Dr. Tamara Fackler

Dr. Tamara K. Fackler, a medical retina specialist at Chesapeake Eye Care and Laser Center, brings over 18 years of clinical experience to the Annapolis practice. Dr. Fackler is board certified in ophthalmology and practiced in Florida and Washington, D.C., before joining Chesapeake Eye Care in 2005. She utilizes high definition OCT, digital fluorescein angiography and fundus autofluorescence to treat her patients’ retinal needs.
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Frequently Asked Questions About Macular Degeneration

Posted by Dr. Tamara Fackler

Apr 16, 2015 11:01:12 AM

macular_degenerationMacular degeneration, a common eye condition in people over the age of 50, is the leading cause of severe vision loss in Caucasians over 65 years old.  With mild cases of macular degeneration, often there are no symptoms. The impact on one's vision is more noticeable, however, with more advanced cases. 

Due to the dynamic nature of macular degeneration, the topic naturally elicits questions from those who are concerned, at risk or already diagnosed. Here are the answers to some of those most frequently asked questions.

Who is at risk?

Macular degeneration is more common as we age.  Caucasians, as well as people with a family history of macular degeneration, are more at risk.  Smoking also increases the risk of macular degeneration. 

What are the symptoms?

When the macula does not function properly, you can have difficulty performing activities such as driving, reading, recognizing faces, or using a computer. You may notice a blurred spot in the center of your vision, or straight lines may look distorted.  Macular degeneration usually does not affect the peripheral vision, and does not result in total blindness. 

How is macular degeneration diagnosed?

Your ophthalmologist will dilate your pupils and carefully examine the macular directly with a microscope.  Other testing, such as Ocular Coherence Tomography (OCT) or Fluorescein Angiography, may be beneficial. 

OCT uses light waves to produce high definition images of the macula.  OCT can help detect microscopic swelling or fluid in the macula.  Fluorescein angiography uses a special retinal camera to delineate the abnormal vessels in wet macular degeneration.

What are the different forms of macular degeneration?

Macular degeneration is divided into 2 forms: 

Dry (non-neovascular)

The dry form occurs in about 90% of patients, and is caused by aging and thinning of the macular tissues.  Drusen, which are yellow deposits under the retina, start to accumulate.  The vision loss is usually gradual.

Wet (neovascular or exudative)  

The wet form is the more severe form, and accounts for about 10% of all patient with macular degeneration.  The wet form develops from the dry form.  In wet macular degeneration, abnormal blood vessels start to grow under the macula.  They can bleed, leak fluid, or cause swelling in the macula.  The wet form can be associated with more rapid and severe vision loss.  

What can be done for wet macular degeneration?

Treatment for wet macular degeneration has undergone a revolution over past several years.  The most common treatments for wet macular degeneration are injections of medications called AntiVEGF's (anti-vascular endothelial growth factor drugs). 

Anti-VEGF drugs reduce the growth of the abnormal blood vessels in wet macular degeneration, and can reduce their associated leakage and swelling in the macula.  The three commonly used drugs are Avastin, Lucentis, and Eylea.  These drugs are injected directly into the eye in the office using anesthetic drops. They can be given as frequently as once a month, and usually multiple injections are required. 

Are vitamins helpful?

A large scientific study called "The Age Related Eye Disease Study" (AREDS), evaluated the benefits of antioxidants and zinc.  The AREDS2 study found that a high dose combination of vitamin C, vitamin E, lutein, zeaxanthin, copper, and zinc, lowered the risk for developing advanced macular degeneration by 25% in patients who already had intermediate stages of macular degeneration.

One such commercially available preparation is called Preservision AREDS2.  Diet alone will not provide the same high levels of antioxidants and minerals as found in the AREDS formulation.  Vitamin supplementation will not restore the vision lost from macular degeneration, nor will it cure macular degeneration. 

 

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Topics: Macular Degeneration

What is Diabetic Retinopathy?

Posted by Dr. Tamara Fackler

Jun 24, 2014 4:49:11 PM

diabetic_retinopathyIt is important for someone who has diabetes to get their eyes checked because diabetic eye problems are a leading cause of blindness. All patients with diabetes, type 1 and type 2, are at risk. High blood sugar levels can damage blood vessels in the retina. The retina is the specialized nerve layer in the back of the eye. It collects light rays and transmits images to the brain allowing us to see.

Types of Diabetic Retinopathy

There are two types of diabetic retinopathy: nonproliferative (or background) and proliferative. Many people with diabetes have the milder nonproliferative form, which may not affect the vision; however, both forms can cause bleeding and swelling of the retina. Often, people with the nonproliferative form have no symptoms. 

The more severe proliferative form occurs when new, abnormal blood vessels develop on the surface of the retina, often manifesting with the sudden onset of floaters when the vessels bleed into the vitreous cavity of the eye and obscure your vision. Sometimes scar tissue can develop on the retina, leading to other more serious problems. Macular edema is another cause of visual loss in diabetics. The macula gives us our central vision allowing us to see fine details clearly. Swelling or thickening of the macula from diabetes causes blurred vision. 

In most cases, nonproliferative diabetic retinopathy is carefully followed. Proliferative retinopathy is usually treated with laser surgery in the office, often spread over several sessions. More severe cases, especially those involving vitreous hemorrhage, require surgical intervention in the operating room. We now have different options to treat macular edema, such as lasers and injections into the vitreous cavity. Often a combination of treatments is done. 

When you come in for a diabetic eye evaluation, your ophthalmologist will dilate your eyes and carefully examine the retina. Diagnostic tests, such as fluorescein angiography and ocular coherence tomography may be needed. More visits may be necessary if problems are present.

Of course, prevention is the best treatment possible. Good blood sugar control will reduce the long term risk of vision loss and diabetic ophthalmic problems. If you have diabetes, be sure to schedule an appointment with your ophthalmologist at least once per year.

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