Understanding Macular Disease: Causes, Symptoms & Central Vision Loss

Understanding Macular Disease: What You Need to Know About Central Vision Loss

Our eyesight is one of our most vital senses, but what happens when the centre of your vision starts to blur or distort? This could be a sign of macular disease, a group of eye disorders that affect the macula, the central part of the retina responsible for detailed vision.

What Is the Macula?

The macula is a small but critical part of the retina — the light-sensitive layer of tissue at the back of the eye. It enables us to see fine details clearly, whether we’re reading a book, driving, or recognizing faces. When the macula becomes damaged, it can lead to serious vision problems, especially in the centre of your visual field.

Types of Macular Disease

There are several forms of macular disease, each with different causes and progression rates. The most common types include:

1. Age-Related Macular Degeneration (AMD)

This is the most prevalent macular disease, especially in individuals over 50. AMD comes in two forms:

Dry AMD: A slow breakdown of the macular cells, leading to gradual vision loss.

Wet AMD: Less common but more severe, involving the growth of abnormal blood vessels under the retina that can leak fluid and blood.

2. Diabetic Macular Oedema (DMO)

A complication of diabetes, DME occurs when high blood sugar damages retinal blood vessels, causing fluid to leak into the macula and leading to swelling and vision changes.

3. Retinal Vein Occlusion (RVO)

Retinal Vein Occlusion (RVO) occurs when one of the veins in the retina becomes blocked. This can lead to bleeding, swelling and fluid leaking into the surrounding retinal tissue. This can result in sudden painless vision loss or distortion depending on the location and severity of the blockage.

4.Macular Hole

This condition involves a small tear or opening in the macula. It can develop as part of the natural aging process and may require surgery to repair.

5. Macular Pucker

Also known as an epiretinal membrane, this condition is caused by scar tissue that forms on the macula, causing it to wrinkle or pucker, which distorts vision.

6. Inherited Macular Dystrophies

These are rare genetic conditions, like Stargardt disease, that typically affect younger individuals and cause gradual central vision loss over time.

Symptoms to Watch For

Early detection of macular disease can help slow progression and preserve vision. Early macular disease may not cause any symptoms initially, however as they progress, common warning signs include:

Blurred or fuzzy central vision

Difficulty reading or seeing details clearly

Straight lines appearing wavy or distorted (a key symptom of wet AMD)

A dark or empty spot in the centre of your vision

Fading or dullness in colour perception

Diagnosis

Macular diseases are usually detected during a comprehensive eye examination. Because macular disease is painless and often does not have any obvious symptoms in its early stages, it’s important to maintain regular eye checks, especially as you age.

A comprehensive eye examination will include vision assessment and a thorough retinal examination including:

Dilated eye exam: To closely inspect the retina and macula.

Optical Coherence Tomography (OCT): A non-invasive imaging test that captures detailed cross-sections of the retina.

Retinal photography and Autofluorescence: Using a specialised wide-view camera that takes images of your retina (in colour and black and white)

Fluorescein angiography: A diagnostic procedure performed for some macular diseases, to identify leaky blood vessels in cases like wet AMD and diabetic macular oedema.

Treatment Options

While not all types of macular disease can be cured, many can be managed or slowed with treatment. Options include:

Anti-VEGF injections: Commonly used for wet AMD and DME to stop abnormal blood vessel growth.

Laser therapy: Sometimes used to seal leaking vessels.

Vitrectomy surgery: Used for macular holes or puckers.

Nutritional supplements: The AREDS2 formula (vitamins C, E, zinc, copper, lutein, and zeaxanthin) can help slow progression in certain cases of dry AMD.

Living With Macular Disease

Being diagnosed with macular disease can be overwhelming, but you are not alone. With early detection, lifestyle changes (like quitting smoking, managing diabetes, and eating a nutrient-rich diet), modern treatments, and low vision aids, many people continue to live independently and maintain quality of life.

Macular disease is a serious condition, and regular eye exams, especially as you age or if you have underlying conditions like diabetes, are essential to protect your vision. If you notice changes in your central vision, don’t ignore them — speak to your eye care professional.

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