Fading Vision in the Old? Beware!
A 58 years old lady, Mrs D’Souza* came with symptoms of blurring of vision in her left eye since 2 weeks with distortion of objects (known as metamorphosia). On examination her best corrected visual acuity was 6/9 N6 in the right eye and 6/18 N18 in her left eye. (6/18 indicates a vision where she can see at 6 meters what a normal person can see at a greater distance of 18 meters. N6 and N18 indicate abnormal near vision where N5 is considered normal.) Detailed examination of the front portion of both her eyes was normal. This was followed by examination of her retina (the photo sensitive layer at the back of her eye) she showed changes in her right eye that were suggestive of Dry form of ARMD and Wet ARMD changes in her Left eye. Tests called Fundus Fluorescein Angiography which is a test to study the blood vessels of the eye and OCT (Scanning of the macula or the central part of the retina) were then done with a view to finalize diagnosis and determine severity of disease.
Age Related Macular Degeneration (ARMD) has become the second most common cause of irreversible blindness in urban areas like ours. Our macula which is the central part of the retina makes up only a small part of our retina, yet it is much more sensitive to detail than the rest of our retina. Our macula is what allows us to read small print and thread a needle. Age- related macular degeneration or ARMD is the degeneration of this macula which is so important for sharp, central vision.
A large number (and a number that is steadily increasing) of patients are getting affected with this condition. Increasing life expectancy, changing life-style, exposure to UV light, smoking are some of the culprits. This condition occurs in two forms i.e. dry and wet, both of which are equally disastrous for vision. The Wet form leads to more serious vision loss. Dry ARMD is treated with oral antioxidants. There is no other treatment available to reverse dry macular degeneration. Wet ARMD needs intra-vitreal injection of anti-VEGF (Vascular endothelial growth factor). The treatment aims at stopping the progress of the disease.
The below are images of Mrs D’souza’s retina before treatment:
Subsequently Dr Yogesh Patil, Vitreo Retinal Surgeon at Advanced Eye Hospital started her on intra-vitreal Anti-VEGF injection treatment for her left eye at monthly intervals. Till now she has taken 3 injections in her (Left eye) and she has shown remarkable improvement in her condition. Following are her retinal photos after 2 injections,
After 2 intravitreal injections,
Take home message
Take blurring of vision and distortion of images as serious symptoms particularly in old age
Avoid direct sunlight exposure
Annual eye check-up is must after age of 50 years at least once in a year
*Name changed to protect privacy.