What is macular degeneration?
Macular degeneration is the physical breakdown of the central portion of the retina called the macula. The macula, which is about the size of the capital letter “O” in this sentence, is the part of the eye capable of our most acute and detailed vision. We use the macula for reading, driving, recognizing faces, watching television, and fine work. Macular degeneration is the leading cause of legal blindness in people over age 55, more commonly in women and those with light colored eyes. (Legal blindness means that the best a person can see is 20/200 or worse with eyeglasses.) Even with a loss of central vision, however, color vision and peripheral vision may remain clear.
Thirty percent of adults over age 75 have early signs of macular degeneration, and over 50% by age 80. With longevity increasing each decade, the outlook for today’s baby boomers is not good. Vision loss can occur over a short period of time, but usually occurs gradually, affecting both eyes at different rates.
There are two forms of age-related macular degeneration, “wet” and “dry.” Eighty to ninety percent of patients have the “dry” form, which involves thinning of the macular tissues and disturbances in its pigmentation. Ten to twenty percent have the “wet” form, which can involve leakage of serum and bleeding within and beneath the retina, opaque deposits and eventually scar tissue. The “wet” form accounts for ninety percent of all cases of legal blindness in macular degeneration patients.
What causes macular degeneration?
Like virtually every degenerative disease of the body, reactive molecules known as “free radicals” are likely the root cause of macular degeneration. Hereditary, dietary and lifestyle factors determine how well any individual is able to control these free radicals and where they will do the most damage. Diseases such as diabetes and atherosclerosis may accelerate the process.
Younger patients can also develop macular degeneration. These non-age related cases also may be linked to heredity, diabetes, nutritional deficits, injury, infection, or other factors such as excess exposure to sunlight. Scientists are undertaking the basic research necessary to determine the cause of these disorders. Finding the cause is the first important step toward prevention and cure.
The following are NOT known to be linked to macular degeneration:
- floaters (moving spots caused by debris floating in the vitreous fluid between the lens and the retina)
- dry eye syndrome
- cataracts – cataract surgery, due to decompression of the eye during the procedure, may in some cases aggravate early macular degeneration.
How is macular degeneration detected?
Reduced vision noticed by the patient before or during a routine eye exam may be the first indicator of macular degeneration. While examining the retina with an instrument called an “ophthalmoscope,” the doctor may detect the formation of new blood vessels or leaking from blood vessels called “drusen” in and under the macula. In addition, the following signs may be indicative of macular problems; anyone experiencing these symptoms should consult their eye doctor immediately:
- straight lines appear distorted and, in some cases, the center of vision appears more distorted than the rest of the scene
- a dark, blurry area or “white-out” appears in the center of vision
- color perception changes or diminishes.
Is early detection important?
Early detection IS important because a patient destined to develop macular degeneration may benefit from nutritional intervention, which may slow or stop the progress of the disease. Furthermore, as we develop better treatments for macular degeneration, whether nutritional, medicinal, surgical or low vision aids, those patients can sooner benefit from them. One problem is that many eye physicians, optometric and ophthalmologic, DO NOT MENTION early changes to their patients in order to not worry them. Because they are either not aware or convinced of the ability of nutritional intervention to be beneficial, they simply monitor it over time.
If I have macular degeneration in one eye, will it develop in the other?
Yes, this is usually the case. In the early stages, only one eye may be affected, but as the disease progresses, both eyes are usually affected. Recent research, however, is showing promise for reducing the risk of developing macular degeneration as well as slowing its progress using nutritional factors.
Is there a cure for macular degeneration?
At this time, there is no accepted “cure” for macular degeneration. In some cases, macular degeneration may be active and then slow down considerably, or even stop progressing for many, many years. Depending on the type and degree of the condition, it is possible to influence the speed at which it progresses, and in many cases halt it. This is done through nutritional intervention (supplements, avoiding hydrogenated fats, chemical food additives, etc.) or by doing laser surgery of the blood vessels (see below). After the disease has damaged the vision permanently, we also have developed low vision aids and techniques for maximizing the use of peripheral vision to help patients adapt better to their loss of central vision. Educating susceptible groups about macular degeneration risk factors can reduce their risk of developing the disease. We advise that a patient select an eye doctor who is knowledgeable about nutritional research and who will refer you to a retinal specialist should you need laser surgery.
Can nutrition help treat macular degeneration?
Some scientists have suggested an association between macular degeneration and a diet high in saturated and hydrogenated fats and other substances (including MSG and aspartame). Also, a diet high in Omega 3 fats and carotenoid pigments, especially lutein, zeaxanthin and lycopene, may be protective against the disease. These carotenoid pigments, which are obtained from eating fresh fruits and dark green, leafy vegetables (such as kale, spinach and collard greens), may significantly delay or reduce the severity of age-related macular degeneration. In the absence of consuming 5-9 fruit and vegetable servings each day, it is imperative to take a quality multiple supplement for the eyes which contains lutein (lutein is converted to zeaxanthin in the retina). Taking anti-oxidants like Vitamins C and E and selenium may also have positive effects. Zinc in moderate levels is probably beneficial, as well. Consuming the wrong form or too much of this mineral can cause digestive problems and anemia. Zinc in the L-monomethionine or proprionate forms is recommended.
Can surgery help cure macular degeneration?
Surgery to remove the scar produced by macular degeneration has occasionally been successful in younger patients, but less so in older patients. If the degeneration is associated with leaking blood vessels in the center of the macula and vision is worse than 20/70, a laser procedure called photocoagulation is recommended. This rarely improves vision and generally slows, but does not stop, further vision loss. In fact, laser photocoagulation permanently destroys the small spot which is treated. Retinal transplantation is a new experimental approach to macular degeneration but has been extremely unsuccessful, frequently causing total loss of vision. We caution you strongly against having it done to yourself or a loved one.
Is macular degeneration hereditary?
Macular degeneration appears to be hereditary in some families but not in others. Since macular degeneration affects most patients later in life, it is difficult to study successive generations in a family. Recent studies of twins indicate that both genetic and non-genetic factors play important roles in age-related macular degeneration. Research is underway to determine the genes associated with hereditary macular degeneration which may help lead to early detection, early intervention, and possible cures. Heredity plays a major factor in one’s ability to fight free radicals in various parts of the body, which play a part in the development of macular degeneration. Fortunately, dietary and lifestyle changes can sometimes overcome poor heredity in many of these cases.
Does sunlight affect macular degeneration?
Yes, it has been demonstrated that the blue rays of the spectrum seem to accelerate macular degeneration more than other rays of the spectrum. This means that very intense light, such as sunlight or its reflection off of bright surfaces, may worsen macular degeneration. Regular sunglasses with UV protection and dark neutral density lenses, or lenses that also block out the blue end of the spectrum (for those who spend a great deal of time outdoors), may reduce the likelihood of developing and progression of the disease. Again, more research is needed in this area.
Does hypertension and heart disease affect macular degeneration?
Yes, hypertension tends to make some forms of macular degeneration worse, especially in the “wet” form where the retinal tissues are invaded by new blood vessels. The medications used to treat hypertension have not been shown to have any direct effect on macular degeneration, but they may slow progression of the disease by reducing hypertension. Likewise, those suffering from atherosclerosis heart disease also are at a higher risk for developing macular degeneration, and the same nutrients which protect from heart disease (i.e., the antioxidants) are helpful for macular degeneration, as well.
It is interesting to note that deficiencies of the vitamins and minerals which have been shown to cause heart disease also have been implicated in macular degeneration risk.
Does smoking or second-hand smoke contribute to macular degeneration?
Yes, any type of smoking or exposure to tobacco smoke can greatly accelerate the development of macular degeneration. This is especially true if the smoker consumes few of the carotenoid nutrients, especially lutein, with those smokers increasing their risk of developing advanced macular degeneration by up to 600%.
What kind of basic research about macular degeneration is underway at eye research facilities around the country?
Many eye centers are devoted to the study of eye disease, visual dysfunction and blindness. To work toward a cure for macular degeneration, they are studying the anatomy, physiology and development of the retina at the tissue, cellular and molecular levels in both healthy and diseased eyes. Laboratory and clinical researchers work closely together to devise new strategies in our fight against macular degeneration. New optical technology is being developed to observe and measure the condition of the eye, as well as new techniques to study the vision process. Research to develop low vision aids for patients with macular degeneration and other eye diseases is also going on.
The National Eye Institute is currently funding the first large study on the effects of nutrition and macular degeneration. Other smaller studies have shown great promise, even with marginal amounts of nutritional supplementation.
Would it be helpful if people with macular degeneration bequeath their eyes to eye research facilities?
Yes, donated eyes are in short supply. Both diseased and healthy eyes are extremely important for the continuation of eye research. If you intend to donate your eyes, we suggest that you inform family members and make arrangements with your local eye bank.
What can I do to help prevent and cure macular degeneration?
- Have annual routine eye exams (you should have your eyes dilated for this exam). Ask your doctor if there are any early signs of macular degeneration.
- See your nutritionally knowledgeable eye doctor without delay if you notice any changes in your vision.
- Take a wide spectrum antioxidant supplement on a two-to-three times daily basis.
- Recommend this website to others who are at risk for the disease.
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