When To Call A Professional

Macular degeneration (also called age-related macular degeneration, or AMD) is a common cause of blindness and vision problems among people older than 50 in the United States. AMD damages the macula, a small part of the eye’s light-sensitive retina, which sends vision signals to the brain.

The macula is responsible for seeing sharp details directly in the center of the field of vision, so damage caused by AMD can interfere with the ability to see straight ahead—necessary for driving and viewing distances, such as when recognizing faces or watching television. It can also affect fine, detailed vision, which is important for reading newsprint, sewing, working with crafts, and making repairs.

Most people with AMD have fluffy, yellow-white spots on the macula. These spots are called drusen. Not everyone who gets AMD has these spots, and the connection between drusen and AMD is not clear. There are two ways to lose vision as a result of AMD. Both occur during the early stage of the disorder.

• Dry (non-neovascular) AMD — About 90% of people who lose significant vision from AMD have this form of the illness. In dry AMD, light-sensing cells in the eye malfunction or disappear over time, producing blank spots in central vision that are subtle at first, then eventually become more noticeable.
• Wet (neovascular) AMD — In wet AMD, delicate new blood vessels begin to grow beneath the retina and can leak blood and fluid into the macula, causing scarring. Damage from the blood vessels, blood and fluid, and scar tissue can occur in a very short period of time, causing rapid loss of vision over days to weeks and continued loss of vision over time. This process is probably responsible for about 90% of the cases in which AMD has led to legal blindness. But it is far less common than the dry form.

Age is the most important risk factor for AMD, and the early stage currently affects approximately 3.5 million to 10 million people in the United States older than 65 (the exact number depends on how macular degeneration is defined). Only a small percentage of people in their 50s have AMD. This percentage increases dramatically in people aged 75 and older. In that age group, about 10% have the advanced form of AMD that causes vision loss.

Treating, preventing, and slowing AMD

While there is no surefire way to prevent AMD, you can take steps that may delay onset of the disease or reduce its severity. Because smoking can accelerate AMD damage, quitting smoking is an important preventive step. Wearing hats and sunglasses that block the sun’s blue wavelengths — which are thought to possibly promote AMD — may also provide protection.

Some evidence suggests that using statins, a group of drugs usually prescribed to lower cholesterol, may lower the risk of AMD. Heart disease is usually identified with an increased risk of AMD, so the statin connection is not surprising. Nevertheless, much more research is needed before doctors begin prescribing statins to prevent AMD.
Some evidence hints that a diet high in saturated fat may increase your risk of developing AMD. Although the jury is still out, reducing saturated fat in your diet is healthful in several ways and might also help prevent AMD.

Evidence also suggests that certain nutrients may help prevent macular degeneration. Middle-aged and older people may benefit from diets rich in fresh fruits and dark green leafy vegetables, such as spinach or collard greens. The large, multicenter Age-Related Eye Disease Study reported in 2001 that for people at high risk of developing advanced stages of wet AMD, high-dose combinations of the antioxidant vitamins and minerals lowered risk by about 25%. The supplements provided no apparent benefit for people who had either no AMD or early AMD. But ask your doctor about taking such supplements if you have intermediate or advanced dry or wet AMD.

The AREDS study found that the following combination of antioxidants and zinc may help protect against advanced age-related macular degeneration (copper is added to the mix because high levels of zinc may cause copper deficiency):

• vitamin C: 500 milligrams (mg)
• vitamin E: 400 international units (IU)
• beta carotene: 15 mg
• zinc: 80 mg
• copper (cupric oxide): 2 mg

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