‘Macular disease' covers a range of painless conditions that affect the central retina (the macula) at the back of the eye. The macula is responsible for detailed central vision and you use it for activities such as reading, driving and recognising faces. Macular disease is the leading cause of blindness and severe vision loss in Australia. Macular diseases do not lead to total (“black”) blindness.
You can have early signs of macular disease without knowing it, but when symptoms do appear, these can include:
- Difficulty in reading or any other activity which requires detailed central vision (despite wearing appropriate glasses)
- Distortion, where straight lines may appear wavy or bent
- Problems distinguishing faces
- Dark patches in your central vision
Early detection and prompt intervention are crucial to saving sight.
The key macular diseases include:
Age-related macular degeneration (AMD)
AMD is a chronic and progressive disease of the macula, which affects people over the age of 50 years. AMD is influenced by both genetic and environmental risk factors.
Early and intermediate stages of AMD are characterised by a progressive build-up of waste material (drusen) under the retina.
The late, vision-threatening stages are divided into:
- Neovascular (wet) AMD, caused by the formation of fragile blood vessels (neovascularisation) which leak fluid and blood within and under the retina.
- Atrophic (dry) AMD, caused by the gradual loss (atrophy) of retinal cells.
There is no ‘cure’ for AMD. Diet and lifestyle can play a role in preventing and slowing down the progression of AMD. Highly effective treatment (anti-VEGF injections) is available for the wet form of AMD. There is currently no treatment for the dry form of AMD. Research is ongoing to improve current treatment methods and develop new treatment options.
For more information about AMD click here
Diabetic retinopathy (DR), including diabetic macular edema (DME)
Diabetic retinopathy (DR), including diabetic macular edema (DME) is a common complication of diabetes which results in damage to the small blood vessels in the eye, and can lead to swelling and ischaemia (lack of oxygen) of the retina.
Everyone with diabetes is at risk of developing diabetic retinopathy, and the longer you have diabetes, the greater your chance of developing diabetic retinopathy. It is the leading cause of preventable blindness in working aged Australians.
Many cases of vision loss can be prevented with regular eye exams, careful management of diabetes, medication and in some cases, treatment with injections (anti-VEGF agents or steroids) and/or laser.
For more information about DR click here
Retinal vein occlusion (RVO):
RVO is a blockage to one of the veins at the back of the eye. When a blockage occurs, the pressure increases inside the small retinal blood vessels causing them to bleed and leak fluid into the retina, resulting in swelling. Unlike AMD and DR, RVO usually only affects one eye, with most cases occurring in people over the age of 60 years. The main risk factors include high blood pressure, high blood lipid levels, diabetes and smoking.
Treatment is with anti-VEGF or steroid injections. Targeted laser may be used in select cases.
For more information about RVO click here
Myopic macular degeneration
Myopic macular degeneration is a form of macular degeneration which occurs in people who have severe short-sightedness (myopia). Stretching of the retina can lead to loss (atrophy) of cells in the macula. In some people, fragile blood vessels grow under the retina and leak blood under the macula; similar to the wet form of age-related macular degeneration (AMD).
There are no treatments available to stop the progression of severe myopia. Treatment is available (anti- VEGF injections) to manage the growth and leakage of fragile blood vessels.
For more information about myopic macular degeneration click here
Macular telangiectasia (MacTel)
MacTel is a rare, slowly progressive disorder of the macula resulting in cyst-like structures and loss of tissue in the fovea (central macula).
Effective treatment is currently not available. Research is being conducted to develop treatments.
For more information about MacTel click here
Inherited forms of macular disease (also called macular dystrophy):
Inherited forms of macular disease include a number of rare inherited diseases that can affect younger people, but some not being diagnosed until later in life. They are caused by specific defects (mutations) in one or two genes. Examples include Stargardt disease, Best disease, Sorsby fundus dystrophy and others.
Although gene therapy has been developed for only one very rare condition caused by a defect in the RPE65 gene, this form of treatment is not yet available to treat other inherited retinal diseases.
Other conditions affecting the structure of the macula
These include macular holes, macular pucker (epiretinal membrane), vitreoretinal traction syndrome, retinal detachment, central serous chorioretinopathy and others. Some of these conditions can be managed with surgery, some with injections and others may only require monitoring.
For more information about other macular conditions click here
If you have been diagnosed with macular disease it is important to monitor your vision carefully using an Amsler grid and consult your eye care professional immediately if you notice any sudden changes in your vision. Prompt action can save sight.
Macular Disease Foundation Australia exists to provide information and support for people with macular disease, their families and carers. Our National Helpline can provide you with a free Amsler grid and further information about your condition, and can advise you on the various supports and services available: 1800 111 709.