After this father’s day weekend, I have been contemplating the unhappy news I had to deliver to my own father last week.

I discovered that his 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 more likely to develop ARMD yourself.  Other risk factors include a history of smoking, lots of sun exposure without the use of UV 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.

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.

Dry Macular Degeneration is the number one cause of vision loss in Americans over age 65, according to Dr. John Henahan of Spectrum Eyecare in Peachtree City.  ”When I was director of low vision services at LSU Eye Center (in New Orleans), macular degeneration was the cause of vision impairment in more than 90% of my patients.”  The condition afflicts 10 to 15 million Americans.

To date, dry macular degeneration has been untreatable, so prevention is a primary focus. Perhaps that will change with stem cell therapy.  Bloomberg News reports “Advanced Cell Technology Inc. (ACT) is to test a therapy made from stem cells in patients with” age-related “macular degeneration (AMD). “Doctors will inject retinal cells made from stem cells into the eyes of 12 people with the dry form of macular degeneration.”

The Los Angeles Times reported that the “Phase I/II trial…would primarily test the safety of the cells and whether they are well-tolerated by patients.” Researchers “hope that these patients can be helped by the company’s retinal pigment epithelial (RPE) cells, which would theoretically replace the ones that have been destroyed by the disease. The RPE cells have restored vision in rats and mice with an animal version of the disease.”

The Worcester Telegram reported that “the trial is the second human study for” ACT. Back “in November, the company received approval from the Food and Drug Administration to test its cells in patients with Stargardt’s Disease, a form of juvenile macular degeneration.”

While this clinical trial brings hope for the millions who suffer from this condition or may suffer in the future, the best strategy is still one of prevention.  According to Dr. Henahan, use of UV protective sunglasses, fish oil, lutein and a multivitamin should be a mainstay of preventive efforts.  Additionally, smoking is a major risk factor for macular degeneration, so smoking cessation should be a top priority as well.  Finally, regular eye exams with a dilated retinal evaluation is critical, especially for patients over the age of 45.

If you or a family member are at risk for AMD, contact Spectrum Eyecare and Dr. Henahan in Peachtree City for a complete eye examination.  We will take the time to thoroughly examine your eyes and discuss the best ways to ensure a lifetime of healthy vision.

Winter is the season for celebration.  The joy of Christmas trees, stockings and fires crackling in the hearth make the season bright.  Unfortunately for many people, the colder weather and drier air also leads to a flare up in their dry eye symptoms, according to Dr. John L Henahan at Spectrum Eyecare in Peachtree City.

The good news is that the treatment options for dry eye continue to evolve.  “We use a staged approach to treating dry eye to find maximum relief of dry eye without over treating”, continues Dr. Henahan.   “We also firmly believe in using natural therapy whenever possible, and we resort to prescription medications only when necessary.”

Advances in Treatment

Of the big advances in 2010 in treating dry eye, perhaps none is more exciting than a new contact lens that secretes a moisturizing compound as it is worn.  This breakthrough product uses the most effective moisturizing compound used in eye drops for treating dry eye.  Since contact lens wearers are among those who most commonly suffer from dryness problems, this exciting lens can represent a real breakthrough.  Imagine a contact lens that corrects your vision AND secretes artificial tears all day!

Another exciting development is in the arena of topical foams that reduce dry eye caused by blepharitis, which creates symptoms due to inflammation in the eyelid.  This hygiene regimen is especially powerful when combined with nutritional intervention such as vitamins and fish oil capsules.

A simple in office procedure, called punctal plugs can provide almost immediate relief for a majority of patients with chronic dry eye.  It is often a first line treatment due to it’s ease, the fact that it is covered by most insurance companies, and it’s simple “set it and forget it” nature.

Smart Strategies for Treating Dry Eye

Before undergoing treatment for dry eye, patients should ask themselves some simple questions, reports Dr. Henahan.  “Do you drink adequate amounts of water every day?  Do you eat a healthy diet or is your diet overloaded with fried foods and products loaded with High Fructose Corn Syrup?  Are you having other symptoms, that might be associated with thyroid problems?  Finally, if you are on any number of different medications including anti-histamines, birth control or hormone replacement therapy they could be playing a role in your symptoms.

In most cases, if you can make changes in these areas, your symptoms may be reduced.  For many, these changes are not practical, in which case evaluation and treatment by your eye doctor is warranted.

Dr. John Henahan is a fellowship trained doctor of optometry practicing and living in Peachtree City, GA with his wife and two sons.  You may call his office at 770 487-0667 or visit him on the web at www.speceye.com.

Large-scale study shows omega-3 fatty acids may lessen AMD severity

At Spectrum Eyecare in Peachtree City, Dr. John Henahan has long been an advocate for use of high quality fish oil in treating dry eye.  Now a new study from National Institutes of Health researchers found that those reporting the highest intake of omega-3 fatty acids (from fish oil) had the lowest reported rating of Age related Macular Degeneration (AMD) severity.

J.R. Chang, MD, and colleagues reported that “dietary DHA/EPA (the key components of fish oil) was inversely related to AMD score in energy-adjusted comparisons of participants reporting highest vs. lowest quintile intake.”  In other words, those with the highest level of fish oil intake had the lowest risk of AMD.

There were 4,203 patients in the study; they had a baseline mean age of 73 years; and 57% of the patients were women. All patients had good visual function at baseline, but the majority had risk factors for progression to advanced AMD, according to the poster.

“This is the strongest evidence yet that we can help reduce the severity or possibly even prevent macular degeneration in at risk patients with a strong nutritional program that includes fish oil, lutein and other vitamins”, according to Dr. Henahan.

“Historically, I have been recommending smoking cessation, polarized sunglasses, a multi-vitamin and 20mg of natural lutein per day.  But now I will be adding fish oil to my recommendations.  The great thing about fish oil is that it appears to have so many collateral benefits, such as reducing symptoms of dry eye, improving cholesterol levels and reducing the risk of cardiovascular events. However, those taking blood thinners (such as coumadin) should consult their physician before beginning fish oil”, continued Dr. Henahan.

When looking at fish oil supplements, it is important to shop very, very carefully.  Lower quality fish oils have increased contaminants such as lead or mercury and lower levels of the key omega-3′s called EPA and DHA.  Look for at least 40% of these components in each capsule.

At Spectrum Eyecare, Dr. Henahan takes the time to truly understand how he can work with patients to prevent the most serious eye diseases, especially through the use of nutritional supplements and other non-drug interventions.  Of course, he uses prescription medications when indicated, so you can be sure that you will get the best of both traditional and natural medicine to provide a lifetime of great vision.  If you would like to have Dr. Henahan evaluate you, please contact us by clicking here or calling 770-487-0667. Dr. Henahan is in the Peachtree City office every Monday, Wednesday and Friday as well as two Saturday’s per month.

The Washington Post on March 16 reported that, according to the Nutrition Business Journal, people in the US “spent an estimated $10 billion on” vitamin and mineral supplements in 2008.

This is despite the fact that “recent studies undertaken to assess their benefits have delivered a flurry of disappointing results.The supplements failed to prevent Alzheimer’s disease, cancer, heart attacks, strokes, type 2 diabetes, and premature death.” These studies have caused many to question the benefit of supplements.

However, in the case of eye disease, “people who have at least moderate age-related macular degeneration (AMD), a leading cause of blindness, may be able to limit further damage by taking a daily supplement that contains vitamins C, E and beta carotene.”

“Lutein and Zeaxanthin are likely to be even more important in slowing the progression (or even preventing the development) of AMD.”, according to John Henahan, OD, FAAO optometrist at Spectrum Eyecare in Peachtree City.  Getting enough lutein in your diet, through dark green leafy vegetables, such as kale, collard greens or cooked spinach is ideal, but for most of us that just isn’t going to happen regularly.  That is where a high quality lutein/zeaxanthin supplement can come in handy.  Dr. Henahan recommends a 20mg per day dose of lutein.  ”Lutein supplements are widely available in stores”, according to Dr. Henahan.  ”Just be sure that you choose the naturally occurring FloraGlo version which is derived from marigold flowers.”, he continues.

If you or a family member are at risk for AMD, contact Spectrum Eyecare and Dr. Henahan in Peachtree City for a complete eye examination.  We will take the time to thoroughly examine your eyes and discuss the best ways to ensure a lifetime of healthy vision!