(December 24, 2007 - Insidermedicine) Welcome to Insidermedicine's If I Had, where we get a chance to ask an expert what they would do if they had a medical condition.
Today I have the pleasure of introducing Dr. Carl Regillo, who is Director of the Wills Clinical Retina Research Unit, Professor of Ophthalmology at Thomas Jefferson University School of Medicine, and Principle Investigator of several major international clinical trials investigating new forms of treatment for macular degeneration. He runs several instructional courses at the annual American Academy of Ophthalmology meeting and is a recipient of the Academy’s Achievement Award, in addition to chairing the Academy’s Basic and Clinical Science Course Retina Section committee. A fellow of the American College of Surgeons, he has authored numerous scientific papers, lectured nationally and abroad, and has published three major textbooks in the field.
We asked Dr. Regillo for his thoughts on what to do if you experience central visual blurring.
Dr. Regillo: If I had the sudden onset of central visual blurring in one of my eyes, I’d be concerned I might be having the symptoms of wet macular degeneration. And I would then contact my primary eye care provider for a complete eye examination, typically to try to get in to get the eye checked within about a week. When I get the eye checked, I should expect to have the eyes dilated after my vision is tested and the doctor will use different types of lenses to examine my retina. When the doctor looks at the center of the retina, which is the macula, he’d be looking for signs of macular degeneration. The hallmark signs of degeneration are the presence of these small, yellow drusen under the center of the retina. The doctor may then see signs of wetness, and signs of wetness would be fluid or blood under or in the center of the retina. The risk factors for getting macular degeneration, in general, include: age is the big one because it tends to present in older people. We start to see signs of macular degeneration in people aged 55 years or older, and the incidence goes up quite a bit as people get into their 70s and 80s. That’s the primary risk factor. Other risk factors include a family history of macular degeneration, so the condition does tend to run in families. Smoking is a known modifiable independent risk factor, so for those that smoke, they can expect to have an increased risk of having macular degeneration problems.
During the course of the eye examination, if there are signs of wetness or the doctor suspected I might be having signs of wet macular degeneration, typically the first test that is ordered is called a fluorescein angiogram, which is a series of pictures of the eyes after injection of the yellow dye in the arm vein. And that will tell me if I have macular degeneration that is the wet type. In addition to a fluorescein angiogram, another type of test, a newer test, called an OCT, and that stands for optical coherence tomography. That test is a simple, non-invasive scan of the macula, the center of the retina, and that’s very sensitive at picking up any swelling or fluid in or under the retina. The good news is that there’ s been a lot of progress in treating and controlling wet macular degeneration. Within just the past few years there are new medicines that are injected in the eye that can help dry up the macula, and in many cases improve the vision to some degree. It’s very rare for the vision to get back to the pre-wet state, or normal vision, but without treatment, the condition will tend to progress over 6, 12, or 18 months, and usually lead to scarring and relatively severe central vision loss.
So, with these new treatments, not only are we better able to control the condition now, but we’re getting outcomes that we could never get before, including some degree of vision improvement. And the most important part of all of it, like with many other things in medicine, many other eye conditions or medical conditions, the best results are when the condition is caught early.
Dr. Regillo: Macular degeneration is a major public health problem. It is the number one cause of severe vision loss in people greater than age 55. There are much better ways to control and treat the condition now than there ever was in the past, and results—vision outcomes—are much better. But the most important thing is knowing that you have the condition and recognizing the symptoms of wet macular degeneration early on to get the best vision results.