age-related macular degeneration

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Understanding AMD

AMD is one of the leading causes of vision loss among people over the age of 50. While AMD itself does not lead to complete blindness, it does lead to loss of one’s central vision, which can interfere with simple everyday activities such as reading, driving, cooking, etc. Progression can vary considerably for each individual, advancing slowly over time or more rapidly, depending on the nature of the disease. As AMD progresses, a blurred area near the center of vision is a common symptom. Over time, the blurred area may grow larger or you may develop blank spots in your central vision.

Types of AMD

Dry AMD

Dry macular degeneration is the most common form of macular degeneration, totaling about 85-90% of AMD cases. It is non-neovascular by nature and is characterized by the slow breakdown of cells and the depositing of pigment in the macula or center vision of the retina. With less of the macula functioning, central vision diminishes. The actual cause of dry AMD is unknown.

Gradual central vision loss may occur with dry macular degeneration but usually is not nearly as severe as wet AMD symptoms. However, dry AMD through a period of years slowly can progress to late-stage geographic atrophy (GA) — gradual degradation of retinal cells that also can cause severe vision loss.

Wet AMD

Wet macular degeneration occurs when abnormal blood vessels behind the retina start to grow under the macula. These new blood vessels tend to be very fragile and often leak blood and fluid. The blood and fluid raise the macula from its normal place at the back of the eye. Damage to the macula, and the loss of central vision, occurs rapidly.

Risk Factors

Age

Age is a major risk factor for AMD. The disease is most likely to occur after age 60, but it can occur earlier.

Smoking

Research shows that smoking doubles the risk of AMD.

Race

AMD is more common among Caucasians than among African-Americans or Hispanics/Latinos.

Family History

People with a family history of AMD are at higher risk.

Lifestyle Factors

Researchers have found links between AMD and some lifestyle choices. You may be able to reduce your risk of AMD or slow its progression by making these healthy choices:

Smoking

Do not smoke or over-expose yourself to second hand smoke.

Exercise regularly

Blood Pressure/Cholesterol

Maintain normal blood pressure and cholesterol levels.

Nutrition

Eat a healthy diet rich in green, leafy vegetables and fish. Read more about nutrition and ocular health.

Detection of AMD

Early detection is key. The early and intermediate stages of AMD are often asymptomatic. One of the most common early signs of macular degeneration is the presence of drusen -- tiny yellow deposits under the retina. A comprehensive dilated eye exam can detect AMD, even before changes in vision are noted. Advanced digital technology enables us to document those findings and closely track progression over time.

Management of Dry and Wet AMD

Nutritional Supplementation (AREDS and AREDS2 Formulation)

Researchers at the National Eye Institute tested whether taking nutritional supplements could protect against AMD in the Age-Related Eye Disease Studies (AREDS and AREDS2). They found that daily intake of certain high-dose vitamins and minerals can slow progression of the disease in people who have intermediate AMD, and those who have late AMD in one eye.

The first AREDS trial showed that a combination of vitamin C, vitamin E, beta-carotene, zinc, and copper can reduce the risk of late AMD by 25 percent. The AREDS2 trial tested whether this formulation could be improved by adding lutein, zeaxanthin or omega-3 fatty acids. Omega-3 fatty acids are nutrients enriched in fish oils. Lutein, zeaxanthin and beta-carotene all belong to the same family of vitamins, and are abundant in green leafy vegetables.

The AREDS2 trial found that adding lutein and zeaxanthin or omega-three fatty acids to the original AREDS formulation (with beta-carotene) had no overall effect on the risk of late AMD. However, the trial also found that replacing beta-carotene with a 5-to-1 mixture of lutein and zeaxanthin may help further reduce the risk of late AMD. Moreover, while beta-carotene has been linked to an increased risk of lung cancer in current and former smokers, lutein and zeaxanthin appear to be safe regardless of smoking status.

Here are the clinically effective doses tested in AREDS and AREDS2:

500 milligrams (mg) of vitamin C

400 international units of vitamin E

80 mg zinc as zinc oxide (25 mg in AREDS2)

2 mg copper as cupric oxide

15 mg beta-carotene, OR 10 mg lutein and 2 mg zeaxanthin

If you have intermediate or late AMD, you might benefit from taking such supplements. But first, be sure to review and compare the labels. Many of the supplements have different ingredients, or different doses, from those tested in the AREDS trials. Consult your doctor or eye care professional about which supplement, if any, is right for you. While the AREDS formulation is not a cure, it may delay the onset of late AMD.

Amsler Grid

This test should be performed daily to self-monitor for any changes in vision.

The test and instructions can be downloaded here.

Low Vision Expertise

You must have an excellent support team. This team should include you, your primary eye care professional and a low vision specialist. Occupational therapists, orientation and mobility specialists, certified low vision therapists, counselors, and social workers are also available to help. Together, the low vision team can help you make the most of your remaining vision and maintain your independence.

The Low Vision Center is an excellent resource for those facing visual challenges. It is a nonprofit organization located in Bethesda that works in conjunction with your low vision specialist to help maintain and enhance quality of life. Below is the contact information for your convenience. While the services provided are no charge, appointments are required for individualized attention and care.

The Low Vision Center

4905 Del Ray Avenue, Suite 504

Bethesda, MD 20814

301-951-4444, Email

Treatment

Currently, there is only treatment available for wet AMD.

Injections

One option to slow the progression of neovascular AMD is to inject drugs into the eye. With neovascular AMD, abnormally high levels of vascular endothelial growth factor (VEGF) are secreted in your eyes. VEGF is a protein that promotes the growth of new abnormal blood vessels. Anti-VEGF injection therapy blocks this growth. A few different anti-VEGF drugs are available.

Photodynamic Therapy

This technique involves laser treatment of select areas of the retina. This procedure is less common than anti-VEGF injections, and is often used in combination with them for specific types of neovascular AMD.

Laser Surgery

Eye care professionals treat certain cases of neovascular AMD with laser surgery, though this is less common than other treatments. The surgery may help prevent more severe vision loss from occurring years later.

Services Offered at All Eyes On Rockville

All Eyes On Rockville is focused on the individualized care and management required for people with macular degeneration. The nature of macular degeneration is dynamic, leading to constant changes in vision over time. Early diagnosis, proper management on a visual and ocular health level as well as specialty treatment all aim to optimize vision and minimize the stresses associated with AMD.

Early Diagnosis

Early detection is crucial. The early and intermediate stages of AMD are often asymptomatic. One of the most common early signs of macular degeneration is the presence of drusen -- tiny yellow deposits under the retina. A comprehensive dilated eye exam can detect AMD, even before changes in vision are noted. All Eyes on Rockville is equipped with advanced digital technology, enabling detailed documentation of those findings and to closely track progression over time.

Refractive and Low Vision Services

Optimizing vision at every stage of AMD is imperative to maintaining quality of life. Slight changes in vision over the course of progression can impact life on a daily basis. It is important to routinely check for changes, provide the most updated glasses prescription and offer tools to enable and optimize independent living.

Nutritional Education

Researchers at the National Eye Institute tested whether taking nutritional supplements could protect against AMD in the Age-Related Eye Disease Studies (AREDS and AREDS2). They found that daily intake of certain high-dose vitamins and minerals can slow progression of the disease in people who have intermediate AMD, and those who have late AMD in one eye.

If you have intermediate or late AMD, you might benefit from taking such supplements. But first, be sure to review and compare the labels. Many of the supplements have different ingredients, or different doses, from those tested in the AREDS trials. Consult your doctor or eye care professional about which supplement, if any, is right for you. While the AREDS formulation is not a cure, it may delay the onset of late AMD.

Specialty Optical Services

All Eyes On Rockville works closely with a team of top retinal specialists who are well versed on the latest in AMD treatment. Ongoing research is paving the way for developing new treatments and maximizing the benefits of current treatments for AMD. Dr. Yecheskel takes great care in obtaining the best possible treatment for her patients, ensuring prompt access to leading retinal specialists when and if treatment is required. It is our mission to provide open and thorough communication as well as a smooth transition when coordination of care is required with a specialist.