Macular Degeneration - Medical Malpractice Lawyers

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Macular Degeneration - Medical Malpractice

Macular degeneration is an age-related eye condition which results in a loss of vision in the central portion of the eye. The disease comes in "wet" and "dry" types and is a major cause of loss of vision in patients older than age 50. Peripheral vision usually remains intact so the person can function in most daily activities.

The retina is the inner layer of the eye that contains nerve cells that pick up light and color, and allows us to see. The choroidal layer is the blood vessel layer behind the retina that supplies blood to the central part of the retina, the macula, as well as the rest of the retina. It is the macula that allows you to see the central part of your vision.

Age-related macular degeneration begins with characteristic yellow deposits in the central part of the retina. The yellow deposits are called drusen, which form between the retinal pigment layer and the underlying choroidal layer. Drusen go on to develop advanced age related macular degeneration. If the drusen are large and are of sufficient quantity, it can cause macular degeneration beneath the macula. They are made of cholesterol deposits and their formation can be made less by taking cholesterol lowering agents.

There is dry age related macular degeneration and wet age related macular degeneration. The dry form results from atrophy of the retinal pigment layer beneath the retina, which causes a loss of photoreceptors in the eye, particularly the central portion. There is no treatment for this condition but people have used zeaxanthin and lutein to slow the progression of the disease. Beta carotene, on the other hand, has not been found to be effective.

Wet macular degeneration is exudative. This means that there is abnormal vessel growth in the choroidal layer that leaks blood and protein beneath the macula. It causes bleeding, leakage and scar tissue formation near the blood vessels, which is eventually irreversible. Vision loss is rapid if no treatment is provided. New treatment has been identified for this form of macular degeneration and is known as anti-angiogenic agents, which regress the abnormal blood vessels and improve vision. These agents must be injected directly into the vitreous humor of the eye. They must be done bi-monthly or monthly in order to be effective. The cost of this treatment can sometimes be prohibitive, unless you use bevacizumab (Avastin), which is an off label use but costs only $150 per treatment. The wet type of macular degeneration affects only 10 percent of patients with macular degeneration.

Signs and symptoms of macular degeneration include the presence of drusen in the eye, alterations in the pigment of the retina can be seen and there can be hemorrhages in the eye, hard exudates and subretinal/intraretinal fluid. Atrophy occurs during the process and visual acuity goes from 20/20 to 20/80 or worse. Blurry vision is a universal phenomenon, particular in the central area. If the macular degeneration is exudative, the loss of vision is quite rapid. There are missing areas of vision, known as central scotomas and distorted vision. Colors can be hard to see clearly and there is a loss of ability to see contrast. Recovery from exposure to bright light is difficult with age related macular degeneration.

Only a few people with macular degeneration are totally blind. Most have some peripheral vision. The macula affects only 2.1 percent of the entire retina and the rest of the retina is left intact. Even so, the loss of central vision is a serious problem.

There is a loss of sensitivity of the contrast so that things like shadows, contours and color vision are muted. There is a contrast sensitivity test that can determine the loss of contrast.

The causes of macular degeneration include aging, with 10 percent of patients between 66 and 74 years of age having some degree of the disease. Family history has something to do with who gets macular degeneration and who doesn't. There is a gene for macular degeneration that seems to be associated with the disease. These are genes for the complement system proteins Factor H, Factor B and Factor C3. A mutation of the ATP synthase gene seems to genetically link someone to having macular degeneration. There as a disease caused Stargardt's disease that leads to a juvenile form of macular degeneration and is autosomal recessive.

The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here