THOMAS L. LAWRENCE, M.D. Dr. Lawrence is an outstanding ophthalmologist specializing in MACULAR state-of-the-art cataract surgery and laser vision correction as well as glaucoma and general DEGENERATION ophthalmology. He graduated with Age Related Macular Degeneration highest honors from Wheaton College and received his medical AMD degree from the University of Texas Medical Branch in Galveston where he graduated in the top five percent of his class. Following his internship at Baylor College of Medicine, Dr. Lawrence completed his ophthalmology residency at the University of Texas Medical Branch in Galveston. After practicing for 5 years at the world renowned St. Lukes Cataract and Laser Institute in Tarpon Springs, Florida, Dr. Lawrence came to Tallahassee in 1998. He performs state-of-the-art no needle, no stitch, no patch, small incision cataract surgery with optional astigmatism correction and distance/near premium implants. Dr. Lawrence loves Tallahassee and enjoys tennis, hunting and golf. Married to his wife, Penny, more than 40 years, they treasure their 2 daughters, 7 grandchildren, and one great-granddaughter. Preaching at his church on occasion, you will find Dr. Lawrence to be relaxed, informative and A Deterioration of the Retina personable. Which Causes Poor Central Vision Thomas L. Lawrence, M.D. EYES 4 YO U a ~~~, I

Apalachee Pkwy. Hwy. 27 (850) 942-EYES 3401 Capital Medical Blvd. 3401 Capital Medical Blvd. www.tomlawrencemd.com Tallahassee, FL 32308 (850) 942-3937 www.tomlawrencemd.com acular degeneration (also called age What is the macula? related macular degeneration or The macula is a very small area of the M AMD) is the leading cause of im­ retina which is responsible for cent~ vision paired reading or detailed vision. It is caused and color vision. The macula allows u to read, by the breakdown of the macula, the central drive, and perform detailed work. Su.rround­ portion of the retina. Although macular ing the macula is the peripheral retina which is degeneration causes distortion of central and responsible for side vision and night vision. color vision, side vision is not affected. What causes macular degeneration? What is the retina? Macular degeneration is most commonly The retina is the thin layer of light-sensitive a natural result of the aging process. With tissue which serves as the inner lining of the time, the retinal tissues break down, causing a eye. When light enters the eye, it is focused loss of function of the macula. Smoking, by the cornea and the lens onto the retina. obesity, high blood pressure, family history The retina then transforms the light images and poor diet are known to increase the risk of into electrical impulses which are sent to the developing AMD. brain through the optic nerve. 90% of AMD patients only have early Macula or dry AMD. However, about 10% of the (point of central cases develop into wet AMD where aging of Cornea vision) the retina is compounded by leakage of the tiny blood vessels which nourish the retina. Growth of new, abnormal blood vessels in the scar tissue that forms from the leaking blood vessels occurs. The abnormal vessels, leak blood and fluid which destroy the macula and together with the dense scar tissue cause central vision to become blocked, distorted and blurred. Occasionally, macular Optic degeneration is caused by injury, infection, or Nerve inflammation.

Focusing Retina What are the symptoms of Lens macular degeneration? The retina transforms light images into electrical The most notable symptom of macular impulses which are sent to the brain via degeneration is blurry or distorted central the optic nerve. Drusen (yellowish deposits vision. Difficulty in reading, doing close work, in the retina) can be an indication of macular or driving may also be noticed. A person with degeneration. macular degeneration may experience blurry words on a page, distortion of the center of supplemented with vitamins high in specific Low vision aids antioxidants (A, C, E and beta-carotene with People who suffer from macular degenera­ zinc), can significantly reduce the risk of tion are able to compensate for some of their advanced AMD and its associated vision loss. vision loss through the use of low vision aids. Laser treatments and NEW medications Many sophisticated magnifying devices, as can slow vision loss from AMD and in some well as spectacles and hand or stand magnifi- 0 cases improve sight. ers, are available. Bright illumi- ~ nation for reading and \. i • Cl Laser treatments can seal leaky blood other close work can also } vessels to reduce hemorrhaging and scarring be helpful. Books, news- F that decrease central vision. papers, and other ~ Anti-VEGF Therapy: Recent research materials are .Ii] -0 shows the presence of vascular endothelial available in / • .- i growth factor type A (VEGF-A) stimulates large print. ••. * the growth of blood vessels in patients with ..... i!l wet AMD. The presence of these new ? ~ Low vision aids assist many patients with macular ~ degeneration in leading comfortable, normal lives ~ with few interruptions of regular activities. I ... Prevention is the best medicine ~. ~ Regular eye examinations are important ! in detecting macular degeneration, as the ~ symptoms of the disease often go unnoticed. ~ Early detection of macular degeneration may ~ Distortion of central vision is a common prevent further vision loss, since treatment is i symptom of macular degeneration. Laser only effective when started early. Regular ~ treatment and new medications can slow vision examinations are especially important for .f loss and in some cases, improve sight. older adults and persons who have family l members with a history of retinal problems. j abnormal blood vessels impairs vision. New . If you are experiencing difficulty with ~ anti-VEGF-A medication regimens, like central or color vision, or have other vision 1 Lucentis, Macugen and Avastin, inhibit problems, you should obtain a complete eye ~ VEGF-A, reduce new vessel growth and examination. P.. result in improved vision. Other research is providing treatments that include implantable devices to deliver a controlled release of a drug over an extended period of time. Normal AMD I acular degeneration is detect edure called flunrescein angiogr ----..,_ v,.__ be .. t,,ne to tor blood v t-----, ge. Ad L---- - \ ) '~') ~=z-, I IT j ~ \ I e retin '/ ~\ extent ol ..t.•• er ima .----..,._ ·q1Je; like OIP4lalll erence to y (~ may al'..-- be used t agnosis or to monitor progressi Macular degeneration may cause words in the center of a page to Amsler Grid: When a patient looks at the black dot in the center of the appear blurry. Amsler Grid with one eye closed, damaged areas of the retina may cause the appearance offaded spots or wavy lines.

a scene, a dark or empty area in the center of if the patient cannot detect symbols or letters vision, or the distortion of lines. camouflaged in colored patterns. Macular degeneration may also cause a If macular degeneration is detected, a pro­ dimming of color vision. Fortunately, the cedure called fluorescein angiography may disease does not cause total blindness, as side be done to check for blood vessel leakage. vision is not affected. Macular degeneration A dye, which quickly travels to the eye, is in­ only affects central and color vision. However, jected into the patient's arm. Photographs if macular degeneration occurs in only one of the blood vessels in the retina are then eye, the symptoms of the disease may not be taken to determine the extent of damage. noticed, as the "good" eye compensates for the Other imaging ' . "bad" eye. techniques like optical coher­ ~:~--c.--~~;;r,n>t~ How is macular degeneration ence tomogra­ OCT of Normal Macula diagnosed? phy (OCT) can A lighted instrument called an ophthalmo­ be used to aid in diagnosis or monitoring the scope is used to examine the retina. The progression of AMD. appearance, size and quantity of drusen may be an indication of AMD. In addition, some How is macular degeneration treated? special tests may be administered. The Amsler Unfortunately, there is no cure for macular Grid test, in which the patient looks at a page degeneration. However, a healthy lifestyle similar to graph paper, is used to detect blind can be important in reducing the risk spots or distortion of central vision. A color of developing AMD. A healthy diet rich vision test will indicate damage to the macula m green leafy vegetables and fish,