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Macular Degeneration (AMD)
What is Age Related Macular Degeneration?
Age-related macular degeneration is an eye condition that causes progressive degeneration of the macula, the area of the retina responsible for central vision. Causing slow central vision loss.
Currently there are over 10 million people in the US affected with this condition. Making it the leading cause of blindness in people over the age of 65.
There are two forms of AMD: Dry and Wet. 80% of people diagnosed with AMD have Dry AMD. This typically begins with the retina thinning and tiny yellow deposits, called drusen, form under at the retina base. Patients typically have slow progressive vision loss. In about 10 to 20% of AMD patients, retina damage can progress to Wet AMD. This is where the base of the retina has thinned and degenerated to a degree causing delicate abnormal blood vessels to form and leak, causing more rapid and significant vision loss.
Signs and Symptoms of Age Related Macular Degeneration?
Age-related macular degeneration usually causes slow, progressive, and painless loss of vision. In some cases, however, as in Wet AMD, vision loss can be sudden and severe. Early signs of AMD are generally without symptoms, only evident to your ophthalmologist and optometrist during your yearly dilated eye examinations. As the disease progresses though, mild vision loss becomes evident to most patients, with shadowy areas in one’s central vision or fuzzy or distorted vision. Potentially progressing to severe central vision loss, making it difficult to read and even drive a car. However total blindness rarely occurs, because the peripheral retinal is generally unaffected.
Who is at Risk for AMD / What Causes AMD?
The exact cause of Age related macular degeneration (ARMD) is unknown. What is known is that there are many risk factors associated with AMD, including:
- Age. As we age our risk of developing AMD increases. The risk of AMD at age 50 is only 2%. That rate jumps to 37% by age 75.
- Family History. One’s risk of developing AMD is 300% higher if an immediate family member has the condition.
- Genetics. A strong association between development of AMD and presence of variant genes including complement factor H (CFH) and complement factor B.
- Smoking. Patients who smoke are 5 to 8x more likely to develop AMD compared to nonsmokers
- Racial predisposition. Caucasians and patients with light-colored skin and eyes are more likely to develop AMD than darker pigmented patients.
- Obesity. High Blood Pressure and High Cholesterol
- UV exposure. It is important to protect your eyes by wearing Sunglasses with 100% UV protection
- Diet. Diets high in saturated fats (ie meat, butter, cheese) and low in Vitamin C, E and lutein increase one’s risk factor for AMD
How is AMD diagnosed?
Routine and yearly dilated ocular examination is important for early management. During your examination imaging scans of the retina, called Optical coherence tomography (or OCT for short) are performed. Providing detailed imaging of the retina and macula.
In addition, a dye test, called a Fluorescein Angiography maybe performed. A yellow dye (called Fluorescein) is injected into your vein. Travelling through the body and into the eyes where using a special camera, highlights abnormal new vascular growth or leakage helping identify Wet AMD.
In addition to routine testing, it is important for patients check their eyesight daily through a test called an Amsler grid. This grid is essential to finding any visual changes that may not be obvious otherwise. To start:
- Hold the grid 12 to 15 inches away from your face with your reading glasses on.
- Cover one eye.
- Look directly at the center dot with your uncovered eye and keep your eye focused on it.
- While looking directly, notice if all grid lines look straight or if any lines or areas look blurry, wavy or dark
- Follow the same steps with the other eye.
If you notice changes contact us right away.
How is AMD treated?
Currently, no treatment is available to manage Dry AMD. Health and diet modification including daily eye vitamin intake (called AREDS Eye Vitamins), Sunglass wear with 100% UV protection, daily intake of green leafy vegetables, daily exercise and maintaining a Mediterranean diet have been shown to slow the progression of Dry AMD.
Studies funded by the NIH (National Institute of Health) called the Age-Related Eye Disease Study (AREDS 1 and 2) sought to answer the question whether taking daily vitamins and/or minerals could prevent, treat or cure AMD. What was found:
- High levels of antioxidants and zinc can reduce the risk of vision loss from advanced AMD by at least 25% (patients with Intermediate Dry AMD or Advanced Dry AMD)
- Supplements do not provide significant benefit to patients with Minimal or Early Dry AMD.
- These nutritional supplements do not prevent the initial development of AMD, nor do they improve vision already lost to AMD.
AREDS 2 formulation contains: Vitamin C, Vitamin E, Zinc, Copper, Lutein and Zeaxanthin.
Fortunately, there are ways to manage Wet AMD. Intravitreal Anti-VEGF injections, such as Avastin (Bevacizumab), Leucentis and Eylea have been proven to reduce macular leakage and abnormal vascular growth. Slowing vision loss and at times even improving it (in about 50% of patients).
Can Low Vision Aids help me see?
Low vision optical aids are often helpful for people with significant vision loss from Macular Degeneration. Magnifying devices including high add spectacles, hand or stand magnifiers, telescopes, and closed circuit television for viewing objects are some of the available resources.
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