ARMD Dry Form

The dry form of Age-Related Macular Degeneration involves changes in the maculae which also can lead to legal blindness.  The changes include drusen which are small yellowish spots in the maculae representing changes in the retinal pigment epithelium (RPE) which is the layer of tissue immediately beneath the retina.  In addition to drusen, the pigment of the RPE can clump.  This then can lead to geographic atrophy and irreversible loss of vision.  Generally this is a slower process than the wet form.

The dry form can convert to the wet form; therefore, people with any form of macular degeneration should be aware of changes or distortion in their vision.

Currently the only treatment for the dry form of age related macular degeneration is the use of vitamin and mineral supplements and cessation of smoking.  There are, however, many investigators working on cell based therapies for the dry form of age related macular degeneration.


ARMD Wet Form

The wet form of Age-Related Macular Degeneration means that vessels have grown under or within the retina causing distortion or a change in vision acuity.  This condition can be observed during clinical examination showing some bleeding in the macular area.  The patient can have little or no change in vision and it may only be picked up on clinical examination.

Treatment for Age-Related Macular Degeneration has improved greatly over the last seven years with the advent of anti-VEGF therapy.  It is now common to be able to successfully treat this disease, which in the past led to central legal blindness.  Although not all eyes with Age-Related Macular Degeneration achieve a good outcome, many more eyes than previously are able to retain functional vision.  This does require intense, frequent follow up and often treatment.


Diabetic Macular Edema (DME)

Diabetic Macular Edema (DME) is the leading cause of legal blindness in working age individuals.  It is the result of leakage of liquid from retinal vessels as described in BDR.  In the past, the only treatment for DME has been laser therapy or sometimes vitrectomy.  Current treatment also includes drug therapy, such as steroids and anti-VEGF drugs.


Proliferative Diabetic Retinopathy (PDR)

Proliferative Diabetic Retinopathy or PDR is a more severe form of Diabetic Retinopathy resulting from large areas of reduced circulation and therefore oxygenation of the retina.  This reduced oxygenation stimulates a chemical called vascular endothelial growth factor (VEGF).

This chemical causes  vessels to form which are referred to as new vessels. These new vessels present a risk of bleeding, as well as, leading to scaring and retinal detachment.  These vessels can be treated by laser therapy and pharmacologic methods.


Background Diabetic Retinopathy (BDR/PPDR)

Background or pre-proliferative diabetic retinopathy (BDR/PPDR) shows areas of out pouching (micro aneurisms) of normal retinal vessels and can lead to leakage from these vessels into the retina.  This leakage can be water-like fluid or very viscus fluid containing lipids and cholesterol.  This material called exudates can be locally damaging to the retina.

(BDR/PPDR) is visible usually on clinical examination but often needs optical coherent tomography (OCT) or fluorescein angiography (FA) to identify areas of leakage that may respond to laser or pharmacologic therapy .


Branch Retinal Vein Occlusion

Retinal vein occlusions are divided into both branch and central retinal vein occlusions.  Branch retinal vein occlusions can involve a small or fairly large area of the retina.  Essentially, the venous outflow from the retina is blocked.  The blockage is generally felt to be a clot type of material.  This causes bleeding in the retina and a reduction in vision from blood or from swelling in the retina in the center of vision in the macula.

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Central Retinal Vein Occlusion

Central retinal vein occlusions imply that the main vein leaving the eye from the retina is blocked. This blockage usually leaves a picture of bleeding in all four quadrants of the retina. This central retinal vein occlusion can lead to very devastating loss in vision depending on whether or not capillaries are lost (an ischemic central retinal vein occlusion), or if capillaries are present (a non-ischemic central retinal vein occlusion). Non-ischemic central retinal vein occlusions have a better prognosis for visual improvement. Central retinal vein occlusions also can be accompanied by macular edema or swelling of the macula and this can be treated by either laser or by injections of anti-VEGF drug. Central retinal vein occlusions still can be devastating to the letter-reading visual acuity of the eye and in addition, can contribute to a very difficult to manage form of glaucoma called neovascular glaucoma.

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