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Symptoms of Macular Degeneration | Randall Wong MD Retina Specialist

Signs and Symptoms of Macular Degeneration

is the deterioration of the central portion of the retinathe macula, which is the area of the retina that controls visual acuity and color perception. Macular degeneration usually occurs in people over the age of 55 and is more common in people of northern European ancestry.

Symptoms of Macular Degeneration

The most common symptoms of macular degeneration are blurry vision, blind spots, and distortion.  

New distortion should always be examined and can be monitored at home with the use of the Amsler grid.

Blurriness, blind spots, and distortions are also common symptoms in the following eye diseases:

  • macular edema (swelling) from many causes
  • epiretinal membrane
  • macular hole
  • diabetic retinopathy

Distortion is a common symptom of a disease of the macula and is does not signify a particular disease (i.e. get examined).

The Macula

The macula provides our central “20/20” vision.  As you are reading this article, your eyes are moving to keep the text focused on your macula.  When you are staring at an object, you are focusing the object on your macula.

Macular degeneration can be wet or dry and both types progressively affect the central vision causing blurriness, blind spots, and distortions. However, the wet form causes more serious vision loss.

Retinal Degeneration

For reasons yet to be discovered, the macula degenerates with age.  There are probably environmental risk factors, such as smoking, which increases the chances of developing macular degeneration.

The vast majority, 90% of cases, are the dry variety, which causes very slow, yet progressive blurry vision.  Wet ARMD causes the development of abnormal blood vessels within the layers of the macula.  These blood vessels cause destruction of the normal retinal tissue and can leak fluid and bleed.

Regardless of the type of macular degeneration, the initial symptoms are the sameblurriness, blind spots, and distortion.  However, wet macular degeneration can destroy vision rapidlyin days or weeks.  

What Can You Do?

If you have symptoms such as persistent blurry vision, blind spots, and/or distortion, make sure you get a complete dilated eye examination. 

While there are many causes of blurry and distorted vision other than macular degeneration, you want to make sure that you get an early diagnosis so whatever eye condition is causing your visual symptoms, the proper treatment can be initiated early in the process.  

Early diagnosis and treatment of eye diseases may prevent or limit permanent vision loss.


Best Test for Macular Degeneration

When You Need Eye Exam for Macular Degeneration. Randall Wong, M.D., Retina specialist, Fairfax, Virginia.The best test for macular degeneration (ARMD) is a fluorescein angiogram (FA).  The fluorescein angiogram involves the injection of a dye (not iodine based) called fluorescein.  As the fluorescein dye travels through your retina, pictures are taken which may help your doctor diagnose macular degeneration.

Who Performs a Fluorescein Angiogram?

In most instances, a retinal specialist performs an FA.  It is a diagnostic test used mainly for the diagnosis and treatment of retinal diseases.

In addition to macular degeneration, an angiogram may be helpful in cases of retinal vein or retinal artery occlusions, diabetic retinopathy, macular edema, etc.  In cases of macular degeneration, a fluorescein angiogram is integral in distinguishing wet ARMD from dry ARMD.

When to Perform a Fluorescein Angiogram

With respect to macular degeneration, the test should be performed at baseline and then if there there are any changes in vision.  For instance, if a patient has a loss or change in vision including new distortion.

Many patients receive anti-VEGF injections of Avastin, Lucentis or Eylea for control of the wet ARMD.  A fluorescein angiogram is very useful in monitoring treatment for wet ARMD.

Patients with drusen or a questionable case of ARMD should obtain a fluorescein angiogram.  This will help differentiate those patients with “normal” drusen versus patients with early macular disease.

What Does This Mean?

A fluorescein angiogram is integral to the diagnosis macular degeneration.  It is the single best test to make a new diagnosis and to also monitor treatment.

The test is fairly easy to obtain…from a retinal specialist.  In my practice, this test invaluable for the diagnosis and management of ARMD.  It is especially helpful for patients in whom the diagnosis is suspect, or, in patients given the diagnosis, but have perfectly normal vision.



Sophie is 93 and Reads!

Treatment for wet ARMD allows wet ARMD patients to read.  Randall Wong, M.D.This summer I’m celebrating another patient of mine.  SR is also a transplant from Florida, just as my oldest patient “Donald.”  As with Donald, SR also suffers from wet macular degeneration.

SR is now 93 years old and moved from FL to the Washington, D.C. area about 2.5 years ago.  She lives independently, reads daily and has a great daughter who accompanies her to every appointment.


I first met SR 18 months ago when she was diagnosed with wet ARMD in her left eye.  As often is the case, she noted subtle changes in her reading vision in the left eye.  She was examined by a good friend who referred her to me for treatment.

In short, we were successful in treating SR’s wet macular degeneration with a series of intravitreal injections of Avastin.  Vision in her left eye did improve and stabilize after the initial series of 3 Avastin injections.

Right Eye Bleeds

In October, 2012, SR called complaining of acute loss of vision in her right, better eye.  She could not read.  She had sustained a large hemorrhage from wet macular degeneration in her right eye.

While the left eye had been stabilized, she couldn’t read with it due to advanced ARMD.  The right eye was now in jeopardy of the same fate.

Most concerning to SR was the acute loss of vision.  The large hemorrhage occurred underneath the retina, physically blocking light and making it impossible for her to see or read.

My plan was to treat the right eye with Avastin, too.  Blood underneath the retina is benign.  By treating the source of the bleeding with Avastin, the abnormal blood vessels should shrink up and disappear.  The accumulated blood underneath the retina would absorb…but with time.

Fortunately, SR’s reading vision has returned.  We now plan on injections every 3 months to maintain status quo, that is, she’s getting injections to prevent recurrence.  I’ve found that once the ARMD is controlled, so-called “maintenance therapy” works quite well when give 3 months apart.

What Does This Mean?

As with Donald, SR has one good eye and one bad eye.  Both have wet ARMD and each is able to read, albeit with one eye.

It is important to note that our aging population does not have to suffer vision loss, regardless of age.  These are my oldest patients.  Both are able to continue to live rather independently and maintain their visual interests and hobbies.  I’d like to add that my personal observation over the years has been that older patients who remain “sharp” do so by keeping mentally active.  Reading remains just as important for the aged as the younger generation.

Seeing and reading is a huge component to remaining independent, perhaps not physically, but independent thought may indeed be the most important attribute to keeping us going as we age.

I’ve now written about 2 of my oldest patients; Donald and SR.

Each has a tremendous support group, but each also is proof that we needn’t succumb to the blindness from macular degeneration.

If you are reading this and have ARMD, I”d like to hear from you.  If you are a child of someone with ARMD and are fearful about the days ahead, Donald and Sophie should give you great hope and inspiration for your mom or dad.


Vitamin & Diet Recommendations for ARMD

Diet and Vitamin Recommendations for ARMD, Randall Wong, M.D. Retinal SpecialistWith the AREDS 2 study recently published, the recommendations for vitamin supplements have not changed.

AREDS 2 did not change any of the recommendations for changing diet or adding supplements.  While it didn’t lead to any discoveries, it did validate the original AREDS study.

Take the AREDS Formulation!

The original AREDS formulation contains;

  • Vitamin C, 500 milligrams
  • Vitamin E, 400 IU
  • Beta-Carotene, 15 milligrams
  • Zinc Oxide, 80 milligrams
  • Cupric Oxide, 2 milligrams

Note that there is no lutein in the formulation.

Some popular brands containing the AREDS formulation;

There are others made by other vitamin companies but they also sell products for which their is no scientific data on efficacy.  In general, look for the AREDS formulation.  Compare to the ingredient list above.

AREDS and Multivitamins

AREDS vitamins and multivitamins are different.  One is not a substitute for the other.  There are elements found in the AREDS formulation not found in the multivitamin.

Consult your physician if your are considering stopping or starting either vitamin.

You do not need vitamins based upon the AREDS 2 formulation.

What Does this Mean?

The new study confirmed the AREDS study released in 2006.

1.  Take AREDS vitamins, but only if you have intermediate or high risk for developing ARMD.  You’ll have to ask your doctor if you meet the criteria.

2.  Lutein is not necessary.

3.  The vitamins do NOT improve or prevent the development of macular degeneration.   They may, when indicated, prevent severe vision loss from the wet form of the disease.

4.  Omega 3 Fatty Acids have no direct effect on macular degeneration.


Randall V. Wong, M.D.
Retina Specialist
Fairfax, Virginia




My Oldest Patient Turns 96

Randall Wong, M.D., Retina Specialist, Fairfax, VirginiaOne of my favorite patients, Donald, is about to turn 96!  We met almost 3 years ago.  He’s a transplant from Florida, has wet ARMD and needs periodic injections for his wet ARMD in the right eye.  The vision in the left eye was lost years ago from wet ARMD, too.

Donald moved to Virginia to be closer to his family (kids, grand and great grandchildren).

I now see him every 3 months to give him an injection of Avastin to his right eye.  He still sees well.  He still lives independently (I’m told he still cooks and cleans!).

More importantly, his story highlights the importance and value of trust, not to mention the remarkable success of treatment for eye disease.

Finding a Retina Specialist

Just before moving here, his doctor had given him an injection of Lucentis to the right eye.  Donald’s quest was to find a doctor to continue therapy as the periodic injections kept his vision at about 20/30.  He had been receiving Lucentis injections every 4-6 weeks for the past 2 years prior to his arrival at my office.

Donald was not eager to continue the injections, however, despite a letter from his former doctor suggesting continued therapy.  As it turns out, Donald was most concerned about pain – he hated the injections even though they saved his vision.

We agreed to wait and see if he really needed continued injections.  Soon after his first visit, the leakage returned.  The injection was scheduled for the next week.

Avastin Injections Do Not Hurt

Our usual protocol for Avastin injections includes and 20 minute period where a series of 3 Q-tips soaked in numbing medicine (Lidocaine) are pressed against the eye.  We’ve tried small injections of the Lidocaine and topical solutions, but Wendell, Dee and I have found this is the best in achieving complete numbing.

Wendell and Dee are my assistants.  They’ve help me develop this method which keeps the eye injections painless.

Induction Treatment vs. Maintenance Treatment

Upon initial diagnosis of wet ARMD, most retina specialists treat with a series of injections to determine the efficacy of the treatment, that is, do the shots work?  I start out with 3 shots given 4 weeks apart.  This is called induction treatment.

Treatment given to prevent recurrence of the wet ARMD is called maintenance treatment.  These are injections are given to keep the vision stable.

What Does This Mean?

It’s hard to takeover the care of a new patient.  It’s easy to repeat or continue the treatment.  It’s hard to replicate the trust.

What makes a great doctor patient relationship?  Trust.  Donald had to trust me, the new doctor, and trust his daughter who was recommending me.

In Donald’s case, an elderly, very acute gentleman.  I let him participate in his treatment, that is, I let him wait for my first injection instead of forcing him.  I empowered him.

Second, I promised no pain.  This helped build the trust.

Item last.  His vision is still great.  We see each other every 3 months for an injection.  He knows to call if things change.

Happy Birthday Donald!


Retina Specialist
Fairfax, Virginia


Patient Blinded by Wet ARMD Reads with iPad

Apple IPAD used as a reader for patients with macular degeneration.My patient, Dick Marquis, has had wet macular degeneration affect both eyes.  While now legally blind, the iPad has allowed him to remain as functional as possible.  I asked him to write this article to serve as an inspiration to others. – Randy

Before Wet Age Related Macular Degeneration (Wet ARMD) struck me, I was an avid reader. My morning ritual was coffee and the Washington Post. I read novels, professional papers, scientific articles, newspapers, magazines, travel guides, whatever.

My left eye went wet first. My right eye, thus far, was unaffected, so I was still able to read well enough without special help.

AMD Affected My Second Eye

About two years later, wet struck my right eye. The effect was mild at first but I was no longer able to read normal print. I was able to obtain “large print” novels at the local library and although this slowed me down, I was still able to read books. Not much else is available in large print but my iMAC, with its zoom feature, provided continued access via the internet to many of the same things as before W-ARMD took hold. But reading in front of the computer for any length of time proved to be too uncomfortable.

Soon vision in my right eye deteriorated and I was no longer able to read large print text.

Unique Features Help Me Read

Enter the iPad. Many Apple applications allow adjustments to larger fixed print sizes, and beyond that, this “reader” possesses its own internal zoom capability that permits enlargement to an almost infinite degree. You can set the zoom level to fit your particular needs and read anything accessible from the internet.

Books, newspapers, magazines, maps, most any app, emails, whatever. The screen is backlit so you can read in low light and in darkness easily. One negative with Apple is glare. Outdoors or in bright light, screen glare can be quite bothersome.

Amazon and the iTunes store are two of many web sites where iPad content is available, some free, most purchasable at reasonable prices. Many other sites are available for direct access, including most magazines and newspapers, and almost anything else on your reading list.

Additionally, the this tablet is mobile so you can take it most anywhere. Once you download an item into iPad’s memory, it goes wherever the iPad and you go.

Kindle vs. iPad

Amazon’s Kindle is another handy device for portable e-reading. It has several fixed font sizes available but no zoom capability. It is smaller than the iPad so it’s a bit more portable. The latest model (Kindle Fire) has many of the same capabilities as the Apple version.

You can buy books for your Kindle on the Amazon web site and, if you have the free Kindle app installed on your iPad, the two devices will sync automatically and the item appears on both devices.

You can also download newspapers and magazines for the Kindle just as you can for the iPad. Kindle’s screen is smaller than the iPad, which is a negative for me since I have to enlarge the print to be able to read, making text lines shorter and more awkward to handle on the Kindle. But it’s cheaper than the iPad and there is no glare with its screen. Its presentation is said to be “eye sensitive” and easier on light-sensitive eyes.

Barnes & Nobles’ Nook is another Kindle-like reading device with similar features.

I prefer the iPad over the others mainly because of its larger screen and its zoom feature, and despite the inconvenience of occasional screen glare. Your iPad won’t do well for you at the beach whereas the Kindle Fire will be fine.

So while ARMD can be debilitating, so long as you maintain a sliver of vision, the iPad or the Kindle or the Nook may help you with keeping in touch with the rest of the world.

Dick Marquis
Fairfax, Virginia

Eye Examination for ARMD: Macular Degeneration

When You Need Eye Exam for Macular Degeneration.  Randall Wong, M.D., Retina specialist, Fairfax, Virginia.Routine eye examinations for macular degeneration in patients without symptoms are probably not necessary.

Unlike conditions such as diabetic retinopathy, where the disease is likely to occur  yet still be asymptomatic, macular degeneration is not “silent” and does have associated symptoms.

Once diagnosed with macular degeneration; however,  routine examinations are important.

Family History Does Not Matter

While it is true that patients of northern European descent have a greater chance of developing the eye degeneration, brothers and sisters and children of patients with the disease are not necessarily at any higher risk.

For example, if I contract the disease, my twin brother is not necessarily going to get the disease.

Vision Must “Degenerate”

The most common symptoms of macular degeneration are decreased vision (e.g. blurry vision) and/or the development of distortion.  Both signify a change in vision.

Without a change in vision, that is, if your vision remains 20/20 it is unlikely you have ARMD.

Signs vs. Symptoms of ARMD

Signs of a disease are those things we, as doctors, see or find during an examination. If you have no  signs of macular degeneration, you do not have it.

For instance, drusen and pigment changes in the retina are common signs, or findings, of dry macular degeneration.  Fluid, edema and blood are common findings of wet ARMD.

Pigment changes, fluid and blood may cause blurry and distorted vision….symptoms (subjective, what the patient experiences) of macular degeneration.

Often, patients are diagnosed with drusen.  Drusen alone, especially without loss of vision, do not make the diagnosis of macular degeneration.

Advancing Age and Macular Degeneration

The National Eye Institute has a nice review of macular degeneration.  The incidence of developing macular degeneration does increase with age.  This means the chance of getting the disease does increase with age, but not without signs and symptoms.

What Does This Mean?

In short, unlike diabetic retinopathy, a disease that may develop without symptoms,  you can safely monitor yourself for any symptoms of the ARMD, regardless of ethnicity, age or family history.

If you develop symptoms of decreased vision or if you develop decreased vision you should get an eye exam.  Often, patients are directed to test themselves with an Amsler Grid.  This is a simple way to monitor changes in your vision.

If you have signs of the disease, for example, drusen and changes in the retina, you might ask your doctor about getting examinations on a routine basis.  This will be more important in the future if/when we discover changes in our diet or behavior (i.e. quitting smoking) alter the course of developing the disease.

If you have neither symptoms nor findings, you most likely require exams periodically as directed by your doc.


What if I Have Drusen?

 Drusen and the diagnosis of macular degeneration.  Randall Wong, M.D., Retina Specialist, Fairfax, Virginia 22031


Drusen are not diagnostic of macular degeneration.  These whitish/yellow spots of the retina can be a normal finding and their presence does not mean you will develop macular degeneration (ARMD).  There are other criteria necessary to make the diagnosis of ARMD.

“Druse” may occur in 3 locations within the eye;

  • The Macula
  • The Peripheral Retina (non-macular)
  • and the Optic Nerve

In the Optic Nerve Head (ONHD)

These are not even found in the retina.  These are calcified and found within the optic nerve, but can be diagnosed when looking into the eye during a retinal examination.

These drusen have nothing to do with macular degeneration.  Loss of the peripheral vision is possible.  Patients with ONHD are probably best evaluated by a glaucoma specialist as the mechanism of vision loss is similar to that of glaucoma.

Diagnosis is usually pretty straight forward.  Often these tiny round globules can be seen during a dilated eye exam and can also be detected with ultrasound and CT scan due to the calcification.  They can run in families.

Outside of the Macula

These whitish spots are found in the retina, but not in the macular area.  These are usually whitish/yellow looking flecks found within the layers of the retina and are visible during examination.

When outside of the macula, they are commonly feared to be related to ARMD, but there is no association.  Non-macular lesions are sometimes called “familial drusen” and are a normal finding with no predisposition to the development of ARMD.

Macular Druse: Can Be Associated with ARMD

These are the most confusing and also the most worrisome.  Drusen in the macula can be NORMAL and do NOT necessarily mean you have or will develop macular degeneration.

Those lesions located within the macula are worrisome due to the association with macular degeneration, or ARMD.  There are two types:  hard and soft.  Both may be found in patients with macular degeneration

Hard and soft types differ in appearance and probably have a different association with macular degeneration.  In general, the “hard” variety are more common, especially as we age.  The “soft” lesions are probably found more often in wet ARMD.

Both types of druse may be found in patients with macular degeneration, but the mere presence of  either drusen does not make the diagnosis of macular degeneration nor are they prognostic indicators for the development of the disease.

What If You Have Drusen?

If your doctor diagnosis you with drusen, do the following;

  1. Relax.
  2. Are the within the macula?  If not, probably nothing to worry about.
  3. If they are located in the macula, do you have any symptoms such as decreased vision, distortion or blind spots?  By decreased vision, I mean, with correction, do  you have any of these symptoms?  If not, probably okay to monitor, but make sure you visit your eye specialist if any symptoms develop.

Retina specialists, like me, are the most appropriate to make the diagnosis.  If there is any question, make an appointment to see a specialist.

What Does This Mean?

There are several criteria needed to make the diagnosis of macular degeneration.  You have to look like you have the disease, have the right genetic makeup, be the right age and have evidence of decreased vision.

A retina specialist might consider additional testing, such as a fluorescein angiogram, to determine if there is any evidence of deterioration or degeneration of the retina.

Drusen only are commonly normal.


How to Diagnose Macular Degeneration

Making the Diagnosis of Macular Degeneration, Retina Eye Doctor

Prevent Blindness America has declared February as “Age-Related Macular Degeneration Awareness Month.”  Making the diagnosis of macular degeneration is usually very straightforward and is based upon your age, your vision and the appearance of your retina.

The “Age-Related” in Macular Degeneration

Age related macular degeneration, or ARMD, certainly increases in prevalence as we get older, that is, the number individuals affected increases as we age.  BUT, this does not mean we are all destined to get the disease.

Overall, I hesitate to diagnose the disease in patients less than 55 years old.  Can a 50 year old have the disease?  Certainly, but not a 20 year old (they must have something different).

So, there is an age requirement:  age > 55.

Your Vision Must be Affected

By definition, the disease is a bilateral (affects both eyes) and causes degeneration of the macula and, thus, decreased central sight.

Remember, the macula is the center of the retina.  It gives us central vision, ability to read fine print and our color vision.

When your vision is tested with the “Snellen” chart (that’s the chart that starts with the big “E” at the top), we are testing only how well your macula functions (as opposed to peripheral sight).

If you your vision is 20/20, it’s hard to say you have any loss of vision caused by a disease.

Your Examination

The examination of your retina is a key to diagnosing macular degeneration.  There are characteristic changes in the appearance of your retina that identify certain patients with macular degeneration.

To diagnose ARMD, I look for pigmentary changes, drusen, loss of pigment, fluid, blood, etc., to make the diagnosis.  Often, I perform a fluorescein angiogram to aid in the diagnosis.

What Does This Mean?

Well, in a nutshell, this means that it is usually pretty easy to diagnose patients with macular degeneration.  Sometimes the diagnosis is difficult, say when the retina appears to have the disease, but the vision is normal.

I get comments all the time about patients who have drusen and wondering if they have, or will have, macular degeneration.

Something Fishy About Macular Degeneration

Eating more fish may slow down the progression of macular degeneration.  A new study based on the original AREDS (Age Related Eye Disease Study) data finds that eating cold water, fatty fish 1-2 times per week may reduce the advancement of macular degeneration.

Fatty fish include salmon, tuna, sardines, certain shellfish and herring.  Two specific compounds, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), have been shown to be protective in the disease.

Omega 3 fatty acids have also been implicated in other studies.

What does this mean? These are really associations noted by researchers.  This is not definitive proof that eating fish is helpful.  Large, randomized cohort studies are needed to have definite proof.


Randall V. Wong, M.D.
Ophthalmologist/Retina Specialist


Currently, I see patients with retinal diseases; macular degeneration, retinal detachment, macular holes, macular pucker within several different's a different arrangement, but it allows more continuous care with many eye specialists. In addition, I am very accessible via the web. To schedule your own appointment, call any of the numbers below.

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