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Macular Degeneration

Macular degeneration, also known as age related macular degeneration (ARMD), is the commonest cause of blindness in people aged over 50 in Australia. The macula is a specialised area of the retina responsible for detailed central vision and colour vision; the remaining area of the retina is known as peripheral retina which is responsible for our side (peripheral) vision. Macular degeneration is a retinal condition which causes progressive painless loss and distortion of the central vision, it does not affect the peripheral vision.

Both genetic and environmental factors play a role in the development of macular degeneration. Increasing age and family history are non-modifiable risk factors. The most important modifiable risk factor is smoking. You can reduce your risk of developing macular degeneration by not smoking, having a healthy and balanced diet, rich in antioxidants (green leafy vegetables, oily fish and nuts). Certain patients with macular degeneration also benefit from vitamin supplementation. If macular degeneration is present within your family, your risk is increased, so regular eye examinations are recommended.

Within the deepest layer of the retina ,there is a layer of specialised cells called the retinal pigment epithelium which are responsible for providing nutrients to the rest of the retina and removing waste products of retinal cells .The retinal pigment epithelium is also an important barrier between the retina and the choroid (vascular coat of the eye).

When macular degeneration occurs, waste products from the retina build up under the retinal pigment epithelium. These are known as drusen. An ophthalmologist can detect drusen when they examine the patient’s macula. Drusen often do not affect vision, but are important early signs of ARMD.

Generally speaking, there are two types of macular degeneration- dry and wet.

Dry Macular degeneration occurs when the retinal pigment epithelium cells die, causing the retinal cells above them to die as well. This results in a gradual loss of vision which can develop over months or years.. There is currently no medical treatment available to reverse the effects of dry macular degeneration, however improving your diet and eliminating certain risk factors such as smoking have been shown to slow the progression of the disease. Importantly, dry macular degeneration can develop into wet macular degeneration over time.

Wet macular degeneration develops when blood vessels from the vascular layer of the eye (the choroid) start to break through the retinal pigment epithelium into the retina. The blood vessels are weak and often leak fluid and blood into the retina, resulting in scarring and distortion. It is this distortion of the retina which causes rapid loss of central vision. Signs of wet macular degeneration include blurred or distorted vision, letters missing when reading, and lines appearing wavy.

There is effective treatment for wet macular degeneration. Although the treatment does not cure the disease, it stabilised the vision in the vast majority of patients. A series of injections into the eye which contain anti-VEGF medication (Lucentis®, Eylea® or Avastin®) are given under local anaesthetic in the Doctor’s rooms. On-going examinations are required to ensure vision is maintained.

Your eye examination involves assessing your vision using a vision chart and an amsler grid. Your pupils are dilated to allow the Doctor to examine the macula and monitor any changes. Further tests like retinal photography, OCT (optical coherence tomography which scans the retinal layers) and a fluorescein angiogram may take place to help diagnosis macular degeneration and ensure your receive the correct treatment.

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A retinal photograph

A retinal photograph

A macular OCT scan

A macular OCT scan

A fundus fluorescein angiogram

A fundus fluorescein angiogram

Dr Dana Robaei - Sydney Ophthalmologist

Dr Dana Robaei

Ophthalmic Surgeon MBBS(Hons) BSc(med) MPH PhD FRANZCO

Dr Dana Robaei is a consultant ophthalmic surgeon, with fellowship training in Cataract Surgery and Corneal Transplantation from Moorfields Eye Hospital, and Medical Retina from Sydney Eye Hospital.

She has extensively published in the national and international ophthalmic literature, and presented at international ophthalmology conferences.

She specialises in Cataract Surgery, Pterygium Surgery, Macular Degeneration and all aspects of comprehensive ophthalmology.

Dr Robaei is committed to clinical and surgical excellence, with the aim of providing the highest possible standard of care based on the latest available evidence, in combination with effective communication to patients and their referrers.

Professional Qualifications

  • Graduated from UNSW with Honours, Bachelor of Medicine, Bachelor of Surgery
  • Master of Public Health, UNSW
  • PhD in medicine (Visual impairment in Australian School Children)
  • Advances specialty training in ophthalmology and ophthalmic surgery at Sydney Eye Hospital
  • Subspecialty fellowship training in cataract surgery and corneal transplantation at Moorfields Eye Hospital, London UK
  • Clinical Senior Lecturer in ophthalmology, University of Sydney
  • Consultant Ophthalmologist, Westmead Hospital
  • Director of Forest Eye Surgery, Frenchs Forest