Age-Related Macular Degeneration
Age-related macular degeneration (AMD) is a disease associated with aging that gradually destroys sharp, central vision. Central vision is needed for seeing objects clearly and for common daily tasks such as reading and driving. AMD affects the macula, the part of the eye that allows you to see fine detail. In some cases, AMD advances so slowly that people notice little change in their vision. In others, the disease progresses faster and may lead to a loss of vision in both eyes. Macular degeneration is a leading cause of vision loss in Americans 60 years of age and older.
The greatest risk factor for macular degeneration is age. However, other risk factors include smoking, obesity, family history, gender (women are more at risk than men), and race (Caucasians are more likely to develop the condition than African Americans).
There are two types of macular degeneration: wet and dry.
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, causing rapid damage to the macula. With wet AMD, loss of central vision can occur quickly.
An early symptom of wet AMD is that straight lines appear wavy. If you notice this condition or other changes to your vision, contact your eye care professional at once. You will need a comprehensive dilated eye exam.
Dry macular degeneration occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye. As dry AMD gets worse, you may see a blurred spot in the center of your vision. Over time, as less of the macula functions, central vision is gradually lost in the affected eye.
The most common symptom of dry AMD is slightly blurred vision. You may have difficulty recognizing faces. You may need more light for reading and other tasks. Dry AMD generally affects both eyes, but vision can be lost in one eye while the other eye seems unaffected. One of the most common early signs of dry AMD is drusen.
Drusen are yellow deposits under the retina. They often are found in people over age 60. Your eye care professional can detect drusen during a comprehensive dilated eye exam. The dry form can advance and cause vision loss without turning into the wet form. The dry form also can suddenly turn into the wet form, even during early stage AMD. There is no way to tell if or when the dry form will turn into the wet form.
Wet AMD can be treated with laser eye surgery, photodynamic therapy, and injections into the eye. These injections are medications that inhibit vascular endothelial growth factor. None of these treatments is a cure for wet AMD. The disease and loss of vision may progress despite treatment.
Once dry AMD reaches the advanced stage, no form of treatment can prevent vision loss. However, treatment can delay and possibly prevent intermediate AMD from progressing to the advanced stage, in which vision loss occurs.
The National Eye Institute’s Age-Related Eye Disease Study (AREDS) found that taking a specific high-dose formulation of antioxidants and zinc significantly reduces the risk of advanced AMD and its associated vision loss. Slowing AMD’s progression from the intermediate stage to the advanced stage will save the vision of many people.
AREDS and Supplements
Doctors have long debated whether taking vitamin and/or mineral supplements could help prevent, treat, or cure certain eye conditions. Early scientific studies seemed to show that supplements had the potential to prevent or slow the progression of cataract and age-related macular degeneration (AMD), although more complete study was needed to answer some important questions:
- Which supplements are helpful for which condition(s)?
- Which patients will benefit from supplementation?
- What doses of supplements would benefit patients?
- What other effects might these supplements have on the body?
What is the Age-Related Eye Disease Study (AREDS)?
AREDS looked at the effects of zinc and antioxidants, and a combination of both, on patients with cataracts, and on those with varying stages and types of AMD. Scientists also studied patients without evidence of cataract or AMD to determine if zinc and/or antioxidants can prevent the development of these conditions. Georgia Retina was one of the study centers chosen by the National Eye Institute. Many Georgia Retina patients volunteered to participate in the study.
NIH’s National Eye Institute conducted the second Age Related Eye Disease Study, or the AREDS 2 study. The original study showed that adding a combination of vitamin C, vitamin E, beta-carotene, zinc, and copper to the patient’s daily regimen reduced the risk of advanced stages of AMD by 25%. Although this study found a successful way to help reduce the risk of AMD, there was still a concern with the high levels of beta-carotene, putting smokers and former smokers at a higher risk for lung cancer. In addition, since the original AREDS study, there had been additional research on lutein and zeaxanthin and eye health. In response, the NIH began the AREDS 2 study to look into revising the AREDS recommended formula to prevent AMD.
The 2013 National Eye Institutes five year AREDS 2 study (Age-Related Eye Disease Study) proved that a revised formula consisting of the AREDS formula without beta-carotene, adding lutein and zeaxanthin reduces the risk of progression of Age-Related Macular Degeneration by an additional eighteen percent compared to those in the AREDS 2 study who took the original recommended formula from 2001.
To learn more about the Age-Related Eye Disease Study (AREDS) and schedule a visit with one of our ophthalmologists, call us toll-free at 888-GA-RETINA.
What Types of Nutritional Supplements Were Found to be Beneficial?
The formulation used in the study was:
- Vitamin C – 500 mg
- Vitamin E – 400 IU
- Lutein – 10 mg
- Zeaxanthin – 2mg
- Zinc Oxide – 25 mg
- Copper (as cupric oxide) – 2 mg
What Should I Do?
If you have AMD and are taking some type of nutritional supplements, continue that regimen. We will inform you at your follow up visit if you should continue that exact regimen or whether you should make some small modification.
If you have AMD and are not taking nutritional supplements, but would like to, we will address that with you when you return for your retinal follow up visit.
Georgia Retina offers its own AREDS vitamin called Focus MaculaPro available for purchase at your appointment or call to our office. Other brands of eye vitamins are available over-the-counter at most pharmacies.
Do not worry if you have not been taking these supplements. Be aware that the beneficial effects of these supplements are small, and thought to occur only after taking the supplements for many years. If you delay starting them for several months, it is unlikely to be detrimental.
What About Lutein?
Lutein, the beneficial pigment found in green leafy vegetables (parsley, spinach, kale, greens) was not addressed in this study, but other studies have suggested beneficial effect. We encourage you to continue eating green leafy vegetables or take a lutein supplement. (If you are on Coumadin, speak to your medical doctor before eating green leafy vegetables.)
Other Ongoing Studies
Did you know that Georgia Retina is participating in a study to learn more about the genetics of AMD? To participate, you must have a brother or sister who has been diagnosed with AMD. Your sibling does not even need to be a patient of Georgia Retina, nor do they need to live in Georgia. Participants only need to be willing to provide a sample of their blood, allow their retinas to be photographed, and have an appropriate screening examination. If you want to participate, call your doctor and let them know. Georgia Retina is proud of the patients who volunteer for these studies now or in the future. Such contribution speeds up medical breakthroughs.
To learn more about the Age-Related Eye Disease Study (AREDS) and schedule a visit with one of our retina specialists in Atlanta, call us toll-free at 888-GA-RETINA.