Join NCRA   |  Store  |  NCRA Online Sourcebook  |  FAQ  |  Resource Center  |  Contact Us
Certification & Training

PDC Test - A Brighter Tomorrow

You can earn 0.25 PDC by passing the exam following this article, which has been approved for publication by NCRA's Council of the Academy of Professional Reporters.

The questions are based on the material in the article but some may require additional research. 

Please take these tests online by following the directions on the main JCR Article test page. 


A Brighter Tomorrow

By Janice Coe

At first it’s easy to ignore; hold the menu a little closer or move under a brighter light. If all else fails, buy some “drug store” glasses to help read the fine print. Things are not as clear and crisp as they used to be. It is just one of the signs of getting older; right? With all the wonderful styles of eyewear available, one can bring things into focus while making a fashion statement.

Unfortunately, vision cannot always be improved with corrective lenses. More than 13 million Americans are affected by a condition called age-related macular degeneration. It is the leading cause of significant vision loss in people over the age of 60.

The retina is a layer of tissue at the back of the inner eye that transfers light and images entering the eye into nerve signals to the brain. The macula is a very small portion of the retina. Though it is only about the size of a pencil eraser, the macula is responsible for our central vision. It is heavily concentrated with photoreceptors that serve to sharpen vision and allow more detailed images.

Macular degeneration is a deterioration of the macula. The tissue damage caused by this deterioration can distort the sharp, clear images that the eye would normally transmit to your brain.

The cause of macular degeneration is unknown. However, you may be at higher risk for developing the disease if someone in your family has it. Half of the cases in the United States may be attributed to a genetic predisposition. There are also environmental factors associated with macular degeneration. All races can be affected but the development of macular degeneration is more common in Caucasians. It is also more common in women. People with light-colored eyes are more susceptible because they have less melanin, which protects the retina from ultraviolet light. The likelihood of developing the disease increases with age. Being obese doubles your risk of developing advanced macular degeneration. Other factors that appear to play a significant role in developing macular degeneration include smoking, heart disease, hypertension, high cholesterol, hyperopia, and exposure to sunlight.

Macular degeneration can be detected in a routine eye exam. An ophthalmologist can see yellow deposits of protein called drusen under the retina. When viewing an Amsler grid, a pattern of straight lines resembling a checkerboard, some lines may appear wavy or possibly missing. If a patient exhibits these or any other signs of macular degeneration, the doctor may perform a flourescein angiography in which a dye is injected into a vein in the arm, which travels to the eye. Photographs are taken as the dye flows through the blood vessels of the retina. This test will detail the pattern of the eye’s blood vessels and can detect various abnormalities.

There are two forms of macular degeneration. Most common is the dry form in which drusen forms under the retina. This may cause blurriness and a blank spot or scotoma near the center of vision. Things appear darker and colors become faded or dull. One may have trouble reading, working on the computer, or doing close-up tasks like threading a needle but can see well enough to get around and manage daily activities. With its progression, the blurry spot gradually becomes larger and darker.

There is no treatment for the dry form. However, the National Eye Institute performed a large study called Age-Related Eye Disease Study and found that a combination of vitamins C, E, beta-carotene, zinc, and copper in specified daily amounts can decrease the risk of vision loss in some patients. This is called the AREDS formula.

About 10 percent of dry form cases may develop into the wet form, in which abnormal blood vessels grow underneath the macula. Blood and fluid can leak onto and beneath the retina causing retinal cells to die. This can cause severe central vision loss. Early detection and treatment can help to prevent or slow the progression of vision loss. Treatment for the wet form may include the injection of anti-angiogenic drugs into the eye to block the development of new blood vessels and leakage within the eye. A high-energy laser is used to destroy the growing abnormal blood vessels. Another type of treatment is photodynamic therapy where a light-sensitive drug is injected into the body and absorbed by the abnormal blood vessels in the eye. The drug is activated by a cold laser light, which then damages the abnormal blood vessels.

Macular degeneration cannot be prevented, but with the help of an ophthalmologist, it may be controlled. The earlier the diagnosis, the better the chance that treatments will help. It is important to schedule regular eye evaluations.

Individuals diagnosed with macular degeneration are encouraged to conduct a daily vision check on an Amsler grid and contact their ophthalmologist or retina specialist immediately if the lines appear wavy or if other vision changes are noticed.

While there is no cure for macular degeneration, the risk for developing the disease may be minimized by maintaining a healthy lifestyle. Include dark green leafy vegetables like collard greens, spinach, and kale in your diet, which are high in lutein and help to protect the macula from sun damage. Fish that is high in omega-3 fatty acids decreases inflammation and promotes eye health. Exercise can lower blood pressure and help to maintain a healthy weight. Smokers are two to three times more likely to develop the disease than nonsmokers; yet another reason to stop smoking.

Living with macular degeneration can be a challenge, but there is help available to make the most of your remaining vision. There are devices with special lenses to produce enlarged images of nearby objects. The central vision is diminished by macular degeneration, but the peripheral vision usually is not affected, so there will never be complete vision loss. It may be easier to see an object better by repositioning it slightly to the side or up and down to move it out of the distortion area. Improved lighting and magnification can make a huge difference. A low-vision specialist can assist with modification of routines or everyday activities. With ongoing research to determine the cause of macular degeneration and advancements in treatment for low vision, individuals with the disease have hope for a brighter future.

Janice Coe, RPR, CRI
This article was published in the September 2012 JCR

Macular Degeneration: A Complete Guide for Patients and Their Families, Basic Health Publications, Laguna Beach, California, 2008; Michael A. Samuel, M.D.


Questions for A Brighter Tomorrow PDC Test

Most of the answers to the questions will be found in the article. However, for some questions, it will be necessary to consult other resources. You can take this test online.

  1. Obesity and high blood pressure are risk factors for the disease. 
    (A) true
    (B) false
  2. Small yellow protein deposits that form under the retina are called 
    (A) lutein 
    (B) plaque 
    (C) drusen 
    (D) drainage
  3. About 10 out of 100 patients with the dry form of the disease develop into the wet form. 
    (A) true
    (B) false
  4. The leading cause of severe vision loss in people over age 60 is 
    (A) retinal translocation 
    (B) glaucoma 
    (C) retinitis pigmentosa 
    (D) macular degeneration
  5. The macula is highly concentrated with 
    (A) pigments 
    (B) photoreceptors 
    (C) drusen 
    (D) neovasculars
  6. The causes of age-related macular degeneration are unknown. 
    (A) true 
    (B) false
  7. A risk factor associated with macular degeneration is farsightedness or 
    (A) presbyopia 
    (B) myopia 
    (C) hyperopia 
    (D) keratotomy
  8. Your doctor may have you look at a pattern of straight lines that resembles a checkerboard; this is called 
    (A) angiography 
    (B) optical coherence 
    (C) tomography 
    (D) Amsler grid
  9. Smokers are two to three times more likely to develop macular degeneration than nonsmokers. 
    (A) true 
    (B) false
  10. A genetic predisposition may account for 50 percent of cases of age-related macular degeneration in this country.
    (A) true 
    (B) false
  11. Macular degeneration can be detected at a regular eye exam. 
    (A) true
    (B) false
  12. Macular degeneration cannot be prevented but may be controlled with the help of your 
    (A) optician 
    (B) blepharologist 
    (C) ophthalmologist 
    (D) otoscopist
  13. The AREDS study suggests supplementation with antioxidants and 
    (A) Q10 
    (B) vitamin B 
    (C) zinc 
    (D) all of the above
  14. Macular degeneration alone almost never causes complete blindness. 
    (A) true
    (B) false
  15. A symptom of macular degeneration is 
    (A) blurriness 
    (B) straight lines appear wavy 
    (C) faded colors 
    (D) all of the above
  16. Anti-angiogenic drugs that block the development of new blood vessels and leakage from the abnormal vessels within the eye are 
    (A) injected in the eye 
    (B) vitamin B 
    (C) beta-carotene 
    (D) all of the above
  17. A light activates a drug that is injected into your body to destroy leaking blood vessels in 
    (A) laser surgery 
    (B) photodynamic therapy 
    (C) angiotherapy 
    (D) retinal therapy
  18. If you are diagnosed with the wet form, it is important to see a 
    (A) retina specialist 
    (B) peripheral specialist 
    (C) iris specialist 
    (D) all of the above
  19. Consumption of fish high in omega-3 fatty acids helps decrease inflammation and promote eye health. 
    (A) true
    (B) false
  20. The disease is more common in 
    (A) women 
    (B) men 
    (C) Asians 
    (D) all of the above