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Macular Degeneration

What is macular degeneration?

Macular degeneration is the deterioration or loss of cell function within the macula. The macula is the central area of the retina that you use for visually demanding tasks like reading, recognizing faces, driving a car, and color vision. Diseases of the macula may interfere with “detail vision”, making these activities more difficult. Macular problems can also cause images to appear distorted, or may cause cloudiness or darkness in the center of the visual field. Fortunately, many diseases that affect the tiny macula may spare the rest of the retina, thereby preserving peripheral vision. Therefore, diseases such as Age Related Macular Degeneration (ARMD) rarely result in complete loss of sight.

There are two types of macular degeneration

Dry macular degeneration

ARMD is a disease of both eyes. Dry ARMD is the most common type, in which the cells of the macula slowly lose sensitivity and may become less numerous. Vision loss with dry ARMD is usually slow and can be mild to severe. In most cases, it is identifiable to your ophthalmologist as drusen, yellow deposits that accumulate under the macula. While these deposits usually do not cause visual loss directly, they indicate that the patient is at risk for developing further problems with the macula. Usually, these deposits do not appear before the age of 50.

Wet macular degeneration

Dry ARMD turns into Wet ARMD when abnormal blood vessels grow beneath the macula. These vessels bleed or leak fluid beneath the macula. This can result in irreversible damage to the macula, resulting in loss of the central detail vision. Development of wet ARMD can occur more suddenly and may cause a more serious drop in vision.

Why does macular degeneration occur?

While the most significant risk factor for ARMD is age, it is not yet understood why macular degeneration occurs in some seniors and not in others. There is a strong genetic predisposition and research to identify genes associated with ARMD is ongoing. Other associated risk factors include cigarette smoking, high-fat diet, obesity, high blood pressure, high cholesterol and artherosclerosis.

What can be done to prevent macular degeneration?

Keeping the entire body healthy— good nutrition, avoiding cigarettes, controlling blood pressure and controlling cholesterol—helps to reduce the risk of developing visual loss in AMD. The Age-Related Eye Disease Study 2 (AREDS 2) looked at the effects of antioxidant vitamins and minerals on patients with AMD. It found that patients who took a high amount of these substances had a lower risk of developing more severe types of vision loss. The doses used in the study were: Vitamin C 500 mg, Vitamin E 400 IU, lutein 10 mg, zeaxanthin 2 mg, Zinc 80 mg, along with Copper 2 mg. Protection from the sun’s UV light is also important, as UV light may be a risk factor for ARMD.

How is macular degeneration treated?

There is no treatment for dry ARMD, except for vitamin supplementation as described above. Treatment for wet ARMD depends on the specifics of each case. Treatment options include laser treatments or intravitreal injections that target the abnormal vessel growth. Intravitreal injections deliver medication into the center of the eye after the eye locally anesthetized. Most of these treatments are able to stabilize vision or slow the progression of vision loss. Damage from leakage is typically permanent, however, the earlier the treatment is initiated the better the visual outcome. Although there is no cure for ARMD, new treatments are always emerging. Your doctor will discuss which treatment options are best for your eye.

What should I watch for?

Your doctor will schedule regular follow-up appointments to monitor your condition. In addition, monitor your vision with an Amsler grid at least twice a week, so that any changes in vision will be recognized as early as possible. Instructions on how to use the grid will be provided. Any persistent changes—waviness of the lines, blank or missing lines, or blurring of the lines—should be reported to your doctor immediately. Early detection is our best defense against visual loss in macular degeneration!

Macular Degeneration Vitamins

The Age-Related Eye Disease Study 2 (AREDS 2) looked at the effects of antioxidant vitamins and minerals on patients with AMD. Vitamins do not prevent AMD and are not a cure for AMD, however patients who took a high amount of these substances had a lower risk of developing severe vision loss. The doses used in the study were:

500 mg vitamin C
400 iu vitamin E
10 mg lutein
2 mg zeaxanthin
80 mg zinc
2 mg copper

We also encourage our patients to take a multivitamin (such as Centrum Silver), in addition to the eye vitamins. It is also important to eat a diet rich in green, leafy vegetables, colored fruits and vegetables, and low in fat and cholesterol. Incorporating fish, such as salmon and tuna, into your diet at least 3 times a week can help provide the essential Omega-3 fatty acids (fish oils).

Tell your doctor if you are on blood thinners or have liver or kidney problems prior to starting these vitamins.

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