Ask an Expert: Dr. Essence Johnson Talks MD Diagnosis

Essence Johnson, OD, FAAO, is a Fellow of the American Academy of Optometry and a diplomate of the American Board of Optometry. Inside and outside of the office, Dr. Johnson is a committed champion, ambassador, and educator of diversity, equity, and inclusion.

In this article, Dr. Johnson answers a few questions about macular degeneration (MD), from diagnosis to symptoms and treatment. Stay tuned for the second half of this "Ask an Expert" interview, coming soon!

Q: If someone is diagnosed with macular degeneration, what questions should they ask their eye doctor?

Dr. Johnson: If you or someone you know is diagnosed with macular degeneration, here are some questions to ask your eye care provider:

• What type of macular degeneration do I have (dry or wet)?
• What stage of macular degeneration am I in?
• What are the expected effects and progression of my condition?
• What lifestyle changes can I make to manage or slow down the progression of macular degeneration?
• Are there any specific dietary recommendations or nutritional supplements that may help?
• What treatment options are available for my specific case of macular degeneration?
• What are the potential risks, benefits, and side effects of each treatment option?
• How frequently should I come in for eye exams and monitoring?
• Are there any low-vision aids or devices that could help me in my daily activities?
• Are there any support groups or resources you recommend for people with macular degeneration?

Q: How does macular degeneration typically come up in a scan?

Dr. Johnson: Your eye care provider may explain that macular degeneration typically shows up as changes in the appearance of the macula (the part of the retina with the most light-sensitive cells), such as:

• The presence of drusen (yellow deposits under the retina)
• Pigment changes
• Atrophy (thinning) of the retinal tissue
• Abnormal blood vessels
• Bleeding, in the case of wet macular degeneration

Macular degeneration is usually detected during a comprehensive eye exam, which may include the following tests (along with how I explain each to my patients):

• Visual acuity (VA) test – Measures the quality or sharpness of your vision.
• Amsler grid test – Helps detect distortion or wavy lines in your central vision.
• Dilated fundus exam (DFE) – The eye doctor uses eye drops to dilate the pupils, allowing a better view of the retina and macula.
• Fundus photography – Detailed photos or images of the retina, which can be used to monitor changes over time.
• Optical coherence tomography (OCT) – A non-invasive scan of the eye that provides high-resolution, cross-sectional images of the retina, allowing the eye doctor to assess the retinal layers and detect any abnormalities.
• Fluorescein angiography (FA) – A diagnostic procedure that involves injecting a fluorescent dye into the bloodstream, followed by taking a series of photographs of the retina. This test helps identify any leaking blood vessels or abnormal blood vessel growth in the macula.

Q: Are symptoms such as flashes/floaters a sign of early MD? Are they generally dangerous?

Dr. Johnson: Flashes and floaters are not typical symptoms of early macular degeneration. They are more commonly associated with posterior vitreous detachment (PVD), retinal tears, or retinal detachment.¹

Flashes occur when the vitreous gel inside the eye pulls on the retina, causing the sensation of flashing lights. Floaters are small specks or cobweb-like shapes that appear in your field of vision, caused by small clumps of cells or protein in the vitreous gel.²

Flashes and floaters can be a normal part of the aging process and are generally not dangerous. But a sudden increase in their number or intensity, or the appearance of a dark "curtain" or shadow in your peripheral vision, could be signs of a more serious issue, such as a retinal tear or detachment. In such cases, it is essential to seek immediate medical attention, as prompt treatment can help prevent permanent vision loss.²

Check out the second installment of this "Ask an Expert" series here.

Do you have questions for Dr. Johnson about macular degeneration diagnosis or signs and symptoms that she sees most commonly in her patients? Share with us in the comments below!