Macular Densitometer

Macular Densitometer
'Vekaria Healthcare promises to protect & preserve the precious gift of sight.'
The Device
  • It is imperative here to trace back the history (half a century) of the device which has roots… way above:
  • To real understanding of human vision science.
  • To the Noble Prize in Vision Science.
  • To the phenomenal contribution to the ophthalmic, neurological, nutritional science lexicon by its use in research & clinical practice in 20+ years world over.

Dr. George Wald

Dr. George Wald won the Noble Price in 1967 He gave the real understanding of role of Vitamin A in human visual sciences and he also identified the presence of Xanthophyll pigments at macula which plays a key role. But, for years together, there was no attention given to these macular pigments. Pigments in photo receptors produces neural response to light, hence it is considered very important.

Whereas, because macular pigments do not produce neural responses, historically it is/was considered to be secondary or of less importance, not only that at times even considered nuisance by many!

But in reality, what we need to know today is, Again
  • What is the Importance of these macular pigments?
    In other words,
  • What does it do?
    How important they’re/is it?
  • Macular Pigments are extremely important, they are useful in many ways.
    Preserves the eye sight well and also improves the quality of vision.
    Protects the human eye from the damage due to blue light radiation exposure & oxidative stress.
    Prevents (and delays) the onset of blinding diseases like Macular Degeneration & Diabetic Retinopathy.

Brief list of functions of Macular Pigments

It provides improved quality of vision in normal individuals

Protects the human eyes from the blue light radiation exposure damage. (UV from sunlight & blue light radiation exposure from electronic/digital devices.)

Macular Pigments play a potential role in preventing or slowing the progression of certain age-related eye diseases that manifest in part from the cumulative oxidative damage.

Plays important role in reducing the risk of development of Macular Degeneration.

Improves visual function in early Macular Degeneration.

Reduces the risk of progression of intermediate to late Macular Degeneration.

Plays very important role in prevention of common neovascular retinopathies…. Diabetic Retinopathy (proliferative & non proliferative) & Retinopathy of Prematurity.

These classic, in-depth knowledge has come to us by the use of this Macular Densitometer, invented by prof Billy R Wooten and subsequently use of this device was at leading 200+ leading ophthalmic institutes world over. We have plethora of published literature available; Vekaria Healthcare has complied about 200+ clinical trials, clinical studies & peer reviewed published papers and made an excellent clinical compendium.

Giving here, a key reference of Prof. Billy R. Wooten, the inventor and research scholars Prof. Richard Rosen and Prof. John Nolan:

Prof. Billy R. Wooten

Prof. Billy R. Wooten worked with Prof. George Wald at Harvard Medical and over a period of time found out the way to measure Macular Pigment (Xanthophyll pigments mentioned as above) Optical Density (MPOD) by using principle of heterochromatic flicker photometry. His invention came into being in the year of 1997, and he named the device the Macular Densitometer.

He designed and developed different versions of this device and over a period of about 21 years, since the publication of his first peer reviewed research paper on this device (1999), two models: one for research purpose & other for clinical applications. With the use of this device 200+ clinical trials, clinical studies & peer reviewed published papers have been published by the leading eye care specialists, vision scientists all over the world as the device is in use at 200+ world/globally renowned institutes.

Device is easy to use, a well-trained technician can operate it well, it is non-invasive, it does not require dilatation of the pupil.

Technology and Principle

Macular densitometer works on the simple principle of heterochromatic flicker photometry (HFP).

Incorporating the LED technology, the instrument measures the Macular Pigment Optical Density (MPOD) by viewing a small circular stimulus centrally and peripherally that alternates between a test wavelength absorbed by the MP (typically – blue, 460 nm) and a reference wavelength which is generally not absorbed. The MPOD at the test wavelength is given by log (Icentral/Iperipheral). Variation of the test wavelength is used to measure the MPOD spectrum.

This in vitro MPOD spectrum matching with the carotenoids present in the macular region demonstrate the validity and specificity of this methodology.

This HPF technology has established its niche measuring MPOD to give repeatedly same readings globally.

Dr. Richard Rosen

Eminent Vitreo Retinal Surgeon, Co-inventor of OCT (Optical Coherence Tomography) have also been using Macular Densitometer for past 17+ years more.
He has stated that “Measurement of Macular Pigment Optical Density (MPOD) is extremely critical to judge the oxidative stress in Retina. OCT does not measure MPOD.”
Papers published by him in the recent years throw a light in this field and as such it is becoming a guiding force to eye care professionals.

Prof. John Nolan

Prof. John Nolan, Principle Investigator, Howard Chair in Human Nutrition, Fulbright Scholar, European Research Council Fellow, Waterford Institute, Ireland; is using nine macular densitometers and stated that this is the only Gold Standard Device for measuring Macular Pigment Optical Density (MPOD).

Note From Founder & M.D.

Having gone through this entire fact file, Mr. Yogendra Vekaria, Founder & Managing Director, Vekaria Healthcare LLP and Dr. B. J. Vaishnav, Clinical Affairs & International Business Development, Vekaria Healthcare LLP has a very important personal remark, worth mentioning here

Going over the fascinating long history of vision science, we all are indebted to Prof. George Wald (Noble Prize winner in 1967 for Vision Science); But more we should be grateful to Prof. Billy R. Wooten, who enabled us to measure Macular Pigment Optical Density, complimenting Prof. George Wald (Noble Prize winner in 1967 for Vision Science) and his marvellous research work.
His invention made it possible to avail the benefits of the theoretical knowledge & research work of Prof. George Wald (Noble Prize winner in 1967 for Vision Science) in daily practical life.

The Macular Densitometer

A simple & non-invasive device has put a mark in the ophthalmic lexicon.
This is the only Gold Standard Device for measuring Macular Pigment Optical Density (MPOD).
In science, every method, technique or device has its merits and demerits.

But what gave us confidence to make this device available to every ophthalmic practices in the world and to mainly to induct it in the public health system is the collection of 200+ papers on clinical trials done with the use of this device including peer reviewed published papers and on top of all these, the publications and remarks we’ve obtained from an highly eminent Retinal Surgeon Dr. Richard Rosen, who’s also the co-inventor of OCT. Has used this device for 17+ years and he has stated that “Measurement of Macular Pigment Optical Density (MPOD) is extremely critical to judge the oxidative stress in Retina. OCT does not measure MPOD.”

And a renowned Nutritionist Prof. John Nolan, who has reported and published: Macular Densitometer is the Gold Standard device.
With such an enviable background for a simple looking device… we are soon coming up with the most advanced, user-friendly yet high-tech device, to be manufactured in India under one of the flagship programmes of our Hon’ble Prime Minister Shri Narendra Modi Ji: The Make in India programme. As this device is to play a significant role in preventing irreversible blindness and save billions of rupees of socio-economic burden of the society & the government.

I Have Two Important Eye-Opening Remarks to share for every eye care professionals and decision makers in the healthcare system.

Dr Paul Bernstein, Moran Eye Centre, Utah with his associates from Schepens Eye Research Institute Harvard Medical School, Boston said: “Expansion of the scientific data and improvements in methodology and equipment necessary to measure MPOD levels in diverse population will hopefully bring about a paradigm shift in the way we recognise, diagnose and treat those at the risk of Macular Degeneration, Diabetic retinopathy and other eye diseases.”

The Senior Management European Scientific Affairs & Technical Services, Kevin Human and Health: “It is important to introduce MPOD MEASUREMENT INTO CLINICAL PRACTICE in order to detect potentially low MPOD levels, assess age or disease related MPOD changes over the time and induce when needed clinically, Ophthalmologist recommended supplements and to get it monitored.”

Aiding Innovations

Vekaria Healthcare, Macular Metrics II – has been aiding research & development since inception. The Macular Densitometer has/have often been utilized as an apparatus for conducting studies, especially for industrial & clinical researches.

  • American Food Biotechnology, St. Louis, MO.
  • University of Indiana Medical School, Department of Ophthalmology, Indianapolis, IN.
  • Alexandra Hospital, Singapore.
  • Louisiana State University, Dept of Human Ecology, Baton Rouge, LA.
  • Beijing Central Eye Hospital, Beijing, China.
  • University of New Hampshire, Department of Nutritional Science, Durham, NH.
  • Vision Research Foundation (2 machines), Sankara Nethralaya (Eye Hospital), Chennai, India.
  • Arizona State University (2 Machines), Department of Psychology, Phoenix, AZ.
  • University of Wisconsin (2 machines), Department of Ophthalmology & Visual Sciences, Madison, WI.
  • Brown University, Department of Psychology, Providence, RI.
  • New York Eye & Ear Infirmary, Department of Ophthalmology, New York, NY.
  • Scripps Center for Alternative Medicine, LaJolla, CA.
  • Chicago Veterans’Administration Hospital, Chicago, IL.
  • Massachusetts Eye & Ear Infirmary. Harvard Medical School, Boston, MA.
  • Kemin Foods, L.E., Des Moines, IA.
  • Schepens Eye Research Institute and Harvard University, Department of Ophthalmology, Boston, MA.
  • Scheie Eye Institute, Center for Hereditary Retinal Degenerations, University of Pennsylvania Medical School, Philadelphia, PA.
  • University of Oregon, Department of Ophthalmology, Portland, OR.
  • University of Iowa, Department of Ophthalmology, Iowa City, IO.
  • University College, Cork, Ireland.
  • Optometry Division, University of Ulster, Northern Ireland.
  • Whitfield Hospital, Waterford, Ireland.
  • Departments of Nutrition and Neuroscience, University of Texas Austin, Texas.
  • Northrop-Grumman Corp., Air Force Research Laboratory Brooks City Base, Texas.

  • National Eye Institute Bethesda, Maryland.
  • Chinese University of Hong Kong and the Hong Kong Eye Hospital, Hong Kong, China.
  • Karolinska Institue Stockholm, Sweden.
  • University of California Medical School, Ophthalmology Department, Davis, CA.
  • Children’s Hospital Boston, Massachusetts.
  • University of Massachusetts, Department of Health Sciences, Lowell, MA.
  • Johnson and Johnson Co. Vistakon Vision Section Jacksonville, Florida.
  • University of Tennessee, Ophthalmology Department, Medical School, Memphis, TN.
  • Institute of Health and Innovation Queensland University of Technology Brisbane, Australia.
  • The Dublin Institute of Technology, Optometry Dept., Dublin, Ireland.
  • DSM Nutritional Products Wurmisweg, Switzerland.
  • University of Connecticut, Department of Nutrition, Storrs, Conn.
  • University of Bordeaux Dept. of Ophthamology Bordeaux, France.
  • University of Georgia (2 Machines), Psychology Department, Athens, GA.
  • Universtiy of Erlangen Erlangen, Germany.
  • National Eye Institute (National Institute of Health), Bethesda, MD.
  • Santen Pharmaceutical Co.,LTD Toyko, Japan.
  • University of Waterford (2 Machines), Health Science Department, Waterford, Ireland.
  • University of Illinois Biomedical Engineering Champaign, Illinois.
  • Jean Mayer US Dept. of Agriculture Human Nutrition (2 Machines), Research Center on Aging, Tufts University Schoold of Nutrition and Policy, Boston, MA.
  • Alcon Corp., Dallas, Texas.
  • University of Wisconsin, (with the University of Iowa and the University of Oregon Health Sciences) Madison, Wisconsin.
  • University of Hawaii Cancer Research Center Honolulu, Hawaii.
  • Louisiana State University Dept of Nutrition Baton Rouge, Louisiana.
  • Trinity College, Dublin, Ireland.

Research Papers

Inventor of this device, his associates and many leading eye care professionals all over the world used this device, and so far, we have more than 200 published papers on clinical trials, clinical studies done & peer reviewed published papers.

We’ve compiled and made an excellent compendium; we can/may provide the link to that to serious clinicians, upon special request.

Here Is A List Of Some Of Those Publications

  1. Prof. John Nolan 2013 Clinician… Measuring Macular Pigment.
  2. Dr. Richard Rosen 2015 Journal of Ophthal, L, Z, mZ in clinical management of eye diseases.
  3. Dr. Richard Rosen 2016 International Journal of Retina & Vitreous… Macular Pigment in Retinal Health & Diseases.
  4. Hammond, B.R., Wooten, B.R. and Snodderly, D.M. (1997). The density of the human crystalline lens in related to the macular pigment carotenoids, lutein, and zeaxanthin. Optom. Vis. Sci., 74, 449-504.
  5. Hammond, B.R., Wooten, B.R. and Snodderly, D.M. (1998). Preservation of visual sensitivity of older subjects: Association with macular pigment density. Investigative Opthalmology and Visual Science, 39, 397-406.
  6. Hammond, B.R., Wooten, B.R. and Nanez, J.E., and Wenzel, A.J. (1999). Smoking and lens optical density. Ophthalmic and Physiological Optics, 19, 300-305.
  7. Wooten, B.R. Hammond, B.R. Land, R.I. and Snodderly, D.M. (1999). A practical method for measuring macular pigment optical density in diverse populations. Investigative Ophthalmology and Visual Science, 40, 2481-2489.
  8. Hammond, B.R., Wooten, B.R. and Curran- Celentano, J (2000). Carotenoids in the retina and lens: possible acute and chronic effects on human visual performance. Archives of Biochemistry and Biophysics, 385, No. 1, 41-46.
  9. Wooten, B.R and Hammond, B.R. (2002). Macular Pigment: Influences on visual acuity and visibility. Progress in Retinal and Eye Research, 21, 225-240.
  10. Wooten, B.R. and Hammond, B.R.(2003). Assessment of the Raman method of measuring human macular pigment. E-letter, Investigative Oph. and Vis. Sci., 44. Published online at http://www.iovs.org/cgi/eletters.
  11. Wooten, B.R. and Hammond, B.R. (2003). Assessment of the Raman method of measuring human macular pigment: Response to Bernstein and Gellerman. Investigative Ophthalmology and Visual Science, 45. Published online at http://www.iovs.org/cgi/eletters.
  12. Hammond, B.R., and Wooten, B.R. (2005). CFF Thresholds: Relation to macular pigment optical density. Ophthalmic and Physiological Optics. 25, 315-319.
  13. Hammond, B.R., and Wooten, B.R. (2003). Noninvasive assessment of the macular carotenoids. In Ciulla, T.A., Regillo, C.D. and Harris A. (Eds.). Retina and Optic Nerve Imaging. Lippincott, Williams, and Wilkins, Delaware, pgs. 231-43.
  14. Hammond, B.R., and Wooten, B.R. (2004). Validity issues with the in vivo measurement of skin carotenoids using Raman spectroscopy. Investigative Dermatology. 122, 544-546.
  15. Hammond, B.R., and Wooten, B.R. (2004). Questions about Raman spectroscopic detection of carotenoids in human skin and retina. Carotenoid News, 14(1), 7-8.
  16. Snodderly, D.M., Mares, J.A., Wooten, B.R., Oxton, L., Graber, M. and Ficek, T. (2004) Macular pigment measurement by heterochromatic flicker photometry in older subjects., Invest. Oph. and Vis. Sci.
  17. Hammond, B.R., Wooten, B.R. and Smollon, B. (2005). Assessment of the Validity of in Vivo Methods of Measuring Human Macular Pigment Optical Density. Optometry and Vision Science, 82(5), 387-404.
  18. Cooper, D.A., Curran-Celentano, J., Cuilla, T.A., Hammond, B.R., Danis, R.B., Pratt, L. M., Riccardi, K.A. and Filloon, T.G. (2000) Olestra consumption is not associated with macular pigment optical density in a cross-sectional volunteer sample in Indianapolis. Journal of Nutrition, 130(3), 642-47.
  19. Wooten, B.R., Hammond, B.R. and Smollon, B. (2005). Assessment of the validity of heterochromatic flicker photometry for measuring macular pigment optical density in normal subjects. Optometry and Vision Science. 82 (5), 378-386.
  20. Hammond, B.R., and Wooten, B.R. (2005). A comparison of heterochromatic flicker photometry and Raman spectroscopy for measuring human macular pigment. Investigative Ophthalmology and Visual Science, 46.
  21. Hammond, B.R., and Wooten, B.R. (2005) Resonance Raman spectroscopic measurement of carotenoids in the skin and retina. Journal of Biomedical Optics. 10(5), 054002-054014.
  22. Hammond, B.R., Wooten, B.R. and Smollon, W. (2006). Assessment of the validity of in vivo methods of measuring human macular pigment optical density: Response to Gellerman and Bernstein. Optometry and Vision Science. 83 (4), 256-259.
  23. Hammond, B.R., and Wooten, B.R. (2006). Comments on the Use of Raman spectroscopy for the in Vivo Measurement Human Macular Pigment. Applied Spectroscopy, 60 (11), 1348-49.
  24. Stringham, J., Hammond, B.R., Wooten, B.R. and Snodderly, D.M. (2006). Compensation for light loss due to filtering by macular pigment: Relation to the p-1 mechanism. Optometry and Vision Sciences. 83: 887-894.
  25. Mares JA, LaRowe TL, Snodderly DM, Moeller SM, Gruber MJ, Klein ML, Wooten BR, Johnson EJ, Chappell RJ. (2006). Predictors of optical density of lutein and zeaxanthin in retinas of older women in the Carotenoids in Age-Related Eye Disease Study, an ancillary study of the Women’s Health Initiative. Am J Clin.Nutr. 84: 1107-1122.
  26. Ciulla, T. A.. Hammond, B. R., Yung, C.W. and Pratt, L. (2001). Macular pigment optical density before and after cataract extraction. IOVS., 42(6),1338-41.
  27. Ciulla, T., and Hammond, B.R. (2004). The relation between aging and macular pigment density, assessed in the normal elderly, and subjects with cataracts and age-related macular degeneration. American Journal of Ophthalmology. 138, 582-587.
  28. Stringham, J., Hammond, B.R. Nolan, J.M., Wooten, B.R., Mammen, A., Smollon, W. And Snodderly, D.M. (2008). The utility of using customized heterochromatic flicker photometry (cHFP) to measure macular pigment in patients with age-related macular degeneration. Experimental Eye Research, 87, 445-53.
  29. Gallaher et al. Estimation of macular pigment optical density in the elderly: Test–retest variability and effect of optical blur in pseudophakic subjects. Vision Research, 47, 2007, Pages 1253-1259.
  30. Hammond, B.R. and Caruso-Avery, M. (2000). Macular pigment optical density in a Southwestern sample. IOVS., 41(6),1492-1497.
  31. Johnson, E.J., Hammond, B.R., Yeum, K.J., Qin, J, Dong Wang, X., Castaneda, C., Snodderly, D.M. and Russell, R.M. (2000). The relation among serum and tissue concentrations of lutein and zeaxanthin and macular pigment density. American Journal of Clinical Nutrition. 71(6), 1555-1562.
  32. Ciulla, T. Curran-Celentano, J., Cooper, D., Hammond, B.R. Danis, R.P., Pratt, L.M., Riccardi, K.A. and Filloon, T.G. (2001). Macular pigment optical density in a midwestern sample. Ophthalmology,108, 730-737.
  33. Curran-Celentano, J., Hammond, B.R., Ciulla, T.A., Cooper, D.A., Pratt, L.M. and Danis, R.B. (2001). The relation between dietary intake, serum concentrations, and retinal concentrations of lutein and zeaxanthin in adults in a Midwest population. American Journal of Clinical Nutrition, 74, 796-802.
  34. Wenzel, A,J., Fuld, K. and Stringham, J. (2003). Light Exposure and Macular Pigment Optical Density IOVS. 44: 306-309.
  35. Richer S., Devenport J., Lang J.C. 2007. LAST II: Differential temporal responses of macular pigment optical density in patients with atrophic age-related macular degeneration to dietary supplementation with xanthophylls. Optometry 78, 213-9.
  36. Richer S., Stiles W., Statute L., et al. 2004. Double-masked, placebo-controlled, randomized trial of lutein and antioxidant supplementation in the intervention of atrophic age-related macular degeneration: the Veterans LAST study (Lutein Antioxidant Supplementation Trial). Optometry 75:216-30.
  37. Richer, S. 1999. Part II: ARMD- Pilot (Case Series) environmental intervention data. J. Am. Optom. Assoc., 70, 24-36.
  38. Aleman, TS, Duncan JL, Bieber ML, et al. 2001. Macular pigment and lutein supplementation in retinitis pigmentosa and Usher syndrome. Investigative Ophthalmology & Visual Science 42:1873-1881.
  39. Duncan, J. L., Aleman, T. S., Gardner, L. M., De Castro, E., Marks, D. A., Emmons, J. M., Bieber, M. L., Steinberg, J. D., Bennett, J., Stone, E. M., MacDonald, I. M., Cideciyan, A. V., Maguire, M. G. & Jacobson, S. G. (2001) Macular pigment and lutein supplementation in choroideremia. Exp. Eye Res. 74:371-381.
  40. Hammond, B.R., Ciulla, T.A., and Snodderly, D.M. (2002). Macular pigment density is reduced in obese subjects. IOVS, 43, 47-50.
  41. Hammond, B.R. and Wooten, B.R. (2005). CFF Thresholds: Relation to macular pigment optical density. Ophthalmic and Physiological Optics. 25, 315-319.
  42. Iannaccone A., Mura M., Gallaher K.T., Johnson E.J., Todd W.A., Kenyon E., Harris T.L., Harris T., Satterfield S., Johnson K.C., Kritchevsky S.B. 2007. Macular pigment optical density in the elderly: findings in a large biracial Midsouth population sample. IOVS. 48, 1458-65.
  43. Stringham, J., Hammond, B.R. (2007). Compensation for light loss due to filtering by macular pigment: Relation to hue-cancellation functions. Ophthalmic and Physiological Optics. 27, 232-237.
  44. Wooten, B.R., Hammond, B.R. and Renzi, L. (2007). Using scotopic and photopic flicker to measure lens optical density. Ophthalmic and Physiological Optics. 27, 321-328.
  45. Engles, M., Wooten, B.R Hammond, B.R. (2007). The relation between macular pigment density and hyper-and-gap acuity. IOVS 48, 2922-31.
  46. Stringham, J., Hammond, B.R. (2007). The glare hypothesis of macular pigment function. Optometry and Vision Science, 84, 859-64.
  47. Wenzel, A. J., Sheehan, J. P., Gerweck, C., Stringham, J. M., Fuld, K., Curran-Celentano, J. Macular pigment optical density at four retinal loci during 120 days of lutein supplementation. Ophthal. Physio. Opt., 2007; 27(4): 329-335.
  48. Stringham, J., Hammond, B.R. (2008). Macular pigment and visual performance under glare conditions. Optometry and Vision Science, 85, 82-88.

Role Of Device

The Macular Densitometer has an important role to play primarily in the below listed both irreversibly & reversibly blinding eye diseases (and non-primarily in certain neurological disorders)

Macular Degeneration, Diabetic Retinopathy, Retinopathy of Prematurity, Retinitis Pigmentosa, Glaucoma, Cataract (and non-primary role of the Macular Densitometer in certain Neurological Disorders affecting cognitive function).

Macula

Macula is the centre most part of the retina of about 4 mm in size. it is responsible for 85% of the day vision, it also includes most of the colour vision and fine details of an image a person sees. Macula has a very high concentration of photo receptor cells; neural signals are transmitted to the brain from here.

Retina is a thin, semi-transparent, multi-layered tissue lining inside the back of the eye.

It contains millions of light receptors that capture light rays and convert them into biochemical signals. Located in the center of the retina is the macula which has naturally occurring carotenoids; lutein and zeaxanthin, known to absorb and filter out ultraviolet and blue light radiation from the light reaching the macula.

The macula plays a very important part in the process of seeing as it is responsible for central vision, most of the colour vision and fine details of the image a person sees. Since it has a very high concentration of photoreceptor cells, it enables forming of the sharpest image. These cells send signals to the brain which interprets them as images. The rest of the retina processes our peripheral (side) vision.

Also, three major Xanthophyll pigments found in the eye are Lutein (L) Zeaxanthin (Z) and Meso-Zeaxanthin (mZ). The concentration of L, Z, mZ in the Macula is much higher than it is in serum and the human organ liver. This suggests specific uptake and storage mechanism for these pigments in Retina (mainly at Macula) and this emphasizes their essential role in visual function & disease prevention.

Macular Degeneration

Macular degeneration is an eye disease that can blur the sharp, central vision one needs for activities like reading, writing, driving, etc..

It affects the central part of the retina called macula. Earlier this disease was seen in elderly people…. so was known as Age Related Macular Degeneration. But now it is seen as early as at the age of 12 years even.

It is the leading cause of irreversible blindness. It does not cause complete blindness but central vision is lost so becomes hard to see faces, drive or to do any work with close look. In some cases, it progresses very slowly and remains a symptomatic, where as in others it progresses fast and leads to loss of central vision. According to the WHO it is the world’s 3rd leading cause of irreversible blindness. It is also listed as one of the priority eye diseases by the WHO.

Types Of Macular Degeneration

There are two types:
  1. Dry Macular Degeneration (three stages: early, intermediate & advanced)
  2. Wet Macular Degeneration
Dry Macular Degeneration

Most of the macular degeneration starts as dry type, and progresses to wet type. It is always affecting both the eyes but doesn’t necessarily progress at the same pace in both the eyes. It mostly progresses slowly, in this case small white or yellowish deposits called Drusen get deposited beneath the Macula, and due to this over a period of time Macula gets degenerated. There are three stages of dry Macular Degeneration.

Early stage

In this pathological stage patient develops few small Drusen. Usually there’s no symptom or vision loss.

Intermediate Stage

In this stage patient may have many medium sized Drusen or one or more large sized Drusen. Still some people may not have symptoms or may have blurred central spot in some cases. Such patients need more light for reading or some other near work.

Advanced Stage

Also known as geographic atrophy. Large central part of retina is damaged causing central blind spot. The patient finds difficulty to read or to recognize faces.

Wet Macular Degeneration

In this type abnormal blood vessels grow from choroid underneath Macula. It leads to leaking of blood and fluid into the retina, which destroys the vision, Eventually, a scar is formed and results into a permanent loss of central vision. In this case generally there is more serious vision loss, it is rapid.

Risks

Until a decade back, Macular Degeneration was an age related disease (hence was called AMD/ARMD – Age Related Macular Degeneration), usually affecting people above the age of 65/45. In recent times, owing to the drastic changes in lifestyle and constant exposure to blue light present in digital devices, the disease has started affecting people between the age of 12 and 45, and at times even further younger to that.

RACE – CAUCASIANS ARE MUCH MORE LIKELY TO LOSE VISION FROM MACULAR DEGENERATION THAN AFRICAN AMERICANS OR OTHER RACES.

OBESITY

PROLONGED EXPOSURE TO SUN RAYS

HIGH-FAT DIET

HEREDITY

SMOKING

PROLONGED EXPOSURE TO BLUE LIGHT (USAGE OF DIGITAL DEVICES)

FAIR SKINNED PEOPLE ARE MORE PRONE TO MACULAR DEGENERATION

GENDER – FEMALES ARE AT HIGH RISK OF DEVELOPING MACULAR DEGENERATION

LIGHT COLOURED EYES/ BLUE COLOURED EYES

Symptoms

One of the biggest symptoms of having Macular Degeneration is blurred and colour less vision. Although a painless disease, Macular Degeneration, as it progresses, increases difficulties in managing simple everyday tasks.

Common Symptoms Of Early-Stage Macular Degeneration

  1. Straight lines start appearing wavy
  2. Dark, blurry spots in the center of the vision
  3. Diminished or changed colour perception

Symptoms Of Late/Advanced Stage Macular Degeneration

  1. Details seen less clearly than usual.
  2. Difficulties in recognizing faces in the crowd.
  3. Growing blind spots in the center of the vision.

Common Symptoms

Macular degeneration blurs your central vision leading to a loss of visual acuity and contrast sensitivity.

Symptoms of Macular Degeneration

Blank spots and distortion in central vision

Diabetic Retinopathy

Diabetic retinopathy is an eye condition that can cause vision loss and blindness in people who have diabetes. It affects blood vessels in the retina. It is leading cause of blindness and the WHO has also listed it in Priority Eye Disease.

There are two types of Diabetic Retinopathy

  1. Non-Proliferative Diabetic Retinopathy (NPDR) is the early stage of the disease in which symptoms will be mild or not at all there. In this stage blood vessels in the retina are weakened.
  2. Proliferative Diabetic Retinopathy (PDR) is the more advanced form of disease.

Retinopathy of Prematurity

Retinopathy of Prematurity (ROP) is a potentially blinding disease caused by abnormal development of retinal blood vessels in premature infants. The retina is the inner layer of the eye that receives light and turns it into visual messages that are sent to the brain.

Key Points to understand the pathogeneses of Diabetic Retinopathy, Retinopathy of Prematurity and other eye diseases and its possible prevention:

The retinal ischemia can lead to neovascularization, haemorrhage and blindness in case of diabetic retinopathy and retinopathy of prematurity.

Oxidative stress plays a role in the pathogenesis of both conditions.

Evidence suggests antioxidant supplementation increases Macular Pigment Optical Density and there by prevents the disease progression.

Current publications on the effects of Lutein and Zeaxanthin by increasing MPOD levels and thereby preventing and giving therapeutic effects on cataract, open angle glaucoma, diabetic retinopathy and retinopathy of prematurity have shown encouraging results.

So, it is advisable to measure MPOD by Macular Densitometer, and if MPOD levels are measured & found to be low, better to get proper supplements & get it monitored by screening periodically on Macular Densitometer and one can prevent development of Diabetic Retinopathy & can delay the onset of cataract and open angle glaucoma.