covers her good eye she cannot see the face of someone in front of her. The entire central vision is a grey-blank. Her peripheral vision, however, is entirely unaffected. She worries that she will go completely blind and lose her ability to live independently.

Betty is referred to a retina specialist, who diagnoses her with wet age-related macular degeneration. Injection treatments are recommended. These are administered on a monthly basis and allow for a significant improvement in acuity.

Working with her comprehensive ophthalmologist and occupational therapist, Betty begins using magnifiers and new software on her computer to allow her to sew and read more easily. She still has some persistent vision loss, but is able to continue doing the many detailed visual tasks that were not possible at the time of her initial vision loss.

Author: Dr. David Maberley

Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "

Case Introduction

Warning Signs Of Macular Degeneration

Presented by

Dr. David Maberley

MD, FRCS(C), MSc

Ophthalmologist

Macular Degeneration - Action Plan ( 350 engaged.)

Open and print the educational action plan for conversation with your Healthcare provider.

Treatments

Age-Related Eye Conditions Including Macular Degeneration

Practitioner help from:

Dr. Abby Jacob

Optometrist
Eye Prescription Measurements - Considerations If You Have Macular Degeneration

Practitioner help from:

Dr. Abby Jacob

Optometrist
Treatment Differences For Wet and Dry Macular Degeneration

Practitioner help from:

Dr. Richard E. Selser

Ophthalmologist

Treatments

How Routine Vision Tests Can Screen For Eye Conditions Including Macular Degeneration

Practitioner help from:

Dr. Abby Jacob

Optometrist
Importance Of Eye Health Testing In Identifying Macular Degeneration

Practitioner help from:

Dr. Abby Jacob

Optometrist
Signs Of Macular Degeneration To Watch Out For

Practitioner help from:

Dr. Richard E. Selser

Ophthalmologist

Conversation based on: Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "

Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "

Dr. David Maberley MD, FRCS(C), MSc Ophthalmologist, Ottawa, ON 30 June 2023 Ottawa Hospital Ophthalmology

For dry macular degeneration, antioxidant vitamins are commonly used for management. The specific formulation recommended by the National Institute of Health (NIH) includes Vitamin C and E, zinc (with copper supplementation to prevent anemia), and lutein or zeaxanthin, which are carotenoids that protect the macula. It is important to note that the decision to start these vitamins should be made by an ophthalmologist based on evidence of macular degeneration, as not all patients may benefit from them. Taking the recommended vitamins can reduce the risk of macular degeneration by approximately 30% over a period of five to seven years. In the case of wet macular degeneration, the treatment involves injections of anti-VEGF (vascular endothelial growth factor) chemicals into the back of the eye. This treatment has shown significant improvement in vision outcomes compared to previous methods. The injections are performed every month to two months and are relatively painless. The ophthalmologist administers local anesthesia and ensures proper eye hygiene to reduce the risk of infection. Typically, the treatment is required for up to two years, and additional treatments may be necessary depending on the individual's condition. By undergoing this treatment, the likelihood of vision loss is significantly reduced, allowing most individuals to maintain their vision for many years. However, early detection and prompt treatment are crucial, as delaying diagnosis and treatment can lead to irreversible scarring and diminished treatment effectiveness. It is emphasized that the sooner macular degeneration is diagnosed and treated, the better the chances of limiting the damage and preserving vision. While immediate treatment after the onset of the disease is not always possible, it is recommended to seek treatment within a few days of a wet macular degeneration diagnosis. If you have further questions about the treatment of macular degeneration, it is advisable to consult with your family doctor or local ophthalmologist.

Reply to: Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "
Dr. David Maberley MD, FRCS(C), MSc Ophthalmologist, Ottawa, ON 23 June 2023 Ottawa Hospital Ophthalmology

Well the management of macular degeneration involves a few different steps. The first thing we can talk about once you’ve been diagnosed with macular degeneration is prevention. And the easiest thing to do is, if you’re a smoker, is to do whatever you can to reduce your smoking and eliminate it. Because that’s a big trigger for a lot of macular degeneration. There may also be a role to wearing light protection for UV and bright light that wouldn’t hurt in the setting of macular degeneration. Now there’s another piece in terms of early detection, and the early detection of macular degeneration is essential because the sooner a patient is diagnosed with the disease, especially in the form of wet macular degeneration, the sooner the treatment can be initiated, and the better the visual outcomes. And there’s a number of ways you can test your eyes at home to be sure that you’re hopefully not developing macular degeneration that’s progressive. The first of those is called an Amsler grid, which is a grid paper, much like a piece of graph paper, that you can look at and look for areas where the lines start to become wobbly or distorted, or perhaps the lines are even missing. And that’s a very simple test that you can even do. You can look for an Amsler grid on the Internet and find a version of that and test that on your own computer every day. The second type of testing is a home monitoring device that are starting to become available throughout North America, where it’s almost like a small computer device you would keep at home, and it can help you to diagnose early macular degeneration as well. Or simply just paying attention to your reading or any fine, detailed work you do with your eyes. If you start to lose letters when you’re reading or you notice lines, for example, straight lines, doorways, start to become bumpy or wobbly in the middle. Those would be good signs to get your eyes examined to make sure that nothing’s going on.

Reply to: Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "
Dr. David Maberley MD, FRCS(C), MSc Ophthalmologist, Ottawa, ON 23 June 2023 Ottawa Hospital Ophthalmology

Macular degeneration is primarily considered a genetic disease, and this understanding has evolved over the past decade or two. Much of the risk for macular degeneration is determined by your genetic makeup and is already predetermined at birth, which means there are limited preventive measures that can be taken. However, certain behavioral factors such as smoking and excessive exposure to sunlight or UV rays may modify the genes associated with macular degeneration and increase the risk for certain types of the disease. It is important to be aware of these factors and take necessary precautions. If you have a strong family history of macular degeneration and want more information about your genetic risk factors, there are tests available to assess those risks. To diagnose macular degeneration, it is necessary to visit an ophthalmologist for an assessment. This typically involves dilating your pupils using drops. It is important to arrange for someone to drive you home after the assessment and consider bringing sunglasses for comfort. During the assessment, the ophthalmologist will carefully examine your eyes, looking for any changes, hemorrhaging, or other concerning signs of macular degeneration. Based on the findings, further tests may be conducted to confirm the diagnosis. The most common and traditional test is called a fluorescein angiogram, where a dye is injected into your arm, and photographs are taken of your eyes to examine blood flow and details of the back of the eye. Additionally, an optical coherence tomograph may be used to provide detailed laser images of the layers in the back of the eye. A more recent test called an auto-fluorescence test, which involves a bright blue flash of light, can assess the health of the pigment layers under the retina, aid in the diagnosis of dry macular degeneration, and provide information about disease progression. Following the assessment and initial examination, your physician will have a good understanding of whether further testing is necessary. In many cases, the additional tests can be conducted and interpreted on the same day, and treatment can be initiated promptly, depending on the logistics of the specific clinic. If you have more questions or concerns about the diagnosis or causes of macular degeneration, it is advisable to consult your family physician. If they are unable to provide all the answers, your local ophthalmologist will be able to provide further information and guidance.

Reply to: Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "
Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 20 April 2022

Diabetic retinopathy can cause permanent damage to the eyes,

Reply to: Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "
Dr. David Maberley MD, FRCS(C), MSc Ophthalmologist, Ottawa, ON 18 December 2019 Ottawa Hospital Ophthalmology

A swelling in the macula, an area near the centre of the retina, the part of the eye that is responsible for fine or reading vision. People with diabetes are at higher risk of macular edema.

Reply to: Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "
Dr. Ronald Goldenberg MD, FRCPC, FACE Endocrinologist, Thornhill, ON 10 December 2019

A clouding of the lens of the eye, resulting in blurred vision. Cataracts tend to occur in people over 50 years of age, but can occur at a younger age and advance more quickly in people with diabetes. If left untreated, cataracts can cause blindness.

Reply to: Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "
Dr. Baseer Khan MD, FRCS(C) Ophthalmologist, Vaughan, ON 07 December 2019 Clarity Eye Institute

A swelling in the macula, an area near the centre of the retina, the part of the eye that is responsible for fine or reading vision. People with diabetes are at higher risk of macular edema.

Reply to: Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "
Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 09 September 2016

My biggest issue with both reading and driving at night as I get older is that my eye's hurt at night. I find increasing I have to watch how much I drive at night.

Reply to: Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "
- Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 15 April 2022
  
  Vitrectomy surgery is reserved for extreme cases of diabetic retinopathy that can’t be handled in the office by such things as injections and lasers.
- Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 15 April 2022
  
  if your sugars are under good control, your sugars are the same as a non-diabetic person's,
- Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 15 April 2022
  
  Generally, you'll need intravitreal injections monthly.
K. Michael 09 October 2015

Generally when you hear of people losing their vision it begins in the periphery and spreads in. Why with macular degeneration does it begin in the center?

Reply to: Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "
Dr. Duncan Miller MD Family Doctor, Vancouver, BC 27 April 2015 Broadway Plaza Family Practice Vancouver

A lot of patients come in complaining that they may have pink eye. In general, pink eye refers to a viral infection of the conjuctiva. Now, your conjunctiva is the mucus membrane that covers the surface of your eye, right up to your iris or your cornea there, and it can get inflamed for a number of reasons.

Reply to: Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "
- Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 20 April 2022
  
  Surgery for diabetic retinopathy is usually the first treatment option doctors will suggest.
- Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 20 April 2022
  
  Treatments for diabetic retinopathy include intravitreal injections, laser and surgery.
- Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 20 April 2022
  
  One of the best times to exercise is immediately before a meal.
- Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 20 April 2022
  
  Diabetic retinopathy can be controlled by first of all controlling your sugars.
- K. Michael 03 August 2015
  
  I've had two eye infections that I thought were pink eye but in fact where not. One originated behind my eye and required follow up with an ophthalmologist.
Bernadette van der Boom-Bebb 04 February 2015

Are there dietary recommendations to aid in the prevention of Macular Degeneration?

Reply to: Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "
- K. Michael 17 August 2015
  
  That's a very good questions. We've always been told that carrots are good for your eyesight but what foods really do help with diseases like macular degeneration ?
Healthymama 28 January 2015

Macular degeneration runs in our family. I think it is more common in people with lighter (blue?) eyes. I wonder about the vitamins recommended for eye health, if they actually work.

Reply to: Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "
- K. Michael 31 July 2015
  
  That's interesting. I wonder what macular degeneration has to do with eye color ? Why would blue eye people be more affected ?
- Joy 06 April 2015
  
  That's really interesting as the person I know who has Macular Degeneration has blue eyes.
Ms. Sarah Ware RD Registered Dietitian, North Vancouver, BC 17 December 2014

My grandmother suffers from age-related macular degeneration. She was also referred to a retina specialist and received injection. Unfortunately she waited too long and only one of her eyes benefited from the injections.

Reply to: Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "
Yuan Lew, MSc MBA 29 November 2014

What are the side effects from these injections?

Reply to: Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "
- Joy 06 April 2015
  
  Yes, the injections are directly to the eye.
- Yuan Lew, MSc MBA 10 December 2014
  
  I believe it is into the eye
- K. Michael 03 December 2014
  
  Would these injections be to the body or into the eye itself ?
dbutchar 26 November 2014

I have increased ocular pressure in my eyes so I am consistently checked for glaucoma and macular degeneration by my ophthalmologist. It is amazing what they can do nowadays to restore not only vision but independence.

Reply to: Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "
- K. Michael 06 December 2014
  
  My grandfather had glaucoma. Recently my father was found to have higher ocular pressure in his eyes during a routine checkup. I don't think that people take their eye health seriously enough
K. Michael 26 November 2014

Hopefully the treatment slows down this woman's vision loss and allows her many more years of independent living

Reply to: Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "