Ask an Expert about Macular Degeneration

Yes, some people with macular degeneration also develop Charles Bonnet Syndrome (CBS) and hallucinate. Some eye diseases prevent normal nerve impulses from reaching the brain, and it is believed that spontaneous, brain-generated nerve activity may cause visual hallucinations. CBS appears to be more common in women than men and is more likely to occur if both eyes are affected by disease. The hallucinations are normally complex and can include detailed patterns or fully formed images such as animals, people, faces or scenery. Patients know that the hallucinations are not real. These images are not associated with any other sensory (e.g., sound or odor) hallucinations, nor are they delusions. The hallucinations may last for seconds or for most of the day. They tend to disappear when people close their eyes. CBS may last for days or even years, but can be managed by educating the patient and reassuring him or her that the images are a result of eye disease, not a mental disorder.

• View a video of neurologist and author, Dr. Oliver Sacks, discussing Charles Bonnet Syndrome.

The BrightFocus Macular Degeneration Research website goes into greater depth on many of the above topics and covers additional areas of concern, both medical and social. You can learn where to get help and access to resources, as well as download free publications. And explore our Ask an Expert section where you can read or post queries to doctors.

Visit www.childrenscorner.org for information for all members of the family, with stories, games, and other interactive learning tools.

For more information dealing with the topics below, please visit the helpful organizations section of our website. 

• Clinical Trials
• Organizations of Eye-care Professionals
• Federal Government Programs and Services
• General Information, Resources and Referrals
• Legal Assistance
• Low Vision Aid Resources
• Low Vision Organizations
• Print and Audio Materials for the Visually Impaired
• Senior Housing
• State and Local Resources

Researchers continue to explore environmental, genetic and dietary factors that may contribute to developing AMD. New treatment strategies are also being explored, including retinal cell transplants, drugs to prevent or slow down the progress of the disease, radiation therapy, gene therapies, a computer chip implanted in the retina (may help simulate vision) and agents to prevent the growth of new blood vessels under the macula.

Ultraviolet (or UV) light can be a concern for persons with macular degeneration, and care should be taken to avoid it. While sunlight is the most common source, UV lighting can be derived from other sources (including the light emitted by tanning beds). In addition, there has been some suggestion, though it’s currently under debate by experts, that the retinal pigment epithelium (RPE) cell layer in the retina can be damaged by a process called oxidative stress due to exposure to a part of the visual spectrum, called “blue light” (that can be emitted in small amounts by some electronic devices, like cell phones, tablets, and computers, and energy-efficient fluorescent light bulbs and LED lights). However, whether this poses an increased risk for macular degeneration has not yet been determined.

Information specific to the UV emission of a particular bulb should be available on the packaging or can be found on the specific manufacturer’s website; that is the best source for the most accurate information specific to your particular brand and design of bulb.

It should be noted that some people are at greater risk for eye damage from the sun, including those who are taking drugs that make the skin (and eyes) more sensitive to light. In addition, the risk of eye damage also increases in those who do not properly protect their eyes against light from tanning beds, snowfields, arc welding, or solar eclipses.

For more information on UV light safety and your eyes, please visit the following websites from the American Academy for Ophthalmology and the National Eye Institute:

• http://www.aao.org/newsroom/release/20090601a.cfm
• http://www.geteyesmart.org/eyesmart/living/sun.cfm
• http://www.aao.org/eyecare/tmp/Sunglasses.cfm
• http://www.nei.nih.gov/healthyeyes/eyehealthtips.asp
• http://www.nei.nih.gov/health/healthyeyes/index.asp

Wet age-related macular degeneration (ARMD) can cause vision loss for a variety of reasons, but most of these reasons are not treated with surgery. The prognosis and visual recovery depend on the exact reason why the wet ARMD caused vision loss, and exactly what surgery is being done. These questions are best directed toward your retina specialist, as the amount of damage done to the retina by wet ARMD, both acutely and chronically, can widely affect the possibility for visual recovery down the road.

• Read more about macular degeneration treatment.

Avastin is a commonly used therapy for new blood vessels growing from myopic macular degeneration. Avastin injections have been evaluated for safety in multiple studies for a number of eye diseases. Blank spots in vision are not a commonly reported side effect of Avastin eye injections. Likewise, increased retinal atrophy has not been reported as a side effect of this drug. Your blank spots could be from progression of the myopic macular degeneration. Another possibility is that the Avastin caused regression of the new blood vessels, and this may have contributed to your perception of increased blank spots. Due to this reason, future injections may lead to further worsening of the blank spots, so please discuss this possibility with your managing retina specialist. Conversely, the blank spots may worsen without injections as well depending on their cause.

No link has been established between high elevation and progression of dry age-related macular degeneration (ARMD). The only environmental factor that has strong association with ARMD is cigarette smoking.

Your symptoms could be caused from a variety of conditions, some benign and some vision threatening. However, the vast majority of both types of conditions would be detected on an exam. For example, a scratched cornea can usually be picked up on an exam. AREDS vitamins have only been shown to be beneficial for patients with a certain type of age-related macular degeneration (ARMD). If you do not have ARMD, the oral supplements may be of unclear benefit. You may find value from a second opinion by a retina specialist especially if you have swelling near the macular or retinal blood vessel changes. Please take your records from your first exam to your second opinion appointment.