Macula is the small area in the center of the retina responsible for central or straight-ahead vision.

Macula can develop degenerative changes which may effect vision. Some types can begin during early childhood and can be caused by different types of genetic pattern. The most common type of macular degeneration is that which affects the elderly and causes destruction of macular cells and deterioration of vision, to the extent that the affected person will eventually be legally blind. As longevity increases, more and more people are diagnosed with having macular degeneration. This condition most often involves both eyes and is quite slow in progression.

Drusen, which are yellowish white spots in the central retina, (believed to be cell debris) are associated with macular degeneration. Sometimes, the drusens are precursors to the degeneration, and their presence is considered a risk factor for development of Age-Related Macular Degeneration (ARMD). Therefore eye doctors will regularly check the eyes of patients with drusen and to monitor and look for any early sign of macular degeneration (ARMD). Smoking and family history of macular degeneration are important risk factors.

This degeneration has two types: wet and dry. In the more common dry type, the process of degeneration causes breakdown of macular cells, which gradually disappear until the macula resembles an area devoid of cells and spotty like a scar. The wet type is not as common as the wet type, and sometimes the dry type develops the features of that are seen in the wet type.

In wet type, new, abnormal and fragile blood vessels are developed inside macular tissue, which can lead to edema and bleeding in the macula. The changes that occur in the macula will result in changes in visual acuity. At the early stages, the person may notice some distortion of letters while reading or while viewing objects and faces. This should alert him/her to seek a complete dilated eye exam. Gradually, in the course of time when degeneration advances, vision will further deteriorate to the extent that reading regular texts becomes more difficult and straight-ahead vision is compromised. The side (peripheral) vision will never be lost in ARMD and the patient can use side vision to get around. Usually eye doctors give a gridded paper to patients so they can periodically test their vision at home. If they notice any distortion in the grids, they should consult their doctor. They can also simply check for any distortion in their vision by looking at the straight edges of objects such as a TV set or a door, instead of the grid.

Although it takes a long time for vision to worsen, occasionally due to sudden bleeding from the abnormal fragile blood vessels in the macula, there may be sudden drop in visual acuity. In this case, an eye exam should be taken as soon as possible for starting treatment if necessary.

Because of the social impact of this eye disease, there are many research programs underway and recent advances have been made towards understanding and managing this problem. The available methods of current treatment for macular degeneration include vitamin supplements, laser, photodynamic therapy with minimal effect in restoring the vision. Ophthalmologists are recommending vitamin supplements in dry type and laser or photodynamic therapy in the wet type. Recently eye doctors are injecting some newly-discovered medications into vitreous inside the eyeball. Steroids, postulated to inhibit formation of fragile new blood vessels in the macula, are among the medications that significantly improve vision. Systemic use of steroid medications carry several side effects, but local use is much safer. Steroid injection into eyeballs is not yet FDA approved. The complications of steroid injection into the eye can be: infection, vitreous bleeding, retinal detachment, high intra-ocular pressure, and progression of cataract. FDA has recently approved injection of a newly developed drug into the eyeball. This medication is an agent that prevents the development of fragile blood vessels in the macula and significantly improves vision. The drug is only used in the wet type of ARMD, once a month. This medication is expensive, yet highly efficient .