Blogging about Macular Degeneration

As I examine patients and ask about eye disease in their family, nearly everyone has heard of glaucoma and cataracts (although only occasional patients can remember which is which!). Relatively few patients are familiar with Macular Degeneration, also known as Age-Related Maculopathy (ARM), even though it is far more devastating to their loved one’s vision. Remarkably, ARM is the leading cause of permanent vision loss in Americans over 65 years old, and affects 2 million people.

First, a little anatomy lesson to help you understand ARM: the macula is the portion of the retina we use for all our detail vision. Whenever you look directly at something, you are using your macula to see it. For still unknown reasons, in some older folks, the vision-sensing cells in the macula selectively get destroyed. The cells can either atrophy (or degenerate), called “dry” ARM, which makes up 80% of cases, or they can become scarred, called “wet” ARM, which makes up the remaining 20% of cases.

The impact on vision is profound: whatever you look directly at appears blank, but since peripheral vision is retained, you can see around the edges. My patients with ARM tell me that when they look at me, they can tell I have brown hair and the color of my clothes, but they can’t see my face. You can imagine how this affects everything that we love to do: read, watch TV, and drive. People with ARM fortunately do not go completely blind; they always retain peripheral (side) vision.

My mother began to develop ARM in her late 80’s. As her ARM progressed to the severe stage, she had to quit driving, was unable to indulge her lifelong passion for reading, and struggled visually to do even the simplest tasks such as eating. However, as a native Clevelander, it did not prevent her from watching her favorite athlete, LeBron James!

So, who is at risk for ARM? The name “age-related” says it all, with 1% of 60-year-olds affected. Among 80-year-olds, 2% of people are affected (unless you’re Caucasian, where the incidence is a whopping 14%). Risk factors are:

• Advancing age
• Relatives with ARM – 20 different genes are know to contribute to ARM
• Being female – higher risk partially because women tend to live longer
• Being white, especially with blue eyes
• Smoking

How would you know if you are developing ARM? Of course, the best answer is to have a thorough eye examination. We use many different tools ranging from visual acuity to high tech instrumentation such as optical coherence tomography (OCT) to determine a person’s diagnosis. One symptom that patients can detect is distorted (as opposed to blurry) vision. Distorted vision occurs when straight lines are no longer straight and have a bend in them. When my mother called me to report that her neighbor’s roofline suddenly had a jagged bump in it one day, I knew we had a problem.

What can be done to prevent ARM? For decades, eye care practitioners felt helpless, reduced to documenting vision decline in patients with ARM without an ability to slow or stop the progression. Thankfully research in recent years has yielded findings patients and doctors can use to prevent or control ARM:

• Maintain good health with no smoking
• Eat your veggies! Not carrots, but dark green leafy vegetables—think spinach, kale, Swiss chard, bok choy. Turns out, Popeye was right!
• Eat fish and other foods rich in omega-3 fatty acids
• Wear sunglasses—increased lifetime exposure to sunlight seems to accelerate the onset of ARM

What can be done to treat ARM? For those of us who are diagnosed with ARM, treatments are available:

• For dry ARM – special combinations of vitamins commercially marketed as Preservision AREDS 2 have been show to slow the progression of moderate to advanced ARM (the studies are named AREDS and AREDS2). Special note: there is no evidence to show that these formulations prevent ARM, but they slow the progression once ARM is diagnosed.
• For wet ARM – injections of medication into the eye not only stop progression of ARM for years, but in some cases can actually reverse vision loss.

So, back to my mom. Many of my patients know that I call my mom “My First & Best Patient.” She was diagnosed at age 87 with wet ARM. Injections of the “anti-VEGF” medications by retinal specialists retained usable vision for her for a good 5 years! The injections had to be repeated monthly, so she endured over 80 injections in that time period, but she reported that they weren’t painful, just unpleasant to think about. After 5 years, the injections quit working and her central vision declined dramatically.

*I would like to dedicate this blog to my sweet mother who left us last year at the age of 94. Despite her vision impairment and other infirmities, she remained cheerful, grateful and inspirational to everyone who knew her. I want to be just like her when I grow up! ☺