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MACULAR DEGENERATION

 

Macular degeneration is a painless, degenerative eye disease that affects more than 10 million Americans. It is the leading cause of legal blindness in persons over the age of 55 in the United States. While complete blindness does not occur in most people with the disorder, macular degeneration often interferes with reading, driving, or performing other daily activities.

 

There are two forms of macular degeneration. Dry macular degeneration affects about 90% of those with the disease and causes gradual loss of central vision, initially only in one eye. Wet macular degeneration, which accounts for 90% of all severe vision loss from the disease, involves a very sudden loss of central vision.

 

Signs and Symptoms

 

Macular degeneration is accompanied by the following signs and symptoms:

 

 

What Causes It?

 

Dry macular degeneration occurs from the breakdown of the light sensitive cells in the center of the retina, called the macula. Wet macular degeneration occurs when new blood vessels behind the retina grow toward the macula and leak blood and fluid.

 

Who's Most At Risk?

 

People with the following conditions or characteristics are at risk for developing macular degeneration:

 

 

What to Expect at Your Provider's Office

 

Your eye care professional can detect macular degeneration during an eye examination that includes the following:

 

 

Treatment Options

 

Prevention

 

If you have wet macular degeneration, you will test your eyes daily at home using an Amsler's grid. You should report any distortion immediately to reduce the risk of vision loss. Other preventive measures include increasing your dietary intake of flavonoids and carotenoids (see section on Nutrition), using ultraviolet eye protection, estrogen replacement therapy, and moderate red wine consumption.

 

Treatment Plan

 

There is no known cure for macular degneration; however, there are procedures that can help slow vision loss.

 

Drug Therapies

 

Your provider may prescribe the following medications:

 

 

Surgical and Other Procedures

 

Surgical and other procedures may be beneficial for some cases of wet macular degeneration.

 

 

Complementary and Alternative Therapies

 

Nutrition is a valuable treatment for dry macular degeneration. It may also help prevent both wet and dry types related to aging.

 

Nutrition

 

Antioxidants that protect your retina—such as carotenoids, selenium, zinc, and vitamins C and E—may delay or prevent macular degeneration. Some studies have shown that these nutrients help, but not all studies agree. In one study of 356 patients with advanced macular degeneration, diets high in carotenoids lowered risk for the condition. Two particular carotenoids, lutein and zeaxanthin, had the greatest effect; results also suggested that dietary vitamin C may be beneficial for prevention of macular degeneration as well. Three large studies, however, found no connection between macular problems and dietary or supplementary intake of carotene, zinc, or vitamins A, C, and E.

 

Other research reviews, which summarize data from several studies, suggest that eating a diet high in vitamins C and E and carotenoids may reduce your risk of macular degeneration. Vegetables rich in carotene include orange and yellow squash, and dark, leafy greens, such as kale, collards, spinach, and watercress. Although the scientific information is somewhat conflicting about supplements in particular, eating a diet rich in the nutrients mentioned above may be effective in preventing macular degeneration.

 

If, with the advice of your healthcare provider, you decide to take supplements, the following are some suggested amounts of key nutrients:

 

Flavonoids (such as quercetin, rutin, and resveritrol) may also play a role in preventing macular degeneration. A study of 3,072 adults with macular changes showed that moderate red wine consumption may offer some protection against the development or progression of macular degeneration. Red wine is high in certain flavonoids (including quercetin, rutin, and resveritrol) that have antioxidant activity; damage from oxidative stress is thought to contribute to the development of macular degeneration. Dark berries, such as blueberries, blackberries, and dark cherries, are high in flavonoids as well.

 

Omega-3 fatty acids may also offer some protection against macular degeneration. In a study of more than 3000 people over the age of 49, those who consumed more fish in their diet were less likely to have macular degeneration than those who consumed less fish. (Most types of fish are rich in omega-3 fatty acids). Similarly, a study comparing 350 people with macular degeneration to 500 without found that those with a proper ratio of omega-3 to omega-6 fatty acids and higher intake of fish in their diets were less likely to have this particular eye disorder. Another larger study found that consuming docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), two types of omega-3 fatty acids found in fish, four or more times per week may reduce the risk of developing macular degeneration. Notably, however, this same study suggests that alpha-linolenic acid (ALA; another type of omega-3 fatty acid) may actually increase the risk of this eye condition.

 

Herbs

 

Ginkgo (Ginkgo biloba), which contains flavonoids, may help halt or lessen some retinal problems. Clinical studies suggest that it may be useful in treating vision problems specifically due to macular degeneration. If you use anticoagulants, do not use ginkgo without close monitoring by your healthcare provider.

 

Bilberry (Vaccinium myrtillus) and grape seed (Vitis vinifera) are also high in flavonoids; therefore, they may help prevent and treat macular degeneration. Clinical studies suggest that these herbs may stop vision loss and improve visual sharpness. Here are the recommended doses:

 

 

Homeopathy

 

Although scientific research does not necessarily support the use of homeopathy to treat or prevent macular degeneration specifically, an experienced homeopath would consider your individual case to decide whether treatment may be beneficial for you.

 

Acupuncture

 

Studies on acupuncture and macular degeneration have been mixed. In a study of 51 patients with macular problems, researchers found little change in visual sharpness or other symptoms after 12 acupuncture treatments. Another study showed a connection between low blood flow to the head and macular degeneration. Restoring normal blood pressure with acupuncture improved vision.

 

Prognosis/Possible Complications

 

Blindness is a possible outcome of macular degeneration. Low vision aids may help if you have partial blindness. Sometimes blood vessels build up underneath the retina, causing the retina to become detached or scarred. If this happens, the chances of preserving your central vision are poor. This condition, called subretinal neovascularization, occurs in about 20% of cases of age-related macular degeneration. The condition will likely recur even after laser treatment.

 

Following Up

 

Your healthcare provider will see you regularly to monitor your vision and eye health.