To learn more macular degeneration read our Questions & Answers about Macular Degeneration.

Who is Right for Laser Eye Surgery? While many individuals are considered good candidates for LASIK, there are some who do not meet the generally accepted medical criteria to ensure a successful laser vision procedure. Individuals that are not deemed good candidates given today’s technology may be able to have the surgery in the future, as technology advances and new techniques are refined. Anyone considering laser eye surgery must have a thorough examination by an ophthalmologist that will help determine, in consultation with the patient, whether or not the LASIK procedure is right for them. Based on various conditions and circumstances, all LASIK candidates will fall into one of the following three broad categories.

The Ideal LASIK Candidate

The ideal candidate includes those who:

• Are over 18 years of age and have had a stable glasses or contact lens prescription for at least two years.
• Have sufficient corneal thickness (the cornea is the trans-parent front part of the eye). A LASIK patient should have a cornea that is thick enough to allow the surgeon to safely create a clean corneal flap of appropriate depth.
• Are affected by one of the common types of vision problems or refractive error – myopia (nearsightedness), astigmatism (blurred vision caused by an irregular shaped cornea), hyperopia (farsightedness), or a combination thereof (e.g., myopia with astigmatism). Several lasers are now approved by the U.S. Food and Drug Administration (FDA) as safe and effective for use in LASIK, but the scope of each laser’s approved indication and treatment range is limited to specified degrees of refractive error.
• Do not suffer from any disease, vision-related or otherwise, that may reduce the effectiveness of the surgery or the patient’s ability to heal properly and quickly. • Are adequately informed about the benefits and risks of the procedure. Candidates should thoroughly discuss the procedure with their physicians and understand that for most people, the goal of refractive surgery should be the reduction of dependency on glasses and contact lenses, not their complete elimination.

The ‘Less Than Ideal’

LASIK Candidate Sometimes, factors exist that preclude a candidate from being ideal for LASIK surgery. In many cases, a surgeon may still be able to perform the procedure safely, given that the candidate and physician have adequately dis-cussed the benefits and risks, and set realistic expectations for the results. Candidates in this category include those who:

• Have a history of dry eyes, as they may find that the condition worsens following surgery.
• Are being treated with medications such as steroids or immunosuppressant, which can prevent healing, or are suffering from diseases that slow healing, such as autoimmune disorders.
• Have scarring of the cornea.

More often, factors exist that may keep an individual from being a candidate immediately, but do not preclude the individual from being a candidate entirely. Candidates in this category include those who:

• Are under age 18.
• Have unstable vision, which usually occurs in young people. Doctors recommend that, prior to undergoing LASIK, candidates’ vision has stabilized with a consistent glasses or contact lens prescription for at least two years.
• Are pregnant or nursing.
• Have a history of ocular herpes within one year prior to having the surgery. Once a year has passed from initial diagnosis of the disease, surgery can be considered.
• Have refractive errors too severe for treatment with current technology. Although FDA-approved lasers are available to treat each of the three major types of refractive error – myopia, hyperopia and astigmatism – cur-rent FDA-approved indications define appropriate candidates as those with myopia up to -12 D, astigmatism up to 6 D and hyperopia up to +6 D. However, laser eye surgery technology is evolving rapidly, and doctors may be able to treat more severe errors in the future.

The Non-LASIK Candidate

Certain conditions and circumstances completely pre-clude individuals from being candidates for LASIK surgery. Non-candidates include individuals who:

• Have diseases such as cataracts, advanced glaucoma, corneal diseases, corneal thinning disorders (keratoconus or pellucid marginal degeneration), or certain other pre-existing eye diseases that affect or threaten vision.
• Do not give informed consent. It is absolutely necessary that candidates adequately discuss the procedure and its benefits and risks with their surgeon, and provide the appropriate consent prior to undergoing the surgery.
• Have unrealistic expectations. It is critical for candidates to understand that laser eye surgery, as all surgical procedures, involves some risk. In addition, both the final outcome of surgery and the rate of healing vary from person to person and even from eye to eye in each individual.

Macular degeneration is a disorder of the retina, the light-sensitive inner lining of the back of the eye. The macula is a small, central portion of the retina which is necessary for sharp, “straight ahead” vision needed for reading, driving a car or recognizing faces.

There are a number of abnormalities associated with the term “age-related macular degeneration.” They range FROM mild changes with no decrease in vision to abnormalities severe enough to result in the loss of all “straight ahead” vision. Macular degeneration does not cause total blindness because the remaining and undamaged parts of the retina around the macula continue to provide “side” vision.

There are two main types of macular degeneration, “dry” and “wet,” which are discussed in the next section.

Signs and Symptoms
Aging causes the cells in the retina to become less efficient. Ultimately, deposits called drusen appear under the retina and can be seen during an eye examination and on photographs of the retina. A few small drusen may cause no decrease in vision. However, if many large drusen develop, vision may be decreased. Vision may be affected when there are pigment disturbances in the layer of cells called the retinal pigment epithelium. These two types of changes in the macula are known as “dry” macular degeneration, which is the most common form. Currently, there is no known treatment for dry AMD.

A few people experience the “wet” form of macular degeneration which can cause more severe visual loss. In this situation, abnormal blood vessels grow beneath the retina and result in bleeding and leakage of fluid. Vision may suddenly become distorted or blurred. In some cases of wet macular degeneration, laser treatment can be effective at destroying the abnormal vessels, thus preventing or slowing further visual loss. Wet macular degeneration cannot always be treated successfully by laser, however, some experimental drugs and surgical procedures are being tested.

FAMILY GENETIC STUDY OF AGE-RELATED MACULAR DEGENERATION
The Massachusetts Eye & Ear Infirmary and Harvard Medical School, Boston, MA, USA with the generous support of the National Eye Institute of the National Institutes of Health, need volunteers for a research study INTO the causes of age-related macular degeneration (AMD).

There is evidence that AMD runs in families. However, the exact nature of this familial tendency has not been clarified. The goal of this study is to determine whether there is an underlying gene or genes that predispose people to develop AMD. These genes will also be identified.

In this new project, researchers hope to discover how to identify people at risk of developing AMD and to explore new ways of preventing the disorder. Families are needed to participate in this study.

Participants can be seen by an ophthalmologist near their home and do not need to travel to Boston.