Macular Degeneration – a parent’s journey

06 May

Dr. Henahan and his fatherIn 2011 my father was diagnosed (by me) with the more severe wet form of macular degeneration.  Until just a few years ago, this diagnosis would inevitably lead to severe loss of central vision and legal blindness.  But now, due to exciting advances in treatment, my father has almost 20/20 vision in his eye.  This story recounts his experience at diagnosis and since.  It is personally and professionally very exciting for me to see such a wonderful improvement in outcomes for the leading cause of vision loss in Americans over age 65.

2011

Last week I discovered that my father’s age-related macular degeneration (ARMD) had converted from the “dry” type to the “wet” type.  It was personally very difficult for me to deliver this news to my dad. It has also resulted in a lot of questions from my siblings about the nature of this condition.   I thought I would write the answers to their most frequently asked questions here, so they might be of some help to others as well.

What is ARMD?

ARMD is a deterioration of the central detail vision as a result of degeneration of the retina in the macular area.  The retina can be thought of as the film in the camera of the eye.  No matter what kind of lenses you have in the camera, if the film is damaged, you cannot take a clear picture.

Does ARMD cause blindness?

Since ARMD only affects the central detail vision, you can never go blind from ARMD.  However, you can lose your ability to see details.  For example, you could see the newspaper on the table but would struggle to read it.

How does someone get ARMD?

As the name implies, macular degeneration is age-related.  The prevalence increases steadily in each decade after age 60, with a prevalence of nearly 25% in those over age 90.

When other family members have/had ARMD you are genetically more likely to develop ARMD.  Other risk factors include a history of smoking, lots of sun exposure without the use of sunglasses and lightly colored eyes.

What is the difference between dry ARMD and wet ARMD?

Dry ARMD is by far the more common type.  It is characterized by the accumulation of creamy yellow deposits in the retina called drusen.  They eventually interfere with retinal function and can result in blurred central vision.

About 15% of the time, these same drusen can coalesce and then damage the layer of tissue underneath the retina, which causes the body to develop abnormal blood vessels in that area.  These blood vessels tend to bleed and leak (hence the “wet” in wet ARMD).  As this blood spills into the macular area of the retina, the retina swells.  The swelling impairs the function of the retina, causing a sudden deterioration in the central vision in that area.  In most cases, you would know right away that something was wrong when the blood vessels leak and bleed, because the change in vision is pronounced and sudden.

What is the Treatment for ARMD?

At this time there is no treatment for the dry type of ARMD.  Prevention is your best option (see below).

Until recently the treatment for wet ARMD involved the use of lasers to destroy the unwanted blood vessels.  The problem is that lasers create a lot of heat to do that, which invariably destroyed the retina above the vessels.  This left scar tissue and blind spots.  Now we have a new way of treating wet ARMD with medications that cause the blood vessels to regress and disappear.  As the blood vessels regress, the swelling in the retina would go down, often leading to modest improvements in vision.  More importantly, the treatment tends to prevent worsening of vision. 2014 update: My father has undergone about a dozen treatments and now has 20/25 vision in his eye. With that vision it exceeds the vision in his “good” eye that only has the dry type of ARMD.  He is able to read his computer and books as well as drive safely.)

 Can I prevent ARMD?

Since there is no treatment available for the more common dry ARMD, prevention is your best option.  A lifetime of sunglasses usage is a great starting point.  You can also take a multivitamin.  Additionally a supplement called Lutein has been shown to cut ARMD risk by 25-30%.  I recommend 20mg per day of natural form Lutein.

A large study of nurses completed in 2010 showed that those with the highest fish intake had the lowest reported severity of ARMD.  As such, I recommend 3000mg of high quality fish oil supplements per day.  (Take two capsules with breakfast and one with dinner).  Keep in mind that fish oil is very difficult to manufacture and lower quality fish oils are more likely to be rancid (if the pills stink, that is a sign they are rancid).

Finally if you smoke, quit.

How can I make the most of my remaining vision?

If you have have lost vision due to ARMD, you might benefit from low vision aids.  These specialized devices allow you to make the most of the vision you have left and can often help ARMD patients read better.  If the ARMD has only affected one eye, then low vision aids are not typically used.  They are usually only used when your vision is impaired in both eyes.

If you have questions about your vision, ARMD, or would like to find out if you are a candidate for low vision aids, feel free to contact Dr. Henahan at Spectrum Eyecare.  The website is www.speceye.com and the phone number is 770-487-0667.

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