Macular Degeneration

The macula is a small spot near the center of the retina that is responsible for sharp central vision, which enables you to see objects directly in front of you. As the macula ages it may begin to thin and break down (degenerate).

The loss of central vision caused by AMD can interfere with simple everyday activities, such as the ability to see faces, drive, read, and write. Early detection through a comprehensive eye exam is the best defense against visual loss from macular degeneration.

There are two forms of macular degeneration: wet and dry. Dry AMD is by far the most common type, accounting for 90 percent of all cases. It occurs when the light-sensitive cells in the macula break down, causing gradual central vision loss. It may or may not progress to the wet type.

Wet AMD occurs when abnormal blood vessels begin to grow underneath the retina and leak blood or fluid that blurs central vision. Wet AMD leads to faster vision loss and is the most advanced form of the disease. While wet AMD occurs in only 10 percent of cases, it accounts for 90 percent of legal blindness.

The primary symptom of macular degeneration is a blind spot in the center of your visual field. Tasks like driving, reading, or recognizing faces require clear central vision. Symptoms may start slowly with difficulty adjusting to low light levels, reading printed words, or recognizing faces.

Not smoking and maintaining a healthy lifestyle can help reduce your risk of developing macular degeneration.

The ophthalmologists at Jaffe Eye Institute will perform a comprehensive eye exam to detect if you have AMD and are at risk for developing the advanced form of the disease.

Since the early and intermediate stages of age-related macular degeneration usually start without symptoms, the importance of a comprehensive eye exam is paramount in the early detection of AMD.

To perform the exam, your eye doctor will first dilate your eyes. One of the most common early signs of dry AMD is the presence of drusen, which are yellow deposits beneath the retina. Small drusen are a normal part of aging and do not affect vision. However, if your ophthalmologist detects the presence of medium-to-large drusen, you may have AMD or be at risk for developing the condition.

Some scientific studies have suggested that health and lifestyle changes may help reduce the risk of developing macular degeneration. The Age-Related Eye Disease Study (AREDS), sponsored by the National Eye Institute, has found that taking high levels of vitamins and minerals can reduce the risk of developing advanced age-related macular degeneration (AMD) by about 25 percent.

Specifically, the AREDS formulation can slow progression of the disease in people who have intermediate AMD and those who have late AMD in one eye.

Results of the first AREDS study were reported in 2001. The original AREDS formulation contained vitamin C, vitamin E, beta carotene, zinc, and copper.

In 2006, research began on a second study (AREDS2) to see if the original formulation could be improved. The new formulation added lutein, zeaxanthin, and omega-3 fatty acids; eliminated beta carotene; and reduced the amount of zinc.

Following that study, recommended dosages for the AREDS2 formulation include:

• 500 mg of vitamin C
• 400 IU of vitamin E
• 25 mg of zinc
• 2 mg of copper
• 10 mg lutein and 2 mg zeaxanthin
• 1000 mg of omega-3 fatty acids (350 mg DHA and 650 mg EPA)

The results showed that the AREDS formulation, while not a cure for AMD, may play a key role in helping people at high risk for developing advanced AMD keep their remaining vision.

People who are at high risk for developing advanced AMD should consider taking the combination of nutrients used in the study. This includes those who have intermediate AMD in one or both eyes or those who have late AMD in one eye.

Before taking these high levels of vitamins and minerals, you should talk with your ophthalmologist about the risk of developing advanced AMD and whether taking the AREDS formulation is right for you.

An important caution is that combining too many different vitamin pills with some of the same ingredients can result in taking more than the recommended maximum of certain vitamins.

Please realize that most multivitamins combined with the AREDS vitamins will result in higher-than-recommended levels of vitamin E, which has been linked to strokes in some studies.

In patients with age-related macular degeneration, abnormally high levels of vascular endothelial growth factors (VEGF) are usually present inside the eye. VEGFs stimulate the growth of abnormal blood vessels.

Monthly injections of an anti-VEGF medication can help stop these blood vessels from forming. Jaffe Eye Institute offers Avastin®, Lucentis®, and Eylea® injections to help slow the progression of wet macular degeneration. Prior to administering the injection, your doctor will numb and clean your eye. Many patients report virtually no pain with the procedure.