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San Diego Optometrist | Encinitas Optometrist | LASIK | Dr Anshel

Smart Medicine for Your Eyes

Macular Degeneration
 

Age-Related Macular Degeneration (AMD)

The macula is the area of the retina that is the most sensitive and is used for direct, central vision. For one in four people over the age of sixty-five and one in three over the age of eighty, the macula begins to degenerate (deteriorate), therefore this condition is known as age-related macular degeneration (AMD). Very often the macular area of one eye shows this degenerative change while the other eye is perfectly normal. In this circumstance, you may not notice that the change is taking place because the good eye will dominate your vision.

There are two types of AMD: the wet and dry forms. The wet form accounts for only 10% of the cases. It occurs when tiny, new abnormal blood vessels begin to grow behind the retina toward the macula. Here they often leak blood and fluid that damage the macula, causing rapid and severe vision loss. The dry form constitutes the other 90% of cases and occurs when small yellowish deposits called drusen (DROO-zin) start to accumulate beneath the macula. These deposits gradually break down the light-sensing cells in the macula, normally causing distorted vision in the eye.

Total blindness doesn't occur with macular degeneration. Since the macular area is only responsible for central vision, only this area will be affected. However, a person afflicted with macular degeneration can feel very helpless and frustrated due to the loss of detail vision. Peripheral vision usually remains intact and therefore allows a person to function almost normally, especially if only one eye is involved.

There are certain risk factors that can make one more susceptible to AMD. Those are:

Age- it is estimated that about 14% of people aged 55-64 have some form of AMD. This rises to about 25% of 65 to 75 year-olds and up to 37% of those over 75.

Diet and Nutrition- the macula’s fragile cells are highly susceptible to damage from oxygen-charged molecules called free radicals. Early research has shown that people with a low dietary intake of antioxidants may be at risk of developing AMD. Alcohol may also deplete the body of antioxidants. High levels of saturated fats and low –density (LDL) cholesterol harm blood vessels and are also involved in producing free radicals reactions that can damage the macula.

Sunlight- The cells of the macula are highly sensitive to sunlight. Cell damage from the sun can lead, over time, to deterioration of the macula. People with light colored eyes may be more prone to damage from sunlight, as are those who have prolonged exposure to ultraviolet light.

Smoking- A recent study showed that smoking, which reduces protective antioxidants in the eye, more than doubles the risk of AMD. The study found that AMD is more than twice as common in people who smoke more than one pack of cigarettes a day, compared with people who do not smoke, and the risk remains high even up to 15 years after quitting.

Heredity- Some studies show that AMD may be in part inherited. This means that if you have one or more immediate relatives with AMD, you may be at higher risk to develop the condition.

Gender and Race- Being a women over age 75 doubles your chances of developing AMD compared to a man of the same age. Low levels of estrogen in post-menopausal women may also increase risk for the condition. There is some suggestion that post-menopausal estrogen therapy may be protective or AMD, but more research is needed in that area. Women also live longer than men. Caucasians are much more likely than African Americans to lose vision to AMD.

Heart Disease- If you have high blood pressure or another form of heart disease, you may also have a greater chance of getting AMD because of poor blood circulation to the eyes.

Conventional Treatment

Lasers have been used in the treatment of the “wet” form of macular degeneration. In this procedure, the laser can be used to coagulate (clot) the tiny blood vessels that have grown near the macula. Unfortunately, most forms of the problem cannot yet be reliably treated either medically or surgically. Special low-vision aids can be of great help to those with macular degeneration. These aids serve to magnify images so they are spread over a larger portion of the retina.

Most doctors will administer a test called an “Amsler Grid”. This test will be valuable in following the course of the disease process but certainly does nothing to resolve the condition.

More recently there has been the development of certain light-enhanced treatment for AMD, called Photo-Dynamic Therapy (PDT). This process involves injection a solution into the veins, then shining a light into the eyes that will allow this solution to block the development of new blood vessels. This procedure is designed for the “wet” form of AMD. New studies are continuing to look at several other forms of PDT, but little is on the horizon for the “dry” form of the disease.

Self Treatment

While you cannot change your age, your sex or your family tree, there are some lifestyle changes you should adopt to help protect your eyes. First, wear sunglasses or a brimmed hat when exposed to large amounts of ultraviolet light. Moderate amounts of ultraviolet light are good for the human body but overexposure can cause damage to some parts of the eye.

Anything that prevents the clogging of your arteries may help prevent macular degeneration (as well as the degeneration of the rest of your body). Therefore, watching your dietary fat and cholesterol, exercising regularly, not smoking and watching your weight and blood pressure are wise moves. Limit your intake of alcohol to a maximum of six drinks per week for men and three for women.

Finally most doctors are finally recommending that their older patients take antioxidant supplements to prevent or halt the progress of macular degeneration. Recent studies indicate that a well-rounded combination of antioxidants has shown to slow macular degenerative changes. Several research studies on AMD are focusing on the role of a group of antioxidants called carotenoids (care-OTT-ten-oyds). Two of these, lutein (LOO-teen) and zeaxanthin (zee-ah-ZAN-thin), are the only pigments found in the macula that come from the diet. By contrast, beta carotene is virtually absent in the eye (although it’s cousin, Vitamin A, is plentiful in the retina). Lutein and zeaxanthin can be found in almost all fruits and vegetables, but are most likely to be in dark green, leafy vegetables such as cooked kale, cooked spinach and cooked collard greens (cooking or steaming helps to release the lutein bound to chorophyll). Another good source is egg YOLKS (they are yellow because of the lutein). Another study among male veterans showed that increasing antioxidants could slow the progression of vision loss from dry AMD. For more specific information, consider the formulations by Biosyntrx (www.biosyntrx.com) called Eye and Body Complete.

NUTRITIONAL SUPPLEMENTS

Supplement

Directions for Use

Comments

Vitamin A (Retinol)

2,500-5,000 IU per day

Powerful antioxidant. Use emulsion form for easier assimilation and greater safety

Vitamin C with bioflavonoids

1,000-2,500 mg  (250 mg/4 times daily)

An important antioxidant

Vitamin E

300-400 IU daily

An important antioxidant and free radical destroyer

Zinc

25 mg daily

Deficiency has been linked to eye problems. Use zinc in the monomethionine form.

Selenium

400 mcg. daily

An important antioxidant

Copper

1 mg daily (if using Zinc Oxide)

Important to balance the zinc concentration. Not necessary if using zinc monomethionine

Lutein

10-20 mg daily

Increases macular pigment

Zeaxanthin

4 mg daily

Increases macular pigment

Meso-zeaxthanthin 10 mg daily  NOT necessary to include since it is created in the eye by lutein, however not bad to have in a product that you like.