But there might be nothing wrong with the weather or the printing quality of that novel you’re reading; it may be problems with your eyes.

Diseases such as age-related macular degeneration (AMD), macular puckering, or cataracts may be the culprit.

Both AMD and macular puckering are diseases of the retina—the lining of the inside of your eyes.

“It’s like the film inside a camera,” explains Gary S. Kirman, O.D., of Hummelstown. “

The retina is responsible for receiving light that is focused by the cornea (the clear front surface of the eye) and the lens (inside the eye). The retina then processes the light into an image that is transferred to the brain via the optic nerve.” According to Kirman, retinal problems need prompt attention to aid in the healing process since retinal tissue does not naturally regenerate.

“The macula is a very specialized portion of the retina,” he says. “It provides us with our best sighting vision and is responsible for most of our color perception. If you think of the retina as a target, the macula would be the bull’s eye of the retina. The retina is 10 cell layers thick, but only the thickness of tissue paper in total.”

Age-Related Macular Degeneration (AMD)

There are two forms of AMD: “dry” AMD and “wet” AMD, according to Lawrence Y. Ho, M.D., of Pennsylvania Retina Specialists, P.C., with offices in Lancaster, York, Hershey, State College, and Camp Hill. It is a leading cause of central vision loss in people over 50.

“The ‘wet’ form of AMD, or neovascular AMD, results in vision loss from new, abnormal blood-vessel growth under the retina, which bleed or leak fluid into the macula,” Ho says.

According to Kirman, this leaking of blood can happen at any time, and central vision loss can occur very rapidly and be permanent if not treated immediately.

Dry AMD is an atrophy of the macular tissue that occurs as a result of restriction of nutrients to the sensitive macular tissue, says Kirman. When that tissue is disrupted, there is a visible distortion and blur of the central vision; straight lines become wavy or broken.

“The disease is generally slowly progressive, impairing more and more of a patient’s central vision,” Kirman says. “Night-vision impairment is an early warning sign of AMD. Dry AMD may convert later in the disease process to wet AMD.”

There are risk factors that contribute to AMD, including smoking, ultraviolet light exposure, high cholesterol, high blood pressure, diabetes, and heredity. About 85 percent of AMD cases are of the dry type, and 15 percent are the wet type.

Macular Pucker

A macular pucker is the development of a semi-translucent fibrocellular tissue that has formed on the surface of the retina inside of the eye. The disease gets its name due to the wrinkling or puckering of the inner layers of the retina as a result of fluid accumulation between the cell layers of the macula.

Other names for a macular pucker that you may hear upon visiting your doctor include epiretinal membrane or ERM, surface wrinkling retinopathy, cellophane maculopathy, preretinal membrane, or preretinal macular fibrosis, says Ho.

“The location of this membrane is over the macula, which is the area of the retina responsible for your central visual acuity,” Ho adds.

“Many patients do not have any symptoms when the membrane initially forms, but if it progresses, patients will usually complain of blurry central vision, distortion of images, monocular diplopia, and misropsia, where images appear smaller than normal.”

While a person’s average age of diagnosis of a macular pucker is 65 years old—and the condition can be age related and from a separation of the vitreous from the back of the eye—there are other factors that come into play, according to Ho.

The condition can also develop with a history of trauma, retinal vascular diseases, ocular inflammation, retinal tears or detachments, or after intraocular surgery. “Increased lighting is helpful to improve vision,” says Kirman. “Most times the distorted vision is not improved with new glasses.”

Cataracts

Most of us have heard of or have already had cataracts. It’s part of the natural aging process of the lens inside our eyes.

“It is like the old plexiglass rear windows of the old convertible cars made in the ’60s and ’70s,” Kirman explains. “When you bought the car, the window was clear, but a decade later the window was yellowed and clouded.”

The symptoms to watch out for include poor vision at night, glare from headlights, and difficulty reading or watching television. Often, a glasses prescription will change due to the hardening of the lens.

“There are several types of cataracts, but the most common is called a nuclear sclerotic cataract,” says Erik Chotiner, M.D. F.AC.S., a fellowship-trained corneal, cataract, and refractive surgeon at Memorial Eye Institute in Harrisburg. “This type typically develops slowly as we age.”

According to Chotiner, cataracts are monitored in their early stages with yearly exams as long as the patient’s visual needs are adequate.

Treatment

Dry AMD is treated using high-dose multivitamins formulated specifically for the retina, says Kirman. Studies proved the effectiveness of vitamin therapy to reduce the progression of dry AMD.

“Early detection of dry AMD is very important so that vitamin therapy can be initiated for the patient,” Kirman says.

Specifically, these studies showed that mineral and antioxidant supplementation may reduce the risk of progression for certain types of dry AMD along with vitamins such as vitamin C, vitamin E, beta-carotine, zinc, and copper.

“If a patient is a current smoker, we advise that they should not take beta-carotine as this may slightly increase the risk of lung cancer in these patients,” Chotiner says. “These vitamins are available in prepackaged commercial forms.”

Patients with wet AMD are treated with intravitreal injections, which are given into the eye during a routine office visit. The eye is anesthetized and disinfected with antiseptic medication to minimize discomfort and risk of infection.

“These injections are usually given at time intervals, ranging from every month to three months based on disease activity,” Ho says.

According to Chotiner, cataract surgery is an outpatient procedure performed under topical anesthesia that is one of the safest and most beneficial surgeries in all of medicine. There are no stitches, and patients see improved vision as early as the day after surgery.

The newest advancement in the treatment of cataracts involves the use of femtosecond lasers to remove the cataract and treat corneal refractive errors to help patients see better without glasses, says Chotiner.

There are also new intraocular lens implants now available that may give patients the ability to see at all distances without glasses.

“Modern cataract surgery has merged in many ways with refractive surgery, as many of our cataract patients want not only to have their cataracts removed, but also the ability to see without glasses after cataract surgery,” Chotiner says.

Technology and medical advances have enabled us to maintain our vision, despite our age. Remember the song “I Can See Clearly Now”? Now we can say we can!