Age Related Macular Degeneration

Have you ever thought about what it would be like not to be able to see your loved ones’ faces, read your favorite book, or work a crossword puzzle? One in 200 Seniors over 65 have age-related macular degeneration (AMD), a condition that slowly destroys the eye’s ability to see what it focuses on.

According to the American Academy of Ophthalmology, March is National AMD Awareness month. This is a good time to learn about the condition and make an appointment for an AMD screening. No dilly-dallying!
   
What is AMD?

AMD is a group of visual disorders caused by progressive cell loss in the macula, the site responsible for fine, central vision. AMD does not affect peripheral vision.

The Macula Vision Research Foundation describes AMD as what it would be like to “hold both hands flat, palms in, one inch in front of your face... for the rest of your life.” However, vision loss may be so gradual that a person does not even realize it is happening until it reaches advanced stages.

AMD is categorized as either dry or wet. Nine out of ten AMD patients have the slow progressing dry form. The hallmark of dry AMD is drusen — yellowish deposits that form under the retina. Drusen formation in both eyes increases a patient’s risk of developing wet AMD.

Ten to twenty percent of patients with AMD develop the wet form, which causes more rapid and severe loss of central vision. Although relatively few patients have wet AMD, this condition leads to 90 percent of the severe vision loss caused by AMD. Wet AMD is defined by blood vessel formation — and sometimes bleeding — under the macula.

What are the risk factors?

Age, gender, race, heredity, and smoking are proven AMD risk factors. AMD occurs most often in white females over age 65. Although you can not change your age or your genes, you can quit smoking. Ask your doctor about stop-smoking programs, medications, counseling and nicotine products.

For those who have not smoked in more than 20 years, the risk of developing AMD is comparable to the risk in nonsmokers. The most recent data suggest that smoking is most strongly associated with advanced (severe dry or wet) AMD.

How often should I get screened and why?

According to the American Association of Ophthalmology, routine, comprehensive eye exams are critical for early detection of AMD. All individuals ages 40-64 should be examined every 2-4 years; those over 64 should be examined every 1-2 years.

If you or your primary physician suspect AMD, you should be evaluated by an ophthalmologist. Early diagnosis is important because therapies can slow the pace of vision loss.

What if I am diagnosed with AMD?

Keep family and friends in the loop!  Let them know how they can assist you.

Be active and try to expand your social network and recreational activities. A diagnosis of AMD does not require you to downgrade your lifestyle — especially not right away. AMD-related vision loss is usually very gradual, and it could affect only one eye.

Seek guidance and support. Arming yourself with information reduces fear caused by uncertainty. Governmental and other agencies can help with all aspects of AMD. If needed, these groups provide help with rehabilitation programs and home modifications that will best preserve your lifestyle and reduce the chance of injuries and falls resulting from poor vision.

If your sight has been affected, consult a low-vision specialist. Tools that can help include magnifiers, closed-caption television, high-contrast watch faces, Kindle e-book readers, and computers that read printed materials.

If you feel depressed, let your doctor know. Patients with advanced AMD are twice as likely as healthy people of the same age to suffer from clinical depression.

How is AMD managed?

In the earliest stages, patients with AMD are provided with a screening tool called an Amsler grid to self-monitor vision changes between eye exams. If gridlines appear distorted or missing, the ophthalmologist should be contacted immediately.

Ophthalmologists often recommend dietary supplementation to slow vision loss. Dietary supplements do not stall the progression of early AMD.

In trials, Vitamin C (500mg), vitamin E (400IU), beta carotene (15mg), zinc oxide (80mg) and cupric oxide (2mg) have been shown to slow the progression of intermediate to advanced AMD in 25 percent of patients. Lutein and zeaxanthin, yellow plant pigments found naturally in spinach and corn, may also reduce advanced AMD incidence.

If you are a smoker with AMD, let your doctor know because beta carotene supplements increase lung cancer risk in smokers.

Wet AMD should be managed by an ophthalmologist with special training and/or experience with that condition. Wet AMD treatments include anti-neovascular agents, thermal laser, and photodynamic therapy (PDT). If you have received PDT, avoid the sun for one week. Sunscreen will not prevent damage to your skin during this post-treatment time. §

Kendra Siler-Marsiglio, Ph.D. is a neuroscientist, medical writer and VP of the WellFlorida Council Board of Directors.

The following organizations provide AMD information and support for patients and their families:

Macular Degeneration Partnership
1-888-430-9898
www.amd.org

Macular Degeneration Support
1-816-761-7080
www.mdsupport.org

Lighthouse International
1-800-334-5497
www.lighthouse.org

Foundation Fighting Blindness
1-888-394-3937
www.fightblindness.org