FEBRUARY BLOG

Age-Related Macular Degeneration and Low Vision Awareness

What is Macular Degeneration?

Macular Degeneration is the leading cause of vision loss, affecting more than 10 million Americans – more than cataracts and glaucoma combined.  Macular degeneration, also known as age-related macular degeneration (AMD), is caused by the deterioration of the retina, which can severely impair vision.  Currently, there is no cure, but it can be treated with vitamins, laser therapy, medications and vision aids.   The disease actually gets worse over time and the leading cause of severe, permanent vision loss in those over the age of 60.

Macular Degeneration is caused by the deterioration of the central portion of the retina that records the images we see and sends them via the optic nerve from the eye to the brain.  The retina’s central portion, known as the macula, is responsible for focusing central vision in the eye, and it controls our ability to read, drive a car, recognize faces or colors, and see objects in fine detail.  Degeneration occurs when the central portion of your retina, the macula or light-sensing nerve tissue at the back of your eye, wears down.  The disease actually occurs as you age – BUMMER!  It usually doesn’t cause blindness but may cause severe vision problems.  Another form of macular degeneration, called Stargardt disease or juvenile macular degeneration, affects children and young adults.

One can compare the human eye to a camera. The macula is the central and most sensitive area of the so-called film.  When working properly, the macula collects highly detailed images at the center of the field of vision and sends them up the optic nerve to the brain, which interprets them as sight.  When the cells of the macula deteriorate, images are not received correctly.

Macular degeneration may have something to do with genes.  If in your family genetic history, your risk may be higher.   Smoking, high blood pressure, high cholesterol, obesity, eating lots of saturated fat, being light-skinned, being female and having a light eye color are also risk factors.

Macular Degeneration - Wet vs. Dry

There are two main types of degeneration:

• Dry form - Usually shows as yellow deposits, called drusen - tiny yellow spots under your retina or pigment clumping, in the macula.  A few small drusen may not cause changes in vision, but as they get larger and more numerous, vision may begin to noticeably dim or distort when reading.  As the condition worsens, light-sensitive cells in the macula get thinner and eventually die.  As degeneration begins, you may experience blind spots in the center of your vision.  As the condition worsens, you may lose central vision.  85% to 90% of cases are the “dry” (atrophic) type. 

• Wet form - Blood vessels grow from underneath your macula, leaking blood and fluid into the retina.  Vision is distorted making straight lines look wavy!   You may also experience blind spots and loss of central vision.  These blood vessels and bleeding eventually forms a scar, leading to permanent loss of central vision.   10-15% of cases are the “wet” (exudative) type.

Symptoms of Macular Degeneration

You may not experience noticeable signs early on or not until the condition gets worse, affects both eyes or diagnosed.  Symptoms may include:

• Worsening or less clear vision - vision might be blurry or it may become hard to read fine print or drive.

• Dark, blurry areas in the center of your vision

• Worse or different color perception on rare occasions

How Is Macular Degeneration Diagnosed?

A routine eye exam can spot age-related macular degeneration.  One of the most common early signs is drusen, which your doctor can see with an eye examination.  Your physician may also have you look at an Amsler grid, a pattern of straight lines that resembles a checkerboard, with some missing.  This can be a sign of macular degeneration.

If age-related macular degeneration is found, there are a couple of procedures:

• Angiography – dye is injected into the arm and photographs are taken as the dye flows through the blood vessels in your retina.  If there are new vessels, vessels leaking fluid or blood in your macula, the photos will show their exact location and type.

• OCT – the doctor will be able to see fluid or blood underneath you retina without dye.

What Treatments Are Available for Macular Degeneration?

Treatment may slow it down or keep you from losing too much vision, but there’s no cure for macular degeneration!  Your options might include:

• Anti-angiogenesis drugs.   Medications such as: aflibercept or Eylea, bevacizumab or Avastin, pegaptanib or Macugen and ranibizumab or  Lucentis - block the creation of blood vessels and leaking from the vessels in your eye that cause wet macular degeneration.  Many who’ve taken these drugs have got back vision that was lost, but you may need multiple treatments. 

• Laser therapy - High-energy laser light can destroy abnormal blood vessels growing in the eye.

• Photodynamic laser therapy - your physician injects a light-sensitive drug, verteporfin or Visudyne into your bloodstream and it’s absorbed by the abnormal blood vessels.  Then a laser is shined into the eye to trigger the medication to damage those blood vessels.

• Low vision aids - are devices that have special lenses or electronic systems to create larger images of nearby things.  They assist those who have vision loss from macular degeneration make the most of their remaining vision.

Researchers are studying new treatments for macular degeneration, but they are experimental and include: 

• Submacular surgery - removes abnormal blood vessels or blood.

• Retinal translocation - a procedure to destroy abnormal blood vessels under the center of your macula, when a laser beam cannot be safely used.  In this procedure, the center of your macula is rotated away from the abnormal blood vessels to a healthy area of your retina, reducing the chance of scar tissue and additional damage to the retina.  Then a laser is used to treat the abnormal blood vessels.

Macular Degeneration Prevention

A large study found some experiencing dry AMD could slow the disease by taking supplements of vitamins C and E, lutein, zeaxanthin, zinc, and copper.  Ask your doctor whether these supplements would help you.  It’s important to see your eye doctor regularly to find signs of macular degeneration early.  Treatment can slow the condition or make it less severe.

Can we reduce the risk of developing macular degeneration?

The New England Eye Center at Tufts Medical Center recommends:

• Do not smoke -  smoking affects macular degeneration and eye health.

• Eat healthy foods - a diet rich in green, leafy vegetables such as kale, spinach, collard greens and fruit.

• Eat fish high in omega-3 fatty acids at least once or twice a week. This includes salmon, sardines, mackerel, herring and albacore tuna.

• Avoid processed snack foods - cakes, cookies, potato chips, candy, and soft drinks.

• Avoid partially hydrogenated fats - coconut or palm oils.  Use oil from olives, canola, or flaxseed in moderation.

• Maintain normal blood pressure, blood sugar and cholesterol levels.

• Maintain a healthy weight.
• Exercise - Walk or participate in more strenuous activities if possible, like yoga, aerobic activities or sports.

• Wear sunglasses and a hat with a visor in bright sunlight to protect your eyes from potentially harmful ultra-violet (UV) light and blue light.

But……….. What is Low Vision?

Low vision is used when referring to a visual impairment not correctable through surgery, pharmaceuticals, glasses or contact lenses.  It is often characterized by blurred vision, blind spots or tunnel vision. Low vision can impact all ages, but primarily associated with older adults.

Causes of Low Vision

The most common visual impairments include:

• Age-Related Macular Degeneration (AMD/ARMD) - Accounts for almost half of low vision cases and caused when the macula breaks down and causes a loss of central vision.   There are three phases:

1. Early AMD – Most do not experience vision loss with early stage AMD.  Early AMD is diagnosed by the presence of medium-sized drusen (yellow deposits beneath the retina).

2. Intermediate AMD – This stage may be some vision loss, but there still may not be noticeable symptoms.  A comprehensive eye exam with specific tests will look for larger drusen and/or pigment changes in the retina.

3. Late AMD – At this stage, vision loss has become noticeable.

• Diabetic Retinopathy - According to the National Eye Institute, 30 percent of Americans diagnosed with diabetes have some form of diabetic retinopathy.  It is a major cause of blindness and directly related to high blood sugar, which damages blood vessels affecting the retina and can lead to its detachment!

• Glaucoma - the second leading cause of blindness!  Portions of vision are lost over time, usually with no warning signs or symptoms prior to vision deterioration.  For many, the decrease in peripheral vision is the first sign.

• Cataracts - Over 20 million in the U.S. alone have cataracts according to Prevent Blindness America.  It appears as a clouding of the lens of the eye.

• Retinitis Pigmentosa - a group of inherited diseases affecting the retina, resulting in progressive vision loss.  This type often begins in childhood with poor night vision and progresses over time.

There are also many additional causes of low vision, including strokes, TBI or traumatic brain injury and other diseases with a wider age range such as Stargardts, Albinism and ROP or retinopathy of prematurity.

Low Vision Care

Low vision requires different approaches to care as each case differs with low vision.  Some develop low vision over time due to aging or a genetic propensity for certain conditions.  Others suffer sudden trauma to the eyes resulting in the loss of vision or vision impairments. 

An examination by an eye care professional may include tests to establish a baseline of current vision status and to determine an appropriate treatment plan.  Treatment plans may include prescription glasses, specialized optical systems, therapeutic filters, non-optical options, video magnification, and/or medical rehabilitative therapy - to maximize the ability to perform activities of daily living such as self-care, dressing, grooming, eating and bathing.

Diet, Nutrition, Herbs and Supplements

Eat large quantities of dark green leafy vegetables rich in carotenoids, the yellowish pigments that include Vitamin A.  Spinach and collard greens are the most beneficial vegetables.  Two yellow pigments in the macula, lutein and zeaxanthin, are found in these vegetables and filter out visible blue light which might possibly damage the macula.  If you have symptoms of macular degeneration or a family history of AMD and an unhealthy diet, take supplements which include:

• Lutein - "the eye vitamin," a carotenoid.  It is related to beta-carotene and vitamin A. Foods rich in lutein include egg yolks, broccoli, spinach, kale, corn, orange pepper, kiwi fruit, grapes, orange juice, zucchini, and squash.  Lutein is absorbed best when it is taken with a high-fat meal.  Lutein functions as a light filter, protecting the eye tissues from sunlight damage.

• Zeaxanthin -the dominant carotenoid in the central macula.  A potent antioxidant that defends the body against unstable molecules called free radicals, which can damage cells, but best known for protecting the eyes.  Zeaxanthin and Lutein seem to work better together and can combat free radicals more effectively when combined, even at the same concentration.  They also act as a natural sunblock by absorbing excess light energy, especially protecting the eyes from harmful blue light.

• Vitamin C or Ascorbic Acid - People must get this vitamin from food and other sources.  Good sources of Vitamin C are fresh fruits and vegetables, especially citrus fruits.  Taking Vitamin C, Vitamin E, Beta-carotene and Zinc helps prevent AMD from becoming worse in people at high risk for developing advanced AMD. 

• Vitamin E - is an antioxidant.  It helps to slow down processes that damage cells.  High doses of Vitamin A with Vitamin E (alpha-tocopheryl nicotinate) daily, seems to improve healing and vision in people undergoing laser eye surgery.  Taking Vitamin E by mouth seems to be effective for preventing retinopathy in premature infants.

• Zinc - is a mineral.  It is called an "essential trace element" because very small amounts are necessary for human health.  Zinc is needed for the proper growth and maintenance of the human body.  Since the human body does not store excess zinc, it must be consumed regularly as part of the diet.  Common sources of zinc include:  red meat, poultry and fish.  Zinc plays a key role in maintaining vision and is present in high concentrations in the eye.  Zinc deficiency can alter vision and severe deficiency can cause changes in the retina, the back of the eye where an image is focused.  Zinc has been used for macular degeneration, for night blindness and cataracts.  Zinc sulfate is also used in eye drop solutions to treat eye irritation. 

People who consume more zinc as part of their diet seem to have a lower risk of developing age-related vision loss.  Research shows that taking supplements containing zinc and antioxidant vitamins may modestly slow vision loss and prevent age-related vision loss from becoming advanced in people at high risk.  

• Omega-3 fatty acids (fish oil) - Fish that are especially rich in omega-3 fatty acids include:   mackerel, herring, tuna, salmon, cod liver, whale blubber and seal blubber. Two of the most important omega-3 fatty acids contained in fish oil are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).  Omega-3 fatty acids reduce pain and swelling.   There is evidence that eating fish more than once weekly reduces the risk of developing age-related vision loss.   There is also evidence that eating fish three times weekly can slightly lower the risk of developing cataracts.   Higher intake of fish oil from the diet has been linked to a lower risk of dry eye in women.

ALWAYS CONSULT YOUR PERSONAL HEALTH CARE PROFESSIONAL

• https://www.macular.org/what-macular-degeneration
• https://www.macular.org/ten-things-you-can-do-improve-your-vision
• https://www.macular.org/lutein
• http://whatislowvision.org/what-is-low-vision/
• http://whatislowvision.org/causes-of-low-vision/
• http://whatislowvision.org/low-vision-care/https://www.webmd.com/eye-health/macular-degeneration/default.htm
• https://www.webmd.com/vitamins/ai/ingredientmono-754/lutein
• https://www.healthline.com/nutrition/lutein-and-zeaxanthin
• https://www.webmd.com/vitamins/condition-1653/vitamin-c-deficiency
• https://www.webmd.com/vitamins/ai/ingredientmono-954/vitamin-e
• https://www.webmd.com/vitamins/ai/ingredientmono-993/fish-oil