page_title: Macular degeneration
section_title: Diagnosis
hierarchical_section_title: Macular degeneration / Diagnosis
caption_attribution_description: English: Investigation of AMD,macular degeneration a medical condition which usually affects older adults and results in a loss of vision in the center of the visual field (the macula) because of damage to the retina macular degeneration. Sections from human eye tissue were analyzed with Structured Illumination Microscopy (SMI)/ Optical nanoscopy using a specially designed Super Resolution Microscope setup: LSI-TIRF as a total internal reflection interferometer with laterally structured illumination. This SMI technique allowed to acquire light-optical images of autofluorophore distributions in the tissue with previously unmatched optical resolution. Use of three different excitation wavelengths (488, 568 and 647 nm), enables to gather spectral information about the autofluorescence signal. Detailed Image description: Overview image. The SMI image (right) shows more details and less out of focus light than the widefield image (left). The Bruch membrane (B) is located between the choroid (C) and the retinal pigment epithelium (RPE). On the top of the image endings of retinal rod cells (R) can be seen. The scale bar is 2�m. Reference: Best G, Amberger R, Baddeley D, Ach T, Dithmar S, Heintzmann R and Cremer C (2011). Structured illumination microscopy of autofluorescent aggregations in human tissue. Micron, 42, 330-335.
context_page_description: Macular degeneration, also known as age-related macular degeneration, is a medical condition which may result in blurred or no vision in the center of the visual field. Early on there are often no symptoms. Over time, however, some people experience a gradual worsening of vision that may affect one or both eyes. While it does not result in complete blindness, loss of central vision can make it hard to recognize faces, drive, read, or perform other activities of daily life. Visual hallucinations may also occur but these do not represent a mental illness.
  Macular degeneration typically occurs in older people. Genetic factors and smoking also play a role. It is due to damage to the macula of the retina. Diagnosis is by a complete eye exam. The severity is divided into early, intermediate, and late types. The late type is additionally divided into "dry" and "wet" forms with the dry form making up 90% of cases.
  Preventive efforts include exercising, eating well, and not smoking. There is no cure or treatment that returns vision already lost. In the wet form, anti-VEGF medication injected into the eye or less commonly laser coagulation or photodynamic therapy may slow worsening.
context_section_description: Diagnosis of age-related macular degeneration depends on signs in the macula, not necessarily vision. Wet AMD is typically the advanced progression of dry AMD and will require additional diagnostic tools. Additionally, early diagnosis of wet AMD can prevent further visual deterioration and potentially improve vision.
  Diagnosis of dry (or early stage) AMD may include the following clinical examinations as well as procedures and tests:
  The transition from dry to wet AMD can happen rapidly, and if it is left untreated can lead to legal blindness in as little as six months. To prevent this from occurring and to initiate preventive strategies earlier in the disease process, dark adaptation testing may be performed. A dark adaptometer can detect subclinical AMD at least three years earlier than it is clinically evident.
  There is a loss of contrast sensitivity, so that contours, shadows, and color vision are less vivid. The loss in contrast sensitivity can be quickly and easily measured by a contrast sensitivity test like Pelli Robson performed either at home or by an eye specialist.
  When viewing an Amsler grid, some straight lines appear wavy and some patches appear blank
  When viewing a Snellen chart, at least 2 lines decline
  In dry macular degeneration, which occurs in 85–90 percent of AMD cases, drusen spots can be seen in Fundus photography
  Using an electroretinogram, points in the macula with a weak or absent response compared to a normal eye may be found
  Farnsworth-Munsell 100 hue test and Maximum Color Contrast Sensitivity test (MCCS) for assessing color acuity and color contrast sensitivity
  Optical coherence tomography is now used by most ophthalmologists in the diagnosis and the follow-up evaluation of the response to treatment with antiangiogenic drugs.
  Diagnosis of wet (or late stage) AMD may include the following in addition to the above tests:
  Preferential hyperacuity perimetry changes (for wet AMD). Preferential hyperacuity perimetry is a test that detects drastic changes in vision and involves the macula being stimulated with distorted patterns of dots and the patient identification of where in the visual field this occurs.
  In wet macular degeneration, angiography can visualize the leakage of bloodstream behind the macula. Fluorescein angiography allows for the identification and localization of abnormal vascular processes.
caption: Super resolution microscopic investigation of human eye tissue affected by AMD
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