What exactly is macular degeneration?

The functioning middle of the retina is usually called macular. It is the inner third of the retina hole and it is responsible for the highest sharpness within the retina. In the middle of the macular you find the dimple, the so called Foveola, which is the most sensitive part of the macular with around 30,000 vision cells, which again are directly connected via individual nerve cells to the brain. The macular is responsible for the direct fixation (viewing) of an object. This fixation is necessary in order to recognize things with a high visionary acuity. This is especially valid for reading and the recognition of faces respectively facial expressions. The functioning of the macular is even more important because the collaboration of both macular areas of the right and left eye lets create a stereoscopic (spatial) image in the brain. This only allows us a good estimation of distances which is for example needed when driving a car where distance and speed is important to gauge. This also makes the macular degeneration so dangerous for the infected.
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Current numbers for macular degeneration

According to sources more than four million people were infected alone in Germany in the year 2008. Worldwide according to estimates of the UN there are approximately 25 to 30 million people affected. Yet only 14 percent of the Germans know what macular degeneration is and assign it with an eye disease although macular degeneration has become a common illness. Out of all affected ca. 20 percent of the 64 to 74 year old and ca. 35 percent of the 75 to 84 year old people have the dry form. 10 to 15 percent have the wet form of macular degeneration. There is a rate of approximately 50,000 new patients each year.

The number of people with macular degeneration, according to estimates, will triple within the next 30 to 40 years.
Source: Ärzte Zeitung Extra, 19.09.2008 Topic Macular Degeneration
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What happens at Macular Degeneration?

In a medical term degeneration means the atrophy and the decay of tissue or even entire organs. At macular degeneration the functions of the macular decrease so quickly that the tissue of the macular decays. At the end of this decay the functions die. Often morbid cells are generated or abnormal growth of vessels which further derogate the macular degeneration. The degeneration often leads to the complete loss of the viewing functions in the macular and it can also come to strong deterioration around the macular and even in distant areas. Then it is called a macular degeneration.

If the macular degenerates (macular degeneration) fatally not only the viewing capacity is lowered in this place but also the total viewing capacity of the entire vision.
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The Dry Macular Generation

The entire functional loss of the macular at a progressed macular degeneration is fatal because the capable area of the retina fails. One can still see a sharp image across the entire space, but actually only the macular has such a high visual acuity. Even a healthy eye’s capacity of vision drastically decreases outside the macular’s lying retina areas. The impression of high visual acuity across the entire field of vision is generated because the brain generates sharp vision through examining the surroundings with the macular and combines those results in all areas. The unsharp images of the outer areas of the retina are simply retouched away by the brain, meaning it is not noticed by people. It rather serves the orientation in space and the perception of movement - both the own and the of the surroundings.

If the functions of the macular are disturbed by a degenerative process such as macular degeneration the viewing centre at the brain misses truly sharp information about the look of the surroundings and is no longer able to produce a sharp total picture. Viewing is restricted over the entire viewing field, the outer areas cannot be used for a sharp examination of the surroundings. At a late state of macular degeneration even the ability of orientation can get lost. The affected is even more dependent on foreign help.
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The Dry Macular Generation

The disease macular generation is distinct into a dry macular degeneration and a wet form of macular degeneration. The latter is also called exudative form. The dry form is diagnosed in ca. 85% of macular degeneration affected people. Here it comes to strong sediments of byproducts of the metabolism which often store together as so called Druzes. The metabolism of the retina is therefore deteriorated at the affected areas. But also blood circulation and nerve functions are often mutated. It is also called functional disruption in the retinal pigmentepithel (RPE), a cell layer laying beneath the viewing cells which are responsible for their supply. At the beginning this leads to more and more loss of functions and later to cell death in the area of the outer retina and the vascular tissue (geographical Atrophy – dry late form). The degeneration continues to advance which often means the decline of the central vision. Generally there is the risk that a dry macular degeneration progresses into a wet macular degeneration.
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The Wet Macular Degeneration

At ca. 15% of the affected the so called wet macular degeneration or also exudative form develops from the dry macular degeneration. Here small vessels beneath the retina are generated probably due to the bad metabolism in order to improve the local supply of the retina. This rescue mission of the body often has fatal consequences for the viewing. Those unwanted vessel neoplasm originates from the lower laying vascular tissue (Chorioidea) towards the retina and can raise the retina itself by doing so. Moreover the walls of these morbid vessels are more penetrable than healthy vessels so that from those increased liquid can enter the surrounding tissue and thus leading to scarring. This damage of the retina at the wet form of the macular degeneration is the highest risk of a macular degeneration. It makes the wet macular degeneration so dangerous. The process is quicker than with the dry macular degeneration. A typical symptom of the wet macular degeneration is the viewing of distortion (Metamorphosis) when looking at straight lines.

Due to bleedings (Hemorrhages) from the newly created vessels (also called as Membrane or CNV (Choriodial Neovascularisation)) into the retina tissue it can come to instant blindness at the affected areas. Through accumulating liquid a so called macular edema (Macular Swelling) may occur. Additionally the supply of the retina through the vascular tissue is cut off by the newly built vessels. Here one distinguishes between the so called occult (“distorted”) and the aggressive classic vessel neoplasm. At the occult CNV the vessels lay beneath the retinal Pigmentepithels (RPE) and are not yet above the area of the sensitive light cells (Photo receptors) as it is the case with the classic CNV.
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Wet Macular Degeneration – Conclusion

Therefore: Base for a wet macular degeneration is generally the existence of a dry macular degeneration. A wet macular degeneration consists of to simplify it two components: A dry macular degeneration plus a morbid cell neoplasm. We think it is important to understand this to be able to judge the possibilities of therapies at macular degeneration in principle. Because many therapies are only able to influence one component of the wet macular degeneration, namely the morbid cell neoplasm. We think that in such cases the dry macular degeneration can best case scenario be dried up, which means to revert it into the original dry macular degeneration. Therefore the degeneration progresses despite a successfully applied therapy and the viewing acuity deteriorates further as it is the case with the dry macular degeneration.
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How is Macular Degeneration diagnosed?

Often the diagnosis is by pure accident because the by macular degeneration affected goes to the oculist thinking his glasses are no longer good or that a cataract is developing. If it is a macular degeneration an adaptation of the glass values may increase vision acuity somewhat but never to the state of the former healthy eye. In some cases distortions in viewing or spontaneous massive viewing deterioration exist. If the oculist is asked for help he usually takes a so called eye mirror and performs an Ophthalmoscopy. This means the eye background is illuminated and visually examined in order to notice changes of the retina. Moreover the perception of the patient is tested with the Amsler Net. Generally the diagnosis is rather short. Sometimes macular degeneration is not even named to the patient but only blood circulation problems of the eyes or the retina and only afterwards the patient is exposed of having a macular degeneration.

At the dry form of the age related macular degeneration the patient often receives the information that nothing can be done. Regular control examinations are recommended. At the wet form of the macular degeneration a pigment examination (Fluorescence Angiography) is mostly recommended in order to get a clear picture of the current state and to determine about a probable therapy. Through the arm vein a pigment is injected which reaches up to the retina. With a special camera the blood circulation in the vessels of the retina can be better classified and especially it can be seen at least in special areas how the morbid cell neoplasm looks like and what their density is. The macular degeneration patient is generally explained whether and what macular degeneration therapy is possible. Often the patient is told that at a macular degeneration you do not go completely blind, that was what patients reported to us.
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The Pigment Examination (Fluorescence Angiography) at Macular Degeneration

A Fluorescence Angiography, short also FAG or FLA called, describes a diagnostic aid in order to recognize various retinal diseases and thus also the macular degeneration. It is the image of blood vessels at the eye background with the help of a luminous coloring agent.
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How does a fluorescence angiography to diagnose macular degeneration work?

After a viewing test and an ophthalmologic examination the Fluorescence Angiography is done. In order to reach a better insight into the eye the pupil must be enlarged by eye drops, a standard procedure not only at macular degeneration. In most cases both eyes are widely dropped in order to compare the macular degeneration infected eye with the other. To reach an optimal comparison additionally images of the eyes are done without the colorant. Afterwards the colorant (Fluorescein) is injected into the vein.

The given colorant reaches the vessels of the eye which is affected by macular degeneration after approximately 10 seconds. Now this eye is illuminated with a short waved, blue light. This takes care of the colorant making the blood flow of the retina and the surrounding blood vessels visible for about 5 to 6 minutes. With a so called digital rest farsightedness camera shots of the blood flow are done in order to be able to interpret the flowing in and out of the colorant and to recognize a possible macular degeneration.
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Possible complications of a Fluorescence Angiography to diagnose macular degeneration

Basically, according to professional reading, the colorant Fluorescein is considered a safe substance, especially while examining a macular degeneration.

Yet, an allergic reaction is possible; mostly only of short durance dizziness, nausea and vomiting. But also sporadic and very pronounced reactions are reported which can be possibly life threatening. To ensure security an anesthetist is usually present. Further side effects, according to professional reading, can be infections, scarring and damage of nerves originating through the cannula for injecting the colorant. Also the wide eye dropping of the pupils can lead to an eye pressure (glaucoma attack) through which also a damage of viewing can be generated. The cannula is removed after approximately 30 minutes but each patient should calculate not being able to drive for about 3 to 4 hours. The Fluorescence Angiography is a standard procedure at macular degeneration.

The now in the body flowing colorant is gradually discharged. It can come to a yellow tinge of the skin and yellow colored urine. Both is only short term and is considered absolutely harmless.
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How does a macular degeneration progress?

There is no such thing as a typical progress at macular degeneration. Professor Hruby, Austria, writes that this disease usually affects both eyes at the same time or shortly one after the other. Basically the wet form of macular degeneration progresses faster and more dramatic than the dry form of macular degeneration. At both forms it sometimes comes to a standstill giving the macular degeneration affected a momentarily postponement. In the end the macular degeneration progresses further in most cases.

The many experiences macular degeneration patients reported to us that a complete blindness is a rare case. Mostly a more or less large viewing rest remains at the edges of the retina with which one can orient them in a known environment like a “half blind”. In a foreign surrounding on the other hand, many macular degeneration affected are dependent on help. Often only a viewing acuity of only 2 % or less exists. Often the by macular degeneration affected have to live with even lower viewing acuity and are no longer able to do most of the things in a daily life on their own. Some can only recognize bright and dark in the end stadium. A complete blindness at macular degeneration is rather rare.

It is only understandable that especially with older people the process of blindness continuously progresses because also the aging process progresses of a macular degeneration affected person and the bodily functions increasingly work worse while aging. The possibility to keep the status quo decreases with aging. Thus, aging can be leveled up with degeneration generally. Yet a quickly progressing degeneration is also pathologic as it is the case with macular degeneration.

Risk factors leading to a macular degeneration can hardly be classified by science. All in all many influences are in question which can damage the eye. Sunlight and a high blood pressure seem to raise the risk to become infected with macular degeneration. Only smoking and body weight seem to have a clear connection to macular degeneration. The general opinion is that smokers and overweight people are a lot more endangered than nonsmokers and slim persons.
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Macular Degeneration and Obesity

Similar to smoking the connection between macular degeneration and obesity is discussed. Since we were asked about this over the years by affected people we researched this topic in the following.

The English Royal National Institute of the Blind (RNIB) declared: "Overweight people risk a cataract and age related macular degeneration." Overweight people have a double as high risk to lose their sight since their weight to get certain diseases increases the probability. The RNIB declared that people do not take care of their eyes. According to the RNIB there is a direct connection between obesity and the risk of macular degeneration.

Obese people with a MBI over 30 have a double as high risk to get the so called dry macular degeneration they say further. Moreover one could prove that overweight people also have an increased progress at the wet macular degeneration. Further, according to the RNIB, especially people with the genetic predisposition for macular degeneration should watch their weight since their risk to get macular degeneration increases from fourfold (if they are normal weighted) to the eleven fold if they are obese.
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What are the signs of suffering of a macular degeneration?

At the beginning of a macular degeneration the affected person does not recognize a deterioration of viewing. If only one eye is affected by macular degeneration the other, still healthy, eye often covers the deterioration. Thus it is not rare that even a strong deterioration of the first affected eye is not recognized at all. In such cases the macular degeneration often is only diagnosed by accident and the patient is surprised that one eye has such a strong diminished viewing acuity.

Since macular degeneration does not cause any pain often classically reading is the source an affected person notices that he suffers from macular degeneration. In the middle of to reading text he sees grey shadows, distortions or a blurred spot. This often is in conjunction with disruption of colors while the black white viewing remains the same. Often the first signs of a macular degeneration are noticed when viewing tiles, window crosses or similar.
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Amsler Grate and Macular Degeneration

At the wet form of macular degeneration straight lines often seem bent. To see whether there are already distortions the Amsler Grate is used. This is a checkered paper with a fixating point in the middle which a macular degeneration person receives for example from his ophthalmologist or which can also be found in the Internet.

At this test you have to cover up one eye and fixate with the other the point in the middle. Generally the test has to be done for each eye separately and the to be tested eye is not to be pinched. Important at this macular degeneration test is to keep your normal reading distance (ca. 30 to 40 cm) and if you use reading glasses in your daily life put them on as well. With the opened eye you now look calmly at the point in the middle of the grate.

Note whether one of the following effects appear: Should one or several of the described effects be valid for you, please do not hesitate to contact your ophthalmologist and tell him what you saw. At a possible macular degeneration no time is to be wasted.

Furthermore many patients notice a progressing instability of viewing with macular degeneration. The viewing acuity can be good on one day and the next bad and the following after good again. The reason for this are changing light conditions, changing metabolism and changing blood flow of eyes and the visual cortex in the brain. Many patients also reported to us that the viewing capacity is the more dependent on the psychological and bodily condition the worse it becomes.

At both forms of the macular degeneration it is valid that colors become increasingly color less and reading becomes more and more difficult. Later faces, even the own, are no longer recognizable and reading is impossible. In the end the centre of the field of vision seems empty, brighter or more gray or as a black spot (central scotom).

Some people affected by macular degeneration are able to orient themselves in known surroundings. But most are already dependent on foreign help in this state. Macular degeneration patients who have reported to us that they have always believed not to go completely blind were extremely appalled in this state. They were not able to imagine what it could mean not to "go completely blind".
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Healing Chances at Macular Degeneration. Can a macular improve?

As already described the macular degeneration is a cessation of important functions within the retina with a following die out of sensory cells. Only if there is a complete damage in the macular, there is, according to our views, no chance of regeneration.

It is known in medicine that cell structures and even nerve tissue has generally a chance of regeneration as long as certain functions are still working. This is obviously also valid for the retina, the macular and thus the macular degeneration. Many affected people reported to us not only a standstill of their macular degeneration but even improvement and sometimes even a big improvement.

Therefore we think: Only when safely diagnosed that the macular is no longer working the macular has no chance to become improved and the macular degeneration is mostly cureless. Some patients stories show that a rough assessment with the statement the macular is scarred do not mean unavoidably that all functions of the macular have become extinct. Are there in fact no measurable functions in the macular one can still try to achieve improvement in the surrounding retina area and thus slow down progressing of a macular degeneration or even stop it. Even this can lead perhaps to an improved total sharpness.
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Healing Macular Degeneration: Conclusion

Thus: If a macular looks like being dead it does not unavoidably mean that the macular is indeed no longer working and a macular degeneration cannot be stopped. This was reported to us by many patients. This experience shows that at macular degeneration generally improvement is possible if a basic functioning is available as a minimum. With therapies at macular degeneration which treat morbid vessels only this is impossible to reach but with therapies going for an activation of the retina processes good success has been achieved at macular degeneration.

Those subjective reports are supported by scientific knowledge. The medical science believed up to a couple of years ago that the human body was not able to regenerate damaged or functionless nerve cells such as it happens at macular degeneration. 1994 scientists found out that it is possible in principle. Contrary to the experience and the above mentioned scientific knowledge some ophthalmologists– so many patients to us – as well as some publications from the school medical ophthalmology claim that regeneration is impossible. But the contrary is obvious to us. Many patients reported that a macular degeneration has been healed.
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Is Regeneration at macular degeneration possible?

Often it is stated that a macular is scarred and therefore there was no chance to stop a macular degeneration or to heal it. In many cases, according to macular degeneration patients, this was not true. A viewing improvement in the macular has happened often even a strong improvement. We think that in some cases there must have been a rest functioning left where in the daily life only a spot was seen. At a progressed macular degeneration a complete regeneration is, according to our experience, quite rare. Most of the by macular degeneration affected people reported to us they have become quite modest and are happy if the process of macular degeneration would be stopped. Each percent towards improvement would be a blessing.

A near to complete regeneration is only possible if all areas of the retina still have life and react towards a macular degeneration therapy excellently. We think that even a preservation of the otherwise progressing deterioration of the viewing capability is a huge success and this is also what most of the by macular degeneration affected have reported to us.

Macular degeneration cannot be compared with other diseases such as a virus infection at which one is used to the organism to completely heal when the virus is eliminated. And there is still the possibility left to transplant a new organ. There is no such thing to operate on a morbid part of the macular and it is healed. Also medication against macular degeneration is often not able to achieve a standstill, according to the scientific study we have a copy of. Macular degeneration is not curable through conventional or local measures.

Macular Degeneration is rather a progressing process which leads without successful help from outside to almost blindness. It seems as if the organism of the by macular degeneration affected people gives up in this area and does no longer supply it accordingly. This disease demands obviously a new way of thinking and new ways of macular degeneration therapies.
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Macular Degeneration and Prevention

The media notifies more often to go to regular checkups at ophthalmologists if you are between 50 and 60 years old in order to be able to recognize a macular degeneration early.

Preventing measures or medication against macular degeneration is not known. But smoking, obesity and high blood pressure are known risks to favor the development of a macular degeneration. It is also said that sunlight and even the known energy saving light bulbs have an influence on the progress of a macular degeneration. Therefore as a protection against UV rays more and more the consequent wearing of sun glasses are recommended to prevent a macular degeneration. But also up to know un-researched activators for a macular degeneration are taken more seriously. Thus some ophthalmologists indicate the meaning of psychological stress in connection with macular degeneration. Private or professional stress could, so the doctors, influence a macular degeneration negatively as much as the already pointed out smoking or obesity.
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Macular Degeneration in the daily life

You should check your daily life’s habits: All of this can make the eyes very tired and even overload them. Movement and fresh air are probably the best way to give the eyes a "viewing break".
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