Marilyn Gozdon can tell you from personal experience why it’s crucial to know your risks for age-related macular degeneration (AMD).Marilyn lost most of the vision in her left eye to “wet” AMD five years ago, before new medications revolutionized treatment of this form of the disease. Today Marilyn is fiercely committed to working with her Eye MD (ophthalmologist) to maintain the 20/40 vision she still enjoys in her “good” right eye.
AMD is a main cause of vision loss in the United States. Advanced AMD destroys the detailed, central vision we need to recognize faces, read, drive, and enjoy daily life. March is AMD Awareness Month, and the American Academy of Ophthalmology together with the American Society of Retina Specialists, the Macula Society, and The Retina Society, encourage Americans to know their risks for AMD.
“When we catch AMD early, patients can make lifestyle changes that may slow disease progress, or we can start treatment, if needed,” says Mark S. Hughes, MD, a retinal specialist. “Even someone with 20/20 vision can suffer rapid vision loss from undetected AMD.People need to know their risks so that they can save their sight.”
The Foundation of the American Academy of Ophthalmology recommend that adults with no signs or risk factors for AMD or other eye diseases get a baseline eye disease screening at age 40—when early signs of age-related diseases and vision loss often become apparent. People of any age who have symptoms or risks, such as family history, should see their ophthalmologist to determine how often to have checkups. Risks for AMD include: being 60 or older, having a family history of AMD, being overweight, having hypertension or high cholesterol, and being a smoker. Smokers’ risk of AMD is twice that of nonsmokers.
By the time Marilyn became Dr. Hughes’ patient it was too late to save the vision in her left eye. She is well aware that without the injections she receives about once a month to control abnormal blood vessels in her right eye’s retina, she could become legally blind. A few months ago “I fell asleep watching TV, and when I woke up I noticed a red spot in my field of vision,” Marilyn says. “I called Dr. Hughes right away, and he treated me the next day. After a few treatments my eye stopped leaking and has been fine since. I can drive and go about my daily life. Reading is harder than it used to be, but I can do it.”
“Marilyn monitors her symptoms and lets me know immediately if she notices her vision changing,” says Dr. Hughes. “This kind of vigilance and partnership is essential to good AMD care. In contrast, some people—even a highly educated person like my university professor patient—notice their eyes getting worse but delay coming in. Perhaps they’re afraid of what AMD may be doing to their eyes—but the truth is the sooner we intervene, the better our chances.”Once part of the visual field is lost to AMD, it may be difficult or impossible to restore it.
Dr. Hughes advises all AMD patients to control their weight and hypertension and quit smoking. He says lifestyle choices that are good for heart health generally will also benefit AMD patients. UV light exposure has been linked to AMD in some studies, so UV-blocking glasses and hats may be important, especially for people with light-colored eyes. A specific high-potency supplement, the Age-Related Disease Study (AREDS) formula, may slow progression in people with intermediate or early-advanced AMD. (Smokers need to use a formula without beta carotene.) Those with the early stage of the disease should take a daily multivitamin. Eating fruits and deeply colored vegetables such as red peppers, kale, and spinach—sources of antioxidants—provides many health benefits, and one is likely to be a reduced risk of AMD.
“Research is moving forward rapidly and the next few years will probably bring dramatic diagnosis and treatment breakthroughs,” says Dr. Hughes. “Genetic and immune system discoveries may allow us to predict which treatments will be most effective for a given patient. Stay tuned!”
The disease takes two forms, termed “dry” and “wet.”In the early “dry” stage, yellowish deposits called drusen develop under the retina, the light-sensitive tissue at the back of the eye, but most people would not notice their vision changing. Patients with more and larger drusen, and more pigment changes in the central retina, or macula, are considered to have intermediate AMD and are at higher risk for both advanced “dry” and “wet” AMD. Most people with intermediate AMD will not progress to the advanced stage, but they should be carefully followed by an Eye MD so that treatment can be given right away, if needed.
Advanced AMD can occur in the “dry” or the “wet” form. No medical or surgical treatment is available for advanced “dry” AMD, which causes blind areas in the central macula, although patients can use low-vision technologies like improved lighting and magnification to maintain their quality of life. In the “wet” form, abnormal new blood vessels develop under the retina that bleed or leak fluid and form scars, resulting in central vision loss. Only about 10 percent of the 10 to 15 million Americans with AMD have the “wet” form, but until two years ago it was responsible for most severe vision loss. New, highly effective treatments such as the injectable medications ranibizumab and bevacizumab are dramatically reducing damage from “wet” AMD: vision stabilized in up to 90 percent of patients and actually improved in more than 30 percent of patients in two of the large multicenter clinical trials to evaluate ranibizumab.
For more information about AMD and other eye diseases, visit www.geteyesmart.org.
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