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Macular Degeneration

Macular Degeneration

As a disease usually associated with aging and poor circulation, macular degeneration is also called age-related macular degeneration (ARMD), though there are other, less common types of macular degeneration.

Macular degeneration symptoms include a gradual loss of central vision needed to see details and also a distortion or blindspot(s) in the central vision. This affects a person’s ability perform everyday tasks like driving or reading, and a reduced ability to see facial detail. However, it does NOT cause complete loss of vision as the peripheral (side) vision is NOT affected.

Age-related macular degeneration is the leading cause of vision loss in Americans over age 60, and because older people represent an increasingly larger percentage of the general population, vision loss associated with macular degeneration is a growing problem. Caucasians are far more likely to lose vision from ARMD than African Americans, and studies show that obesity, smoking, and exposure to UV rays may also be risk factors for developing the disease. Macular degeneration tends to affect women more than men, and has also been linked to heredity.

It presents itself in two forms: dry macular degeneration and wet macular degeneration. Of the two, the “dry” form is far more common. Both affect the center region of the retina, the light-sensitive area in the back of the eye responsible for processing images we see.

Macular degeneration (also called AMD, ARMD, or age-related macular degeneration) is an age-related condition in which the most sensitive and central part of the retina, called the macula, starts to break down and lose its ability to create clear visual images due to poor circulation and accumulation of waste products.

Forms of Macular Degeneration
Dry macular degeneration (non-neovascular) symptoms include: blurred or distorted vision within your central visual field. Eventually it leads to a blind spot in the center of the vision. One may have difficulty in recognizing faces, or have a sudden need for more light while reading or working. The dry form of this disease gets worse slowly and is more of a gradual atrophy of the macular area.

Wet macular degeneration (neovascular) symptoms include: blurred vision and distortion or even a blind spot which comes on more suddenly. Neovascular refers to growth of new blood vessels in an area, such as the macula, where they are not supposed to be. New blood vessels grow beneath the retina and leak blood and fluid. This leakage causes permanent damage to light-sensitive cells in the retina, causing blind spots or a total loss of central vision. The abnormal blood vessel growth in wet AMD is the body’s misguided attempt to create a new network of blood vessels to supply more nutrients and oxygen to the macula, but the process, instead, creates scarring and central vision loss.

A major study conducted by the National Eye Institute (NEI) looked into the risk factors for developing macular degeneration and cataracts. The study, called the Age-Related Eye Disease Study (AREDS), showed that certain vitamins/supplements may help to slow progression of macular degeneration. A more updated version of the vitamin formula-the AREDS 2 formula- is the currently recommended combination of vitamins recommended for macular degeneration sufferers. This will not reverse damage that has already occurred, but it may help to slow down progression.

Wet macular degeneration can be treated with injections of medication that helps to block the neovascularization and help the body re-absorb fluid that can lead to damage of the macula. Early detection is critical to the success of this form of treatment.

Risk Factors for Macular Degeneration
Age is the most prominent risk factor for AMD, as the disease is most common in individuals over the age of 60 (although it can happen in younger individuals as well). Other risk factors can increase your chances of developing the disease such as:

  • Genetics and Family History: Research shows that there are actually almost 20 genes that have been linked to AMD, and they suspect that there are many more genetic factors to be discovered. Family history greatly increases your chances of developing AMD.
  • Race: Caucasians are more likely to get AMD than Hispanics or African-Americans.
  • Smoking: Cigarette smoking can double your likelihood of developing AMD.
  • Lifestyle: Research shows that UV exposure, poor nutrition, high blood pressure, obesity and a sedentary lifestyle can also be contributing factors.
  • Gender: Females have a higher incidence of AMD than males.
  • Medications: Certain medications may increase the chances of developing AMD.
  • To reduce your risks of developing AMD it is recommended to make healthy choices such as:
    Regular eye exams; once a year especially if you are 50 or over.
    Stop smoking.
    Know your family history and inform your eye doctor.
  • Proper nutrition and regular exercise: Research indicates that a healthy diet rich in “Eyefoods” with key nutrients for the eyes such as orange peppers, kale and spinach as well as regular exercise may reduce your risks or slow the progression of AMD.
  • Maintain healthy blood pressure, blood sugar and cholesterol levels.
  • Dietary supplements: Studies by the National Eye Institute called AREDs and ARED2 indicated that a high dosage of supplements of zinc, vitamin C, vitamin E and lutein may slow the progression of advanced dry AMD (it is not recommended for those without AMD or early AMD). Speak to a doctor before taking these supplements because there may be associated risks involved.
  • Wear 99% -100% UV-blocking sunglasses.

The first step to eye health is awareness. By knowing your risk, taking preventative measures and visiting your eye doctor on a regular basis, you can greatly reduce your chances of facing this debilitating disease.

Treatment of Macular Degeneration
There is as yet no outright cure for macular degeneration, but some treatments may delay its progression or even improve vision. There are no FDA-approved treatments for dry macular degeneration, although nutritional intervention may be valuable in preventing its progression to the more advanced, wet form.

For wet macular degeneration, there are several FDA-approved drugs aimed at stopping abnormal blood vessel growth and vision loss from the disease. In some cases, laser treatment of the retina may be recommended. Ask your eye doctor for details about the latest treatment options for wet macular degeneration.

Testing and low vision devices
Although much progress has been made recently in macular degeneration treatment, complete recovery of vision related vision loss is probably unlikely. Your eye doctor may ask you to check your vision regularly with an Amsler grid – a small chart of thin black lines arranged in a grid pattern. Macular degeneration causes the line on the grid to appear wavy, distorted or broken. Viewing the Amsler grid separately with each eye helps you monitor your vision loss.

If you have already suffered vision loss from macular degeneration, low vision devices including high magnification reading glasses or magnifiers, telescopes or electronic magnifiers/reading machines may help you achieve better visual function. Please ask to have a low vision evaluation if your doctor has not already recommended it.