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Macular Degeneration

What is Macular Degeneration or Age Related Macular Degeneration?

Macular degeneration or Age-Related Macular Degeneration is caused by the deterioration of the central portion of the retina. The retina is located in the back of the eye and is the image processing center that is responsible for transmitting images to the brain.

The images are sent from the retina through the optic nerve to the brain. The part of the retina known as the macula is where we get our central vision, and is responsible for our most detailed vision. It controls our ability to read, work on computers, play athletics, or simply recognize familiar faces. Macular degeneration is the leading cause of blindness affecting more Americans than cataracts and glaucoma combined.

The good news is that you may have some control over the risk factors. Unfortunately there are millions of Americans that are not aware that macular degeneration is an incurable eye disease and that it is the leading cause of blindness for those aged 55 and older.

Age Related Macular Degeneration (ARMD): Wet ARMD & Dry ARMD

AMD occurs in two forms:  
Dry AMD affects about 90 percent of those with the disease. Its cause is unknown. Slowly, the light sensitive cells in the macula break down. With less of the macula working, you may start to lose central vision in the affected eye as the years go by. Dry AMD often occurs in just one eye at first. You may get the disease later in the other eye. Doctors have no way of knowing if or when both eyes may be affected.  
Wet AMD--Although only 10 percent of all people with AMD have this type, it accounts for 90 percent of all severe vision loss from the disease. It occurs when new blood vessels behind the retina start to grow toward the macula. Because these new blood vessels tend to be very fragile, they will often leak blood and fluid under the macula. This causes rapid damage to the macula that can lead to the loss of central vision in a short period of time.  

Treatment of Wet Age Related Macular Degeneration:

Dry AMD currently cannot be treated, but this does not mean that you will lose your sight. Fortunately, dry AMD develops very slowly. You may lose some of your central vision over the years. However, most people are able to lead normal, active lives--especially if AMD affects only one eye. 
 
Some cases of wet AMD can be treated with laser surgery. The treatment involves aiming a high energy beam of light directly onto the leaking blood vessels. Laser treatment is more effective if the leaky blood vessels have developed away from the fovea--the central part of the macula. But even if the blood vessels are growing right behind the fovea, the treatment can be of some value in stopping further vision loss.

The treatment of choice for most patients with Wet ARMD is anti-VEGF therapy in the form of an injection. These medications are directed against the Vascular Endothelial Growth Factor (VEGF) that stimulates the growth of the weakened blood vessels. The three medications are Macugen, Avastin, and Lucentis. They all require multiple doses. The goal with the new treatments is to improve, rather than simply stabilize, the vision. These medicines work best with early leaks, i.e. when the vision has not been severely compromised and before fibrosis and scarring sets in; once this occurs the vision will rarely improve even with therapy.

The Age Related Eye Disease Study 2 (AREDS2), a large study sponsored by the National Institute of Health with thousands of patients over several years, showed that certain vitamins could prevent the progression of macular degeneration.  The following are a list of the vitamins that were in the study:

* Lutein/Zeaxanthin - 10mg/2mg per day

* Vitamin E - 400 IU/day(If you are taking blood thinners (e.g. aspirin, Plavix,Coumadin), this can make you bleed even more, so it is important to check with your internist/family doctor before taking this vitamin

* Vitamin C - 500 mg/day(This is, in general, an extremely safe vitamin even at higher doses)

* Zinc - 80mg/day (Because high doses of Zinc can cause anemia, this is supplemented with approximately 2mg of copper in most formulations)

There is considerable data that suggests Lutein and Zeaxanthin can play a role in the prevention/progression of macular degeneration.  1000mg if Omega-3 fish oil is also recommended to support ocular health.

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