North Texas Eye Care Disease Management
Age Related Macular Degeneration
This is the most common cause of legal blindness in the eldery Caucasian population, but is comparatively rare in other races. Drusen usually starts to appear in middle age and slowly and progressively increase in number and size over a period of many years. They are associated with increasing macular destruction which is seen clinically as spots of atrophy and pigmentation in the macular area. Eventually, central vision will be lost in a substantial number of patients, although the disease is very haphazard in its extent, severity, and progression. Both eyes are usualy affected; although funduscopic appearances and visual symptoms may be very asymmetrical. In the most severely affected patients, acuity falls to levels of counting fingers. At this stage, further deterioration ceases and peripheral vision remains unaffected so that the patient retains peripheral vision and can lead to an independent life. Age related macular degeneration follows two main forms: in the "dry" or atrophic type and "wet" or disciform type.
These originate from a variety of causes all of which have a different natural history. Full-thickness macular holes with vitreo-retinal traction are a rare cause of rhegmatogenour retinal detachment, normally occurring in high myopes (high minus Rx). Solar burns are seen as minute central macular pits in the inner retina in patients with a history of sun gazing. Senile macular holes are ageing change of unknown causes. They produce large, partial-thickness macular holes seen predominantly in elderly females as uniocular lesions which virtually never progress to retinal detachment.
Central Serous Retinopathy
This condition is most commonly seen in patients between the ages of 20 and 40, in a male to female ratio of 8:1. A serous detachment develops under the macula; it is associated with a focal area of leakage through the retinal pigment epithelium which is usually sited above the horizontal meridian and outside the avasular central zone. The leaking point breaks down the retinal pigment epithelial cell barrier to allow fluid to pass freely from the choriocapillaris and accumulate in the subretinal space between the photoreceptors and retinal pigment epithelium. Patients may present with slightly blurred vision. The condition usually has a self-limiting course of several months but recovery may be accelerated by laser photocoagulation of the leak, although the final visual result is unchanged.
Macula Testing Protocol:
Visit 1: Retinal Imaging, Visual Field Testing, and Dilation
Visit 2: Macula OCT, VEP, pERG, Color Test (if applicable), Genetics Testing (if applicable)
Visit 3 (if needed): Macula OCT, Genetics Testing Results, and Vitamin Formulation