Medical Eye Care

What is macular degeneration?

Age-Related Macular Degeneration (AMD) is the most common cause of severe
vision loss in older Americans. AMD is damage or breakdown of the macula of the
eye. The macula is the central part of the retina responsible for high-resolution
vision and is critical for reading, driving, and other activities of daily living. It allows
us to recognize the details in life.

When the macula doesn't function correctly, we experience blurriness or darkness
in the center of our vision. Macular degeneration can make some activities, like
threading a needle or reading, very difficult or impossible. Early symptoms include
blurred or distorted vision. A common complaint is that straight lines appear wavy
or slanted. A dilated eye exam can often detect signs of macular degeneration
before any loss of vision occurs. This is one of the reasons a yearly dilated eye

exam is recommended at 50 years of age. Sometimes macular degeneration runs
in families. Make sure not to wait until you are 50 for an eye exam if this is true for
you.

What causes macular degeneration?

The exact cause of dry macular degeneration is unknown. Risk factors for AMD
include age, smoking, family history of macular degeneration, gender (females are
more likely to be affected by age-related macular degeneration), race (Caucasians
are more likely to be affected by age-related macular degeneration than other
races), prolonged sun exposure, a high fat diet, and/or one that is low in nutrients
and antioxidants, obesity, high blood pressure, and light colored eyes. There are
two forms of AMD: dry and wet. The dry form of AMD is more common and self
limiting.

Dry macular degeneration

Vision loss is usually gradual, and is generally not severe. It is caused by aging and
thinning of the macula and is characterized by the presence of small, yellowish
deposits under the retina, called drusen.

Wet macular degeneration?

Wet macular degeneration accounts for about 10% of all cases. It is caused by the
growth of abnormal blood vessels underneath the retina that leak fluid or blood.
Vision loss may be rapid and severe. Current treatment of wet AMD can prevent
further loss of vision, and even restore vision in some cases, if treatment is
obtained in a timely manner.

Common visual changes noted by patients with AMD are:

Straight lines look distorted

A dark or missing area appears in the center of my vision

How is macular degeneration treated?

The Age Related Eye Disease Study 2 (AREDS2), sponsored by the National Institutes of Health (NIH), showed that supplementation with certain micronutrients reduces the progression from intermediate to advanced stage dry AMD by 25 %. The AREDS2 formula contains:

Lutein 10 milligrams (mg)
Zeaxanthin 2 mg
Vitamin C 500 mg
Vitamin E 400 IU
Zinc oxide 80 mg or 25 mg (no difference noted in efficacy)
Cupric oxide 2 mg

Many people in the study used this formula in conjunction with their daily multivitamin and there was no benefit nor detriment found by this in the study (5 years of use). If you do not have macular degeneration but it runs in your family, I recommend seeking the right nutrients through diet rather than supplementation.

How do I minimize my risk?

If you have the early form of AMD, studies have shown that you can reduce your chances of loss of vision by not smoking, maintaining a healthy diet including fruits and vegetables rich in antioxidants, and working with your doctors to control your blood pressure.

Eat foods containing high levels of lutein and zeaxanthin. These foods also contain hundreds of other phytochemicals that are likely to promote wellness. Foods such as egg yolk (not in excess - cholesterol), yellow corn, orange or yellow peppers, kale, broccoli, spinach, kiwi, grapes, zucchini, and squash have high levels of lutein and/or zeaxanthin and are thought to be protective against AMD.

Treating wet AMD

There have been great strides in the treatment of the wet AMD in recent years. Most patients who begin to experience loss of vision as a result of the presence of abnormal new vessels in AMD can maintain stable vision or perhaps even experience improvement in vision following prompt treatment with a class of medications that block a molecule named Vascular Endothelial Growth Factor (VEGF).

Anti-VEGF treatments seek to stop the abnormal blood vessel growth of wet AMD. The most common anti-VEGF agents used at this time include ranibizumab (Lucentis™), approved for the treatment of wet AMD by the FDA in 2006, bevacizumab (Avastin™), and EYLEA.

These medications are delivered via injection into the eye. Your eye will be numbed prior to the injection. After your injection, you will go home and be instructed to rest. You may want to bring a friend or family member with you to drive you home. Injections are generally performed monthly, although your retinal specialist will determine the dosing schedule that is best for you. Most patients are able to resume their daily activities immediately. While anti-VEGF agents are relatively safe, there are rare associated risks. If you experience worsening vision, pain, or progressive eye irritation and redness following an injection, contact your doctor immediately.