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.

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!