The Amsler Grid
The first line of defense for macular degeneration is awareness. A simple test of your vision will alert you to any changes that may indicate a problem with macular degeneration or a worsening of your condition. This common test is known as the Amsler Grid.
The Amsler Grid looks like graph paper, with dark lines forming a square grid. Some versions have white lines on a dark background. You can download a copy for printing here.
One of the first signs of macular degeneration can be wavy, broken or distorted lines OR a blurred or missing area of vision. The Amsler Grid can help you spot these early. Early detection of wet AMD is critical because laser treatment, when indicated, is most successful when performed before damage occurs. Since dry AMD can lead to development of wet AMD, most patients should use the Amsler Grid. Check with your eye doctor to find out how often you should use this test.
Here’s how to use the graph:
Proper use of the grid will enable you to detect very subtle changes in your vision which can occur when there is just a small amount of fluid under your retina. To perform the test properly, wear the glasses that you normally wear for reading. If you wear bifocals, use the bottom portion or reading portion of the glass. Attach the Amsler's Chart to a wall at eye level and stand 12"-14" (comfortable reading distance) away from it. Cover one eye. With the other eye, look at the center dot.
The first day you observe the grid, mark with a pencil any areas of distortion, any gray or blurry areas, or any blank spots. This will be your baseline pattern.
Each and every morning thereafter, look at the center dot of the Amsler's Chart. If you notice new areas of distortion, wavy lines instead of straight lines, or enlargement of the blank spots, especially towards the center, you should call your ophthalmologist and arrange for an appointment as soon as possible.
Blurry Areas and Black Spots
Wavy or Crooked Lines
Your evaluation will probably include a retinal examination and eye photography to determine whether your new symptoms are due to fluid under the retina, and whether available treatments may help.
A diagnosis of macular degeneration can be a scary event. A patient may leave the office bewildered and confused. Bringing someone with you to your next visit, who will ask questions and gather information may be a good idea. The AMDF has prepared a list of questions you may bring to your appointment.
Printable 10 Questions to Ask Your Doctor - Requires Adobe Reader
If you are in “the macular generation”, over age 45 you should check yourself on the Amsler Grid. But remember that it is a “gross” test and may not catch early vision loss. You should see your eye doctor every year or two for a dilated eye examination.
To receive a free magnetic Amsler Grid, fill out the form located on the AMD Toolkit page. We’ll send one to you along with other information about macular degeneration.
The “Face” Test
Another way to easily test your vision is just waiting for you in your bathroom mirror. The key to catching vision problems is to look with one eye at a time, because when both eyes work together, they can hide a vision problem.
Every morning, simply look at your face in the mirror. Cover your left eye with your hand and focus on your face. Then switch, covering your right eye with your hand so you’re looking at your face with the left eye. If you notice any central blurring or missing parts, contact your doctor for an eye examination.
In this simple outpatient procedure, a colored dye is injected into the patient's arm. A special camera is used to take several photographs of the retina while the dye passes through it. The photographs will show any abnormal fluids in the patient's eye. They will also show what changes have occurred in the retina and where these changes have occurred. These photographs also help the doctor decide whether the patient could benefit from laser treatment. If the wet form of macular degeneration is discovered early enough, laser treatment could prevent severe eye damage for some patients, though laser treatment is not possible for all patients.
Fundus Camera and Autofluorescence (AF)
Autofluorescence imaging of the retina involves capturing fluorescence to detect accumulations of lipofuscin granules in and damage to retinal pigment epithelium cells. (RPE). There are two ways to capture these images. One uses a specialized scanning laser, and the other uses special filters attached to the fundus camera. (A fundus camera or retinal camera is a specialized low power microscope with an attached camera designed to photograph the interior surface of the eye.) Both types are noninvasive.(1.-2.)
Ocular Coherence Tomography — OCT
OCT is a new method of obtaining cross-sectional retinal images. It is a major advancement in the diagnosis and management of retinal conditions. A non-thermal non-burning optical laser is scanned across the retinal surface and produces images of the microscopic layers of the retina. OCT is fast, taking only a few minutes to perform. OCT is non-invasive and no instruments touch the eye. No injections or exposure to painful, high-intensity light is required.
OCT produces images of the retina and ocular tissues that are 10 times superior to Ultrasound B-scan. The program produces precise mapping and monitoring for treatment and management of disease. OCT can be used to study the retina in retinal diseases, and the optic nerve in diseases such as glaucoma and optic neuritis.
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Guttman, Cheryl Fundus autofluorescence imaging useful in AMD, Eurotimes, July 2002.
Vitreous-Retina-Macula Consultants of New York, 2009.