MACULAR DEGENERATION (ARMD)

 

This article will attempt to explain what macular degeneration is and what can be done for it at this time.  We will describe the necessary medical terms you have to know to understand the condition, but will otherwise try to leave out the medical jargon.

 

ARMD is the most common cause of irreversible vision loss in people over age fifty in the United States.  It does not cause complete loss of vision, but can cause a person to become visually disabled by distorting their center vision.  This is because we need our “macula” in order to see details.

 

What is the macula?

The macula is a small part of our retina with the highest resolution.  In Latin, macula means “spot.”  It is the area of the retina we use to read, drive, and recognize faces.  In fact, reading this text requires you to use your macula in one or both eyes.  If a person has no macular function, it is like holding a hand about twelve inches in front of their eyes.  They can see all around their hand, but not what is behind it.  We “look” at something to orient the image on our macula.   If the macula no longer works we will only have peripheral vision.

 

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Why do people get ARMD?

The short answer is - “age and heredity.”  You can start to see ARMD in individuals in their fifties with some rarity.  If you look at people in their eighties, about 30% of them will have some degree of ARMD.  The reason people develop ARMD is mostly genetic with some influence of environmental factors.

 

 

 

The macula is hard working tissue.  It is thought that the metabolic demands of a lifetime cause a layer of cells in the retina to fill with byproducts of oxidation that eventually cause their destruction.  This layer of cells is called the retinal pigment epithelium (RPE).  The RPE is the gatekeeper controlling what comes and goes to and from our light sensing photoreceptors.  The RPE collects waste from the photoreceptors over our lifetime, and it seems this fatty diet makes them sick.  When the RPE cells become ill, the photoreceptors become sick also. The progression of changes is called ARMD and results in decreased vision when the cells eventually die. This happens first in the macula because this is where the metabolism has been greatest all of our lives. Therefore, if we have the genetic predisposition to accumulate oxidative byproducts in our RPE, we develop ARMD at a younger age.  Our general health and habits also have an influence on when we may exhibit ARMD.

 

Text Box: Can I delay or avoid getting ARMD?

Genetics are hard to fight, but there are definitely many things we all can do to either delay the onset or slow the vision loss associated with ARMD:

  1. Do not smoke.  If you do smoke, try your best to stop.  It is well established that people who smoke show ARMD younger and experience a faster loss of vision than people who do not smoke.
  2. Keep your body fit.  Being overweight is also a risk factor for developing ARMD.  Your eyes are just part of your body, and keeping your body in good health will help keep your eyes in good health.
  3. Eat a healthy diet.  Recent reports have indicated women who took supplemental B Vitamins had a reduced risk of ARMD development.  It is also possible that antioxidant vitamins such as A, C, E, and the mineral Zinc may delay ARMD.  These supplements have been shown to slow the progression of ARMD in people who have already established the condition.  Other retinal antioxidants such as lutein and zeaxanthin may be helpful, as well as Omega-3 fatty acids (fish oil).
  4. Wear Sun protection.  People with occupational exposure to unprotected sunlight showed an earlier tendency towards ARMD.  This probably means that it is healthier for the macula to protect it from ultraviolet rays.  We should protect our eyes and protect our skin.  Wear a hat, sunscreen, and sun glasses.
  5. Get regular eye exams.  Our recommendation is that people with no known eye problems be checked every two years from age fifty to sixty-five, and yearly thereafter.  Most eye problems are best treated when the vision is still normal.

 

How is ARMD diagnosed?

The diagnosis of ARMD can be made during a dilated eye exam by an eye doctor when characteristic abnormalities can be seen in the macula.  Usually, there are a cluster of yellow dots of different shapes and sizes scattered about the macula of both eyes.  These spots are called “drusen’” and indicate damage to the retina (RPE).  Not all drusen can be blamed on ARMD, but if a person has macular drusen in both eyes that are increasing over time, it is almost always ARMD.

 

 

                     

              Normal Macula                                           Moderate Macular Drusen

 

 

 

What are the early symptoms?

When mild drusen are present in early ARMD, the patient may still have 20/20 vision and be unaware of any visual problem.  A typical early symptom is difficulty reading even with wearing the correct glasses.  Usually, our reading vision is affected by ARMD before our distance vision.  As the condition advances, a person may notice difficulty distinguishing similar appearing numbers and letters, and might start to notice that when they look at a word some of the letters are missing.  The process occurs in both eyes, but can be at very different rates.  Therefore, one eye could experience some visual decline while the other one seemed alright. 

 

How long will I have my reading vision after being diagnosed with ARMD?

This is the million dollar question.  Of course, we can only answer in terms of averages.  If the ARMD stays in the typical slow dry phase (more about this later), a person can expect to keep reasonable reading vision for ten or more years after the diagnosis in the mild stage.  Perhaps five years from the moderate stage, and one to two years from the severe stage.  Again, these are averages, and a given individual may experience faster decline or slower progression.  Also, one eye could be at a moderate stage and the other at a mild stage.  It is better to know the diagnosis early on in order to start the recommended antioxidants and to do the health modifications to slow the progression of ARMD.  Also, knowing you have the condition allows you to properly monitor yourself for “wet” ARMD.

 

“Wet” versus “Dry” ARMD

The above discussion regarding typical progression was referring to the slow degenerative changes typical of dry ARMD.  Everyone with ARMD starts out with it in the dry phase.  If the ARMD stays dry, the progression of visual deterioration is often slow enough that people have reading vision their whole life.  Said in another way - they do not outlive their macula.

Of people with dry ARMD, about ten percent will convert to what is called wet ARMD.  Wet ARMD refers to the collection of fluid in the macula.  This collection of fluid can cause straight lines to appear wavy, double, or disappear altogether.

The new appearance of visual distortion in either eye means the eyes need to be examined within a day or two maximum – the sooner the better! 

This is because the fluid collected is often from abnormal blood vessels under the macula seeping the fluid.  If these blood vessels bleed and knock out the central vision, the vision is not likely to be recovered.  That is why we want to find this condition when only leakage is present – we do not want the vessels to bleed.   That is why we ask people with ARMD to monitor themselves for the wet ARMD using the amsler grid, one eye at a time at least once per week.

 

One of the greatest advancements in the last twenty years in Ophthalmology has been the development of drugs that can make these abnormal blood vessels regress. 

The drugs are not a fix in that continued treatment is needed over time, but they really do work to control a problem that was almost universally destructive of reading vision.  Injections of the drug are given in the office in the affected eye every one or two months.  This can be done safely and painlessly.  Despite how bad it may sound, the patient usually does not know the injection was given if the eye is anesthetized properly.

Our advice is to be on some sort of antioxidant formula designed for ARMD.  We have developed a product called NutriVision Complete that combines these special antioxidants along with a multivitamin.  Click the link below for more iformation.


NutriVision

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