Macular Degeneration is an eye condition in which the macula, a sensitive area in the retina responsible for central and detailed vision, is damaged, often causing loss of central vision.
"Dry" form: the most common form and usually progresses slowly and causes central vision loss. "Wet" form: less common but more severe. May progress rapidly causing significant central vision loss.
Who Gets It
AMD is most common in people over 50, but can appear as early as age 40. As life expectancy increases, the disease is becoming a significant problem.
No conclusive proof exists. However, some scientists believe heredity may play a part, as well as UV light exposure and nutrition. Studies are ongoing.
Blurred or fuzzy vision
Straight lines, such as sentences on a page or telephone poles, appear wavy
Blind spot in the center of vision
Decreased ability to distinguish colors
Difficulty seeing at a distance.
Dr. Helm is specially trained to detect many vision-threatening conditions even before you develop symptoms. The earlier problems are detected, the better the chance of preventing vision loss.
Protection from UV-A and UV-B rays
Some studies have suggested that prolonged or frequent exposure to UV-A and UV-B rays may be a factor in macular degeneration and other eye conditions, so always wear sunglasses that block 100 percent of UV rays when outdoors.
High levels of zinc and anti-oxidants can play a role in slowing the progression of macular degeneration. A healthy diet can't hurt and can prevent many other health problems as explained below. Growing evidence shows that a heart healthy diet will also contribute to macular health. Conversely, diets unhealthy for the heart may be harmful to the macula as well.
Unfortunately, patients with age-related macular degeneration are inundated with treatment advertisements; both those that are based on sound scientific studies and those which are not.
Current anti-oxidant vitamin therapy for both dry and wet AMD center on the formulation studied in the Age-Related Eye Disease Study (AREDS). This formulation has become the standard of care for intermediate and advanced AMD. Dietary evidence and modifiable lifestyle risk factors have also been identified from the AREDS data.
Anti-Oxidant Vitamin Therapy
The AREDS Study found that high doses of certain anti-oxidants and zinc reduced the risk of progression to advanced AMD by 25%. Vitamin C, 500 mg; Vitamin E, 400 IU; Beta-carotene, 15 mg, and Zinc 80mg (with Copper 2mg) was included in the study.This formulation is readily available as the over-the-counter ICAPS or Ocuvite AREDS formulation.
Dietary omega-3 fatty acid intake was found to help prevent progression to wet AMD. The most widely available sources of omega-3 fatty acids are coldwater oily fish such as salmon, herring, mackerel, sardines and anchovies. Additional sources include flaxseed, butternuts, hempseed and walnuts.
Lutein and zeaxanthin are carotenoids found in high concentrations in the area of the retina affected by AMD, i.e. the macula. Dietary sources include eggs, spinach, kale, broccoli and other green vegetables.
Lifestyle Risk Factors
Smoking and high body mass index are associated with a higher risk of advanced AMD and therefore should obviously be avoided.
FAQ's About AMD, Vitamins and Diet
* Who should take the AREDS formula?
It is not recommended that patients with mild AMD take AREDS supplements, as the likelihood of benefit is low. However, addressing modifiable risk factors (diet, smoking, body mass index) is recommended.Dr. Helm will assesses each patient's potential for AMD and will make the appropriate recommendations based on findings in the eye exam.
* Is Beta-carotene dangerous?
Beta-carotene was found to increase the risk of lung cancer among smokers in studies.Smokers with intermediate AMD are therefore recommended to take an AREDS antioxidant and zinc formulation without beta carotene. There is no evidence on how long former smokers are at increased risk for lung cancer by taking beta-carotene.
* Can patients on AREDS supplements take a multivitamin?
It is acceptable for patients taking AREDS supplements to take a multivitamin, but it is important to not expose oneself to possible vitamin toxicity. Toxic does are estimated as follows: 7.5 mg/kg of vitamin A in one dose or 1.2 mg/kg daily; 2 g per day of vitamin C; >1,500 IU of vitamin E per day; 100 mg of zinc; 15 mg of copper. (Copper is used to prevent copper deficiency anemia, which is caused by high zinc intake.)
* Are there any other viable "herbal treatments"?
There are several herbal antioxidants that have potential in the treatment of AMD but it is important to note that none of them have been conclusively scientifically proven in humans at this time.That being said he most likely candidates include anthocyanins, ginkgo biloba, grape seed extract, resveratrol and catechins.
Anthocyanins are flavonoids occurring in plants with antioxidative properties. They are abundant in foods such as bilberries, currants, raspberries, blueberries, cherries, eggplants and red grapes. Bilberry extract in particular has become a popular herbal supplement, particularly marketed as an antioxidant for cataracts and AMD.
Leaf extracts from the ginkgo biloba tree have long been sold as herbal supplements and retinal protective and anti-oxidative properties have been demonstrated.
Grape seeds contain flavonoids and the extract has potential in preventing wet AMD. Resveratrol is a polyphenol found in grape skin, Japanese knotweed and red wine. It has been shown to have protective antioxidant effects on human retinal cells.
Green tea is marketed for antioxidant properties and benefits in many disease states. Tea leaves contain catechins, which are a type of flavonoid and may prove useful in AMD.
Treatment of Wet AMD
Fortunately the treatment of the wet form of AMD has improved significantly over the last decade.Current common treatments include anti-vascular endothelial growth factor (anti-VEGF) agents and/or steroids delivered inside the eye.Anti-VEGF agents stop the growth of new abnormal blood vessels that attack the macula.Steroids quiet inflammation associated with wet AMD.Photodynamic therapy (PDT) may also be used occasionally to control wet AMD, either alone or in conjunction with the above treatments. It uses a special type of medicine called Visudine which is injected into the bloodstream and is then activated by a gentle laser treatment to the macula to stop the new blood vessel growth.
Be wary of any treatment that promises to restore vision, cure or prevent macular degeneration. There are many so-called "miracle cures" advertised (often in magazines or on the Internet) that have not been adequately tested for safety or efficacy. These treatments may be expensive and are generally not covered by insurance. If you are considering trying a new or untested treatment make sure you talk to Dr. Helm to ensure they are safe and won't interfere with timely and effective treatment of other eye problems.
There is a great deal of research and many major scientific studies are being conducted to find the causes of AMD and to develop effective treatments for all types of macular degeneration. Visit the National Eye Institute Web site for additional information www.nei.nih.gov.
Low Vision Rehabilitation There are resources that can help people who have experienced mild to severe vision loss adjust to their condition and continue to enjoy active and independent lifestyles. Rehabilitation may involve anything from adjusting the lighting in your home to learning to use low vision aids to help you read and perform daily tasks. Dr. Helm can arrange rehabilitation or refer you to organizations that can help.
Adjusting to vision loss can be difficult at first. Dr. Helm may be able to recommend some support groups for people with low vision. You can support friends and family by encouraging them in their rehabilitation efforts and providing help (such as rides to appointments) when needed.
Dr. Helm is your best resource for any eye care question or need. (Dr. Helm is a medical doctor (M.D.) specially trained to provide the full range of eye care, from eye exams and prescribing glasses and contacts to complex surgery for eye problems.)