Dr. Kristen Robinson of Saugeen Shores Family Eye Care answers questions about Age-related Macular Degeneration (AMD)
What does the diagnosis of AMD mean exactly?
Macular degeneration is a chronic age-related disease that slowly impacts your central vision that you use for sharp, fine detail work. The disease can cause blurred vision or a blind spot in your central vision, which can make it difficult or impossible to read or recognize faces. Your peripheral vision, however, remains intact to allow other activities of daily living to remain possible. The amount of damage that has occurred in your retina as a result of macular degeneration will determine the extent that your vision is affected. In the early stages you may not even notice the subtle vision changes that accompany these macular changes. As the disease progresses, your vision can become more and more compromised. It is important to have your AMD monitored regularly by your local eye doctor in Saugeen Shores.
I understand there are two types of AMD. What are the differences between dry or wet AMD?
Yes, there are two types of macular degeneration. Almost 90% of people with AMD will have the dry form, where only 10% will develop the wet form of AMD. In the dry form, debris called drusen accumulates between the retina and the choroid, which distorts it and causes the deterioration of the retina. In the wet form, which is more severe, blood vessels grow up from underneath the retina and leak fluid and can cause the retina to become detached. Dry macular degeneration can progress to the wet form at any time, so it is important to monitor your Amsler grid daily, and continue with routine eye examinations. Early detection is crucial for maintaining and preserving your vision.
Please describe the typical progression for an individual with AMD?
Macular degeneration will generally progress slowly. In the early stages, many people may not notice any changes in vision at all, particularly if the disease is only affecting one eye in the beginning. You may also notice that you require brighter light when reading, and an increased difficulty adapting to low light levels, such as when entering a dimly lit restaurant from a bright, sunny day outside. Eventually the central field of vision in your eye slowly blurs or grows dim. You can still see colours, but the details aren't as clear. This tends to happen over a period of many years. If a person develops the wet form of macular degeneration, the vision loss tends to be much more rapid. The central field of vision can fade and blur until it completely vanishes, leaving a large blind spot. An early sign of wet macular degeneration is when you notice that lines in the centre of your field of view become wavy. This is due to the new blood vessels leaking fluid under the retina, which lifts it and deforms its shape. At this point any eye doctor in Port Elgin will refer you to a surgeon to receive treatment of those leaky blood vessels, in an attempt to prevent further vision loss.
Although the visual deterioration can be very detrimental in some cases, there are also many people with this condition who do not develop a significant impact on vision and continue to live full lives without serious disability.
What treatment options and/or care is available for this condition?
Dry macular degeneration unfortunately does not have any known treatments; there are only methods to slow down its progression. As eye care experts we strongly promote the following management strategies for patients with dry AMD:
Take specific vitamins that follow the AREDS formula
Assess your Amsler grid daily (a test used for early detection of AMD which helps assess macula distortion)
Maintain good health, including proper control of blood pressure, cholesterol and blood sugars
Exercise regularly and eat healthy foods, including dark, leafy green vegetables and fish (and other foods with omega-3 fatty acids), as well as eliminate foods with high saturated fat
Wear sunglasses to block harmful UV radiation
For those patients that develop the wet form of macular degeneration, there are treatments available, but not a cure. In wet AMD, the leaky blood vessels that have grown underneath the retina can be treated with laser surgery, photodynamic therapy, or injections of anti-VEGF medication which all help to stop the growth of new blood vessels and decrease the bleeding in the macula. Treatment does not always reverse the vision loss experienced by wet AMD, however it does prevent any further loss from occurring.
What are the risks and side effects associated with these treatments? What if you don’t proceed with treatment?
If you have developed wet macular degeneration and you don't proceed with treatment, your vision will continue to get worse, and you may become completely blind centrally. Side effects of anti-VEGF injections include: vision changes, inflammation of ocular structures, bleeding, eye discharge, eye pain/discomfort, increased pressure inside the eye, increased sensitivity to light, headache, and painful urination. Usually these side effects are caused by the actual injection, rather than the drug itself. Laser surgery and photodynamic therapy are less commonly used since the discovery of anti-VEGF injections, however they have similar side effects to the injections, but may also cause photosensitivity reactions, low back pain, and additional vision loss due to damage of nearby tissues by the laser. Because the newer anti-VEGF treatments do not damage nearby healthy retina, these older laser techniques are no longer used as frequently.
The studies that support the recommendations for slowing down dry macular degeneration are significant and if you decide not to comply with your eye docotr's advice, you have a much higher risk of having your AMD progress much faster. There really aren't any side effects associated with staying healthy and eating right, so in my opinion, so there is no reason a person shouldn't work towards a healthier way of living. In some cases, the vitamins that are recommended can upset the stomach, which is why it is recommended to take it with a meal to avoid these side effects.
Will a change in a patient’s glasses prescription help at all?
In some cases yes, but it will still not restore any vision that has already been lost due to AMD. However, that being said, having the most up-to-date prescription in your glasses will definitely optimize the vision that you do have and allow you to see the best you possibly can. There is a wide variety of low-vision aids to assist people in utilizing their functional vision to the best of their ability including: magnifiers, larger print books, e-books, audio books, computer modifications, and brighter lights. Even though we do not offer specific low vision assessments at Saugeen Shores Family Eye Care, we are more than happy to refer you to someone who does specialize in those techniques, including low vision specialists and the CNIB.
What can a person do to protect or prolong their vision?
Ocular vitamins that follow the AREDS formula have been proven to slow down the progression of AMD. This specific combination of vitamins can significantly decrease your likelihood of your AMD progressing. It is also important to maintain a healthy diet, which should include plenty of leafy green vegetables and omega-3 fatty acids. Keeping your blood pressure, weight, and cholesterol well controlled will also improve your chances of protecting your vision from AMD progression. Quit smoking! Smoking is a contributor to the progression of AMD. UV protection is also very important, so make sure you wear sunglasses when outdoors during daylight hours, even in the winter!
Can you recommend a vitamin/mineral program for me that might be helpful or are vitamin supplements specific to each patient?
There are many formulations on the market that are advertised for macular degeneration and there are some that are better suited to certain individuals. It is best to ask your eye doctor about which vitamin is best suited to you. As a generality, it is important that people use a supplement that follows the AREDS formula, which is based on scientific evidence. This formula contains zinc, copper, vitamins C and E, as well as beta-carotene, zeaxanthin and lutein. However, smokers (or recent ex-smokers) need to avoid beta-carotene in vitamins, so many companies have produced a "smoker's formula" for their AREDS vitamin. This is a good reason why it is important to talk to eye care specialist in Saugeen Shores to determine which supplement is best for you. There are always new studies being done with respect to AMD and when there are changes made to supplements, your best chance to get the most updated information is from your optometrist.
How often should I have my eyes checked if I have AMD and do I need any special tests?
If you have AMD you should have a comprehensive eye exam once a year, at the very minimum. Often your eye doctor will need to see you more often, depending on which stage of macular degeneration you have. Sometimes you may need to be seen as often as every 1-3 months if you are at a very high risk of developing wet AMD or advanced dry AMD.
At our optometry practice in Port Elgin, ON, we have the most advanced technologies available to our AMD patients. We have a retinal camera, as well as OCT (optical coherence tomography) imaging. We recommend that both of these tests be done on every macular degeneration patient at every exam they have. The OCT is one of the newest advancements available and it is able to detect changes in macular degeneration much earlier, before serious vision loss occurs. Both tests are non-invasive imaging and are quick and painless for patients. The OCT will display a detailed cross-sectional image of your retina, which allows your doctor to identify areas of retinal thinning, thickening or swelling, which can be caused by fluid accumulations from leaking blood vessels in and under your retina from wet AMD. OCT has a very important role in earlier detection of AMD, as well as helping your optometris Elgin monitor the response of the retina to various AMD treatments. At our office, it is always our top priority to provide you with the best care possible for the management and treatment of your macular degeneration.