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Macular Degeneration

Introduction

Macular Degeneration, also known as age-related macular degeneration or AMD) is a loss of eye sight with age. As we age,  so does the part of our retina that has been most active in terms of central vision, the fovea or macula.

For some reason, possibly due to genetic predisposition, the macula undergoes an age-related degeneration easier in whites than in blacks, particularly in old age. That’s why this condition is also called “senile macular degeneration”. The fact that AMD is more common in older people has suggested to some investigators that there may be an underlying hormone deficiency that may be responsible for the development of AMD. Dr. S.A. Dzugan and Dr. G. Rozakis have proposed such a theory as Dr. Rozakis, an ophthalmologist noted an association of cholesterol elevation in the retinas of AMD patients, their blood cholesterol values and associated hormone deficiencies (Ref. 11).

There are two forms how macular degeneration can occur, a dry macular degeneration and a wet macular degeneration. With the common dry form there is an atrophic process happening in the macula, but there are no hemorrhages or exudates. With the wet form of macular degeneration, which is more rare, a neovascularization (new blood vessels) process is happening in the choroidal membrane of the retina where the pigment cells are located.

This leads to bleeding into the retina, leakage of fluid (called exudate) underneath the retina and a threat of retinal detachment.

Signs and symptoms

There is vision loss without pain in both eyes with the characteristic findings as indicated under the links “dry macular degeneration” and “wet macular degeneration” above.

In the beginning of this degenerative process there might be a visual problem on only one eye, which shows up as distortion on the Amsler’s chart. This is a squared grid of lines, which is viewed at a distance of 35 cm (=12 inches) from the eyes. When there is a distortion of the grid, it is time to see an eye specialist on an urgent basis. There might be pigmentary lesions and drusen (thanks to www.kellogg.umich.edu for this link) that alarm the eye physician that macular degeneration is imminent.

Diagnostic tests

Fluorescein angiograms can be used to study the absence (normal finding) or presence of a neovascular membrane formation underneath the retina. It is with the experience of the eye specialist, the fluorescein angiograms, the visual tests, slit lamp, direct and indirect ophthalmoscopy tests that the diagnosis of macular degeneration is made.

 Macular Degeneration (Hemorrhages And Exudates)

Macular Degeneration (Hemorrhages And Exudates)

Treatment of AMD

If there is a neovascular network identified by fluorescein angiograms, the eye specialist may decide to do laser photocoagulation in order to attempt to stop further deterioration. Although the central vision will often be lost, there is still peripheral vision outside of the macula in the remainder of the retina. In other words, patients do not lose all of their sight. However, they will need support services of one or more of these support services, which you can find under this link.

Prevention of AMD

When it comes to prevention of AMD the general opinion of eye specialists and physicians is that mothering could be done for that. However, as I blogged in 2005 about this topic, there are 4 supplements that have been proven in a clinical trial (the Rotterdam study) to reduce AMD by 31% when taken in combination. They are vitamin E, zinc, vitamin C and beta-carotene.

 

References

1. The Merck Manual 

2. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

3. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright  2004 Elsevier

4. http://www.ncbi.nlm.nih.gov/pubmed/22696317 :Cochrane study update June 2012.

5. Spanish study, April 2012: low intake of lutein and zeaxanthin confirmed in 79% of patients with wet macular degeneration. http://www.ncbi.nlm.nih.gov/pubmed/22482894

6. Italian Study March/April 2012: http://www.ncbi.nlm.nih.gov/pubmed/22009916

7. Category 3 and 4 AMD would benefit from supplementation:http://www.ncbi.nlm.nih.gov/books/NBK84275/ (Jan. 2012).

8. http://ukpmc.ac.uk/abstract/MED/11297486 (2001)

9. http://www.ncbi.nlm.nih.gov/pubmed/22577773 (June 2012)

10. http://www.lef.org/magazine/mag2008/dec2008_Preventing-Macular-Degeneration_01.htm

11. http://agelesslifestyles.com/2010/11/many-health-problems-are-really-hormone-problems/

Last modified: December 3, 2016

Disclaimer
This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.