Save Your Sight

By Claire Henley

Behind the Scenes of AMD
Directly behind your eye is a light-sensitive tissue called the retina, at the center of which is a small spot called the macula. AMD occurs when this small spot begins to deteriorate.

The macula shows far more sensitivity to fine details and color than the rest of the retina. Whereas the outer part of the retina gives you side (or peripheral) vision, the macula is responsible for central vision that lets you see objects straight ahead with clarity and definition. Thanks to the macula, you can do things like thread a needle and read small print. You can notice the complex texture of a painting and see the details of a person’s face straight in front of you.

The older you get, though, the more at risk you are for developing AMD, which advances slowly and often goes unrecognized until significant eye damage takes place. The National Eye Institute reports the frequency of the disease increases dramatically after age 65.

Caucasians are far more likely to develop AMD than other races. “This risk factor is related to the protective macular pigment, or melanin, in your skin,” says Dr. Rob McGarvey, an optometrist with Kapperman and White Eyecare. “The higher the melanin, the higher your protection, which is why those who have fair complexions have the highest risk.”

Spotting the Signs
AMD usually starts as a blurred area in your center vision. Over time, the blurred area may grow larger, and you might develop dark or blank spots in the middle of your line of vision. Fine print may become harder to read and faces more difficult to tell apart. Objects might start to appear less bright, and straight lines may begin to look wavy or distorted.

An easy way to spot AMD is to look at an Amsler Grid, which you can download from the Internet, print, and hang on your refrigerator. If the lines on the grid disappear or appear wavy or dark, it’s time to see an eye doctor. “It’s a very simple way to monitor your eyes at home,” says Dr. McGarvey. “Those at risk can do it every day.”

Untreated AMD will eventually interfere with your ability to read, drive, watch television, and do routine tasks. The good news is AMD does not cause total blindness, because it only affects central vision. For example, someone with advanced macular degeneration might be able to see the outline of a street sign, but not the words on the sign.

Two Eye-Opening Forms
Age-related macular degeneration presents itself in two forms: dry and wet.

DRY FORM The majority of people with AMD have the dry form. Dry AMD is caused by the aging and thinning of the macula. “It is simply tissue loss in the central retina,” says Dr. Breazeale.

When bits of yellow or white fatty protein deposits called drusen latch beneath the retina, the macula begins to deteriorate. The dry form can be sneaky, as vision loss is gradual and can affect one eye without a person noticing it. When both eyes are open, the good eye will compensate for the affected eye. Unfortunately, if left untreated, dry AMD can evolve into the more harmful wet AMD.

“The dry form slowly reduces your vision’s sharpness or clarity,” says Dr. Dennis Matzkin, an ophthalmologist with Allied Eye. “If you don’t get regular exams, it can easily progress to the more aggressive wet form and then to severe loss of vision, which is difficult to reverse.”

Dr. Breazeale agrees. “Catching the disease when a patient still has good central vision leaves a better chance of maintaining good central vision.”

WET FORM Accounting for about 10% of cases, the wet form leads to faster vision loss and is the more serious form of the disease. It occurs when abnormal blood vessels grow from the layer beneath the retina. These vessels can leak fluid and blood, resulting in scarring and damage. Since you’ll lose more of your detailed vision the longer the abnormal vessels grow and leak, it’s important to see your ophthalmologist at the first sign of vision impairment. The sooner you have wet AMD diagnosed and treated, the better chances you’ll have for preserving your central sight.

Your Best and Brightest Defense
The best way to protect yourself from the progression of AMD is simple: regular screenings. All adults should receive a baseline eye disease screening at age 40. Adults ages 50 and up should see an eye doctor every year for a comprehensive eye exam.

If your eye care professional suspects you may have AMD, you may undergo a non-
invasive imaging test called optical coherence tomography (OCT). This test can spot fluid or blood underneath the retina. “The newest machines show the layers of the retina in great detail,” says Dr. Matzkin. “This helps us identify and monitor new abnormal blood vessels earlier than ever before.”

Looking After Your Eyes
The shelves of your local drugstore or grocery may be filled with products for eye health, and these can be confusing to navigate. If you want to prevent deterioration but feel overwhelmed in the product aisle, Dr. McGarvey recommends a daily nutritional supplement using the AREDS formulation, which contains vitamin C, vitamin E, beta-carotene, zinc, and copper. Over-the-counter options include Tozal and PreserVision. Any person with a history of smoking should specifically look for the AREDS 2 formulation, which substitutes other ingredients for beta-carotene in order to guard against increased risk of lung cancer.

Other defenses against AMD depend on your lifestyle. For example, studies show that smoking doubles the risk of AMD. By avoiding smoking, you will reduce your risk. Additionally, by exercising regularly, maintaining normal blood pressure and cholesterol levels, and eating a healthy diet rich in leafy greens and fish, you can lower your chances of developing AMD.

Lastly, if you sit at a computer all day, you might want to consider wearing glasses that block blue light. “New research suggests that the wavelength of blue light can be damaging to the macula,” says Dr. McGarvey. “New lenses have the ability to counteract this.”

Hope for All to See
At this time, there is no cure for the dry form of AMD, though early detection and self-care measures may delay vision loss. However, for those with the wet form, monthly injections of anti-VEGF (vascular endothelial growth factor) drugs into the eye has become a standard treatment within the past decade. These drugs work by blocking certain molecules that stimulate the growth and leakage of blood vessels.

The earlier someone can begin this treatment, the better. “In patients with newly diagnosed wet AMD, this treatment now affords us a 95% chance of preventing severe visual loss and a 75% percent chance of no visual loss at all,” says Dr. Breazeale.
Dr. Matzkin says there is hope that the coming years will see anti-VEGF drugs developed into more long-acting products or products available in an eye
drop form.

Learn More About AMD
Don’t let age-related macular degeneration leave you in the dark. If you think you are at risk for AMD, speak with your eye doctor today. To learn more about the disease, visit
geteyesmart.org for trusted eye health information from the American Academy of Ophthalmology.

Dealing with AMD can be difficult, but the good news is effective help is available. The key is to be proactive and block AMD before it blocks your sight.

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