Macular Degeneration and the Digital Retinal Camera

Age-related Macular Degeneration (AMD) is the most common cause of loss of sight in persons over the age of 60 years. Persons under the age of 60 can also suffer from AMD, but this is less common. In either case, it is a debilitating disease, as it causes a loss of central vision, which is the type of vision we use for reading, writing, and our detailed vision work.

Below is a photo illustrating what the view of the previous practice front might look like to a person suffering from macular degeneration. The surrounding vision, the peripheral vision, is retained but the central vision, so important in recognition of faces and details within a scene, is lost. This is a distressing form of vision loss, because it can result in a tremendous visual handicap, which can lead to a loss of confidence and independence. At its worse, it can result in profound visual loss, and these patients are then registered partially-sighted.

The view of a person suffering from macular degeneration. Note the central area cannot be seen while the peripheral detail remains.

The digital retinal camera, while useful in photographing all eyes, healthy or otherwise, is particularly useful in monitoring the progression of macular degeneration. The retinal camera, which captures pictures of the retina and instantly produces a ‘photograph’ on a computer screen, is useful in documenting and dating degenerative changes in the retina. See also Ocular Abnormalities.

Digital photography offers many advantages to the patient. For example, the optometrist can explain to the patient a problem with the eyes by referring to the screen picture. This can be done at the time of the appointment, so the patient leaves the consulting room fully aware of the health of the eyes, and knowing the next course of action, if any is required. Also, if a hospital referral is necessary, a photograph can be included in the hospital referral letter, which identifies the problem to the hospital consultant. But even if there is no need for a referral and all looks well within the eye, a photograph documents this. This is important for all patients, especially those whose ocular health is slightly at risk, for example persons with diabetes.

We feel that the camera represents a step forward in patient care here, as inter/intra- practitioner monitoring of ocular changes is improved, as well as inter-practice communication. For instance, inter/intra-practitioner monitoring no longer relies on interpretation of hand drawings but instead can be done by close examination of photographs taken at previous visits. And inter-practice communication improves as hospital referrals include a photograph with the letter, which highlights the problem seen by the optometrist. This helps the GP and the eye specialist at the hospital to immediately see why the patient has been referred.

Digital Imaging Retinal Camera

What does Macular Degeneration look like to the Optometrist?

Macular degeneration is damage to the central retinal tissue. First symptoms are a fuzziness of vision, which usually brings the patient in for a new pair of spectacles. Examination by the optometrist reveals minor degenerative changes in the macula, as just a small amount of degeneration results in a significant reduction in visual acuity, which is the ability to read down the letter chart.

Unfortunately, for most patients, no treatment is available to limit the progression of macular degeneration. For the few, laser treatment is used to try to stop the progression, but this is a risky treatment which can make vision worse. When used, laser is applied to prevent an even greater loss of vision, which may occur if the condition is left untreated.

Exudative macular degeneration

The patient in the photo above has significantly reduced visual acuity due to leakage of blood fluids into the retina, which has caused deposits and scarring in the delicate central retina. This type of macular degeneration is called 'exudative macular degeneration'.