Macular Degeneration
Ophthalmology located in San Francisco, CA
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Macular Degeneration Services Offered In San Francisco, CA
Regular eye exams are vital for diagnosing age-related macular degeneration (AMD). Dr. Bart delivers precise diagnosis and advanced care for AMD, ensuring patients achieve their best vision. Call the office or request an appointment online today.
What is age-related macular degeneration (AMD)
AMD damages the central part of your vision. The retina is nerve tissue inside the eye that captures light and sends it to the brain for processing into vision. AMD affects the center of the retina, called the macula. When the cells of the macula degenerate, images are not perceived correctly. Symptoms include:
• Early on, difficulty seeing in low light
• Later, wavy or blurry vision
• In very advanced stages, loss of central vision and legal blindness
Who is at risk for AMD?
While the causes of AMD are not known, there are genetic and environmental factors that contribute to its development. You are more likely to develop AMD if you:
• Eat a diet high in saturated fat (found in foods like meat, butter, and cheese)
• Are overweight
• Smoke cigarettes
• Are over 50 years old
• Have high blood pressure (hypertension), heart disease, high cholesterol
• Have a family history of AMD
• Are caucasian
• Have had significant ultraviolet (UV) light exposure
What are the types of AMD?
• Dry AMD is when tiny clumps of yellow protein called drusen build up under the macula, and parts of the macula get thinner. It accounts for 85-90% of all AMD cases. Central vision loss is slow.
• Wet AMD is a more serious form that causes severe, rapid central vision loss. It occurs when abnormal blood vessels grow under the macula, often leaking blood or fluid and causing scarring. Only 10-15% of AMD is of the wet form.
Dry AMD
During an eye exam, Dr. Bart will look inside your eye through a magnifying lens to see if there are abnormalities in the macula. Dr. Bart may ask you to look at an Amsler grid which helps you notice any blurry, distorted, or blank spots in your field of vision. Right now, dry AMD cannot be treated. New medications are on the horizon that may do so in the future. Currently, we focus on preventing dry AMD from getting worse.
Vitamins and minerals for AMD
Many people with intermediate or advanced dry AMD benefit from a specific mix of vitamins and minerals. Age-Related Eye Disease Study 2 (AREDS 2) was a very large research study that showed that taking the following nutritional supplements every day lowers the risk of getting late-stage or wet AMD:
• Vitamin C (ascorbic acid) 500 mg
• Vitamin E 400 international units (IU)
• Lutein 10 mg
• Zeaxanthin 2 mg
• Zinc (as zinc oxide) 80 mg
• Copper (as cupric oxide) 2 mg
Dr. Bart can tell you if vitamins and minerals are recommended for your dry AMD, as not all forms will benefit from the AREDS supplements.
Lifestyle remedies
• Eye-healthy foods. Studies show that nutritional supplements alone are not enough to prevent or delay advanced AMD. You should also eat a healthy, balanced diet. This includes dark leafy greens (like spinach and kale) along with yellow, orange, and other colorful fruits and vegetables. Eating fatty fish like salmon may also lower your risk of early or advanced AMD.
• Manage your other medical conditions. If you have cardiovascular disease or high blood pressure, for example, take your medicine and follow your health care provider's instructions for controlling the condition.
• Smoking cessation. If you smoke, ask your health care provider for help quitting.
• Maintain a healthy weight and exercise regularly. If you need to lose weight, reduce the number of calories you eat and increase the amount of exercise you get each day.
• Have routine eye exams. Dr. Bart carefully evaluates the macula for the presence of AMD during a comprehensive exam.
Home vision monitoring
Dry AMD can change into wet AMD, causing decreased vision. Sometimes these changes go unnoticed at first because the stronger eye compensates for the weaker one. It is important to catch vision changes as soon as possible because early treatment for wet AMD offers the best chance of preserving vision. Dr. Bart may recommend using an Amsler grid every day to help monitor your vision, as described below. A PDF of the Amsler grid with instructions on its use can be downloaded at https://amslergrid.org/AmslerGrid.pdf
How to use the Amsler grid:
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Amsler Grid
• Wear the eyeglasses you normally wear when reading.
• Position the chart 14 inches (35 cm) away from your face, in good light.
• It is important to test EACH eye separately. Cover your left eye with your hand, keeping your right eye open.
• Focus on the center dot, and keep your gaze fixed there.
• While looking at the dot, be aware of the surrounding lines. Do any of the straight lines appear wavy or bent, any of the boxes differ in size or shape from the others, or any of the lines appear missing, blurry or discolored?
• Repeat this process with the other eye. Cover your right eye, and test your left eye in the same way.
• If you notice any changes, contact Dr. Bart’s office right away. Do not wait for your next appointment.
Wet AMD
As stated before, wet AMD occurs when abnormal blood vessels grow under the macula, often leaking blood or fluid and causing scarring. Over 200,000 cases of wet macular degeneration are diagnosed every year in the United States.
How is wet AMD diagnosed?
Dr. Bart carefully evaluates the macula for the presence of wet AMD during a comprehensive exam.
Optical Coherence Tomography (OCT) is probably the most commonly performed diagnostic test of the retina. It gives an extremely detailed evaluation of the layers of the retina. This test takes only a few minutes.
Optical coherence tomography angiography (OCTA) is a modification of standard OCT that allows visualization of retinal and choroidal vessels in separate layers of the eye. This test takes only a few minutes more than a standard OCT test.
Fluorescein angiography is a test during which a yellow dye called fluorescein travels through your blood vessels. A special camera takes photos of the retina to see if abnormal new blood vessels are growing.
Fluorescein angiography is a test during which a yellow dye called fluorescein travels through your blood vessels. A special camera takes photos of the retina to see if abnormal new blood vessels are growing.
How is wet AMD treated?
A protein called vascular endothelial growth factor (VEGF) is produced in our body and regulates the growth of blood vessels. In wet AMD, an excess of VEGF causes the formation of abnormal vessels. Several anti-VEGF medications are available to inactivate the excess VEGF. These drugs need to be injected into the eye. This is called an intravitreal injection. Anti-VEGF injections have led to remarkable gains in vision. These treatments are initially done monthly. As the eye improves, treatments become less frequent and in time may be paused. While most patients initially have an aversion to the idea of an injection into the eye, numbing of the eye is carefully done, these injections are comfortable, and patients do very well.
Since intravitreal injections typically provide the best outcomes, it is less common to use other treatments, such as a cold laser (Visudyne Photodynamic Therapy) or thermal laser treatment to seal the leaky blood vessels. Photodynamic treatment uses a medication, Visudyne, that is absorbed by the leaky blood vessels. A laser light activates the drug, causing the blood vessels to close and stop leaking. Thermal laser treatment seals leaky blood vessels but damages the tissue, so it is usually used when the leaky vessels are farther away from the center of vision.
At the Bart Eye Center, Dr. Bart delivers accurate diagnosis and expert care for AMD, ensuring patients achieve the best possible results. Call us to arrange a macular degeneration screening or request an appointment online today.
TESTIMONIALS
Dr. Bart’s practice blends intelligence, kindness, and state-of-the-art in its science.
Rebecca L.
I’ve been going to Dr. Bart for 10 years or more, and I keep going despite having moved 75 miles away. I trust her care and judgment enough that I’m happy to make that drive.
Michael G.
Dr. Bart is an incredible ophthalmologist – kind, thorough, dedicated to her patients. I highly recommend her.
Denyce H.
Dr. Bart has the qualities I look for in a professionsl - well-educated, experienced, organized, clear and informative communicator, up-to-date. Highly recommended!
Anna-Marie B.
Pleased and Grateful
Dr. Bart diagnosed my problem and gave me explicit written instructions for taking care of it. I was pleased and grateful. I had never seen her before but have decided to make her my eye doctor.
Paul S.