Macular Degeneration

By Deborah Jeanne Sergeant

Macular degeneration is one of the nation’s leading causes of blindness and low vision, affecting 1.8 million Americans, according to the Centers for Disease Control and Prevention.

Age-related macular degeneration (AMD or “dry” macular degeneration) is more commonplace, 70%-90% of cases, than wet macular degeneration (WMD).

“They are the same condition, but there are varying degrees,” said Angeliki ArvanitoGiannis, ophthalmologist with VA Hudson Valley Healthcare System in Montrose and in Rochester. “Macular degeneration is either ‘wet’ or ‘dry,’ but they present differently as far as the signs.”

Either type of macular degeneration affects the central vision, which is important for reading, filling out paperwork and driving. Patients may see fine in their peripheral vision, but not in the center. For example, they may see a person’s clothing and hair, but not the face.

Mark Breazzano, ophthalmologist with Retina-Vitreous Surgeons of CNY in Liverpool.

WMD occurs when blood vessels grow abnormally under the macular and leak blood and fluid. This vision loss is rapid, and typically presents with straight lines appearing wavy. AMD is a slower process as the macula thins, which eventually blurs vision. Patients have a 10% chance of progressing into WMD.

As WMD progresses, “when the eye is under stress, it will form new, weak blood vessels,” ArvanitoGiannis said. “They don’t respond the way they should. They can leak blood or fluids.”

Patients need a clinical diagnosis after a dilated eye exam so providers can form a treatment plan, as ArvanitoGiannis said that other eye conditions can present with similar symptoms.

“There is no cure for it, but with early diagnosis, you can be a little more on top of these preventative measures and if you have the dry form, the sooner you are seen and managed, the better visual outcome you have. If you notice any sudden changes in your vision, don’t delay.”

Mark Breazzano, ophthalmologist with Retina-Vitreous Surgeons of CNY in Liverpool, encourages people with symptoms to seek a dilated eye exam from a retinal specialist.

“This allows us to take a look in the back of the eye,” he said.

His practice also has offices in New Hartford, Binghamton, Ithaca and Watertown.

“Sometimes, the difference between wet and dry age-related macular degeneration can be quite subtle,” Breazzano added. “We also typically rely on optical coherence tomography. This tool can assess smaller than what we can see on a normal dilated eye exam, that are distinct between wet or dry age-related macular degeneration.”

Doctors can treat WMD to reduce its effects with anti-VEGF injections to decrease the bleeding and fluid in the back of the eye. Breazzano said that the treatment is “quite effective. A number of patients will improve; some maintain what vision they have and some will do worse. But the consensus is that even among those who do worse, it’s generally better than not treating at all.”

Taking AREDS2 supplements has also shown to help for people with DMD and help reduce the risk of complications including conversion to WMD.

Lori Youngman, optometrist with Harbor Eye Associates in Oswego, said that patients will need to return to their provider for injections to prevent further damage.

“I would say that 70% of my patients who go that route do better for a while,” she said. “Unfortunately, it’s an age-related disease and with anything age-related it can slowly get worse.”

Ignoring symptoms or delaying treatment are the worst things to do. Even a week’s delay can negatively affect vision. With effective treatment, WMD can be managed for years — even decades — thanks to current protocols with a much lower risk of losing vision.

Youngman also advises patients in lifestyle modifications for those with macular degeneration that can reduce their risk for further vision loss, including avoiding exposure to smoking and eating a balanced diet.

Supplements can also help, including brands such as Preservision and Ocuvite.

Early diagnosis can help patients make lifestyle changes that can slow macular degeneration progress. In addition to smoking, the greatest risk factors for macular degeneration include age, family history, gender (women are more prone), high blood pressure, high cholesterol and poor diet.

Laurel Sterling, registered dietitian, nutritionist and educator with Carlson Laboratories in Canastota, recommends improving the diet by including more healthful foods to prevent further degradation for eye health and in general to promote eye health and reduce the risk of eye issues.

She recommends improving intake of “carotenoids like lutein and zeaxanthin, beta-carotene, vitamin C, bilberry, N-acetyl cysteine and minerals like zinc and copper work as antioxidants that can assist overall eye health.”

Leafy green vegetables like spinach and dark-leaf lettuce, cruciferous vegetables like kale and broccoli, and eggs and peas are good sources of lutein and zeaxanthin. Beta-carotene is found in green leafy vegetables; orange vegetables like squash, carrots and sweet potatoes; and fruits like melons, sour cherries, mangoes and papayas.

N-acetyl cysteine is a supplement form of cysteine, which is in many high-protein foods, like meat, poultry, yogurt, eggs, cheese, sunflower seeds and legumes.

Stellar sources of vitamin C include oranges, strawberries, raspberries, cantaloupe, red peppers, cauliflower, broccoli and Brussels sprouts. Nuts and seeds are rich in numerous minerals.