Age Related Macular Degeneration (ARMD)
Age Related Macular Degeneration
Macular degeneration is a group of chronic, progressive degenerative disorder which affects the central part of vision thus causing difficulty in reading, writing, recognizing faces, Driving etc. it spares the peripheral visual field in most of the cases. It is one of the leading causes of retinal diseases causing severe vision loss.
Macular degeneration is usually related to ageing, most commonly affecting individuals over 50 years of age.
Macular degeneration is progressive and painless and can cause legal blindness although it never causes total blindness.
Types of Age related Macular degeneration
There are broadly two types of AMD:
DRY form of AMD affects 85-90% individuals with Age related macular degeneration. It begins with deposition of yellowish degenerated material in the retina called as Drusen. Drusen in itself does not cause visual problems except in some where it causes visual distortion. In later stages it can cause retinal thinning along with atrophy which affects vision.
Vision recovery typically is rapid, and there is little or no post-operative discomfort. You can usually return to work, and drive, within 24 hours of surgery.
Wet form of AMD is seen in 10-15% of patients with AMD. This is characterized by growth of abnormal blood vessels beneath the macula which causes accumulation of fluid and blood in the retina thus causing severe vision problems in the form of black spots and loss of central vision. These abnormal blood vessels eventually undergo scarring thus leading to irreversible damage to retina.
Most patients with AMD have the dry form of the disease and will not lose central vision. However, the dry form of AMD can lead to the wet form. People who have the wet form of AMD are much more likely to have serious vision loss. For these patients, early diagnosis and treatment are important to save as much vision as possible.
Because Dry AMD can progress to WET AMD , thus patients with DRY form of disease must monitor their eyesight carefully and visit their ophthalmologists regularly.
AMD can also have a genetic predisposition. Patients who have or had family members suffering from AMD should be aware of the higher risk in them of developing the disease. Talk to your eye doctor about your individual risk.
Symptoms & Causes(ARMD)
What causes Age Related Macular Degeneration
Although no definite cause is known but various risk factors include:
- High blood pressure
- Genetic factors
- Nutritional Factors
- Exposure to direct sunlight for a long duration
- certain medical conditions
Symptoms of Age Related Macular Degeneration
AMD often does not have symptoms until it affects the central vision. Initially patients complain of seeing straight line as wavy.
- Blurring or Dimming of vision
- Seeing black spots in vision
- Abnormal colour perception
- Reading difficulty
While it is not possible to change the family history and age which are prominent risk factors for ARMD. But it is possible to change the modifiable risk factors such as dietary and lifestyle measures.
It is possible to reduce the risk of macular degeneration and / or slow its progression by making positive changes to your lifestyle. Here are some suggestions:
Studies have shown that smoking increases the chances of developing ARMD by a factor of 3. It has been documented that smokers develop AMD 10 years before than a non-smoker.
Physical fitness is important as it helps us keep us mobile and perform everyday tasks. However people with low vision and people who feel unsteady on their feet may, over time, do less walking. Consequently the muscles get weaker and joints stiffen. Regular exercise improves strength, balance, reaction time thus preventing trauma in the event of sudden fall. Being physically active also helps manage chronic conditions such as arthritis, diabetes, depression and high blood.
What can you do
There are many activities that help you keep fit and healthy at right pace. One can practice walking, Yoga, Pranayam, dancing or home/group exercises as per individual liking.
Maintaining a healthy weight is an important aspect of a healthy lifestyle and can help reduce the risk of heart disease and diabetes as well as macular degeneration. Nutrition can play an important role in optimising macular health.
Link between macular degeneration and sun exposure has not been conclusively proven but protection for UV rays is recommended.
Going outside also becomes easier as some patients of AMD experience increased glare. Sunglasses or a hat is recommended when out in bright Sun.
Nutrition plays an important role not only for eye health but also for general health of an individual. For some people additional supplements should also be considered.
Incorporating these simple practices as a normal part of your diet can help reduce the risk of macular degeneration, whether or not you have been diagnosed with the disease:
- Limit the intake of fats and oils
- Eat a healthy, well-balanced diet
- Eat dark green leafy vegetables and fresh fruit daily
- Eat fish two to three times a week
- Choose low glycemic index (low GI) carbohydrates instead of high GI
- Eat a handful of nuts a week
Lutein and zeaxanthin
Lutein and Zeaxanthin are naturally present in high concentration in the macular region thus very important for its functioning. They are present in high concentration in dark green leafy vegetables like Spinach,Kale. Other sources include Broccoli, Corn, sprouts and beans.
Omega-3 Fatty acids
They are important for eye health. Fish is a good source of Omega 3 FA especially Salmon, Mackerel, Trout, Sardines etc. Vegetarian sources include Chia seeds, Flax seeds, Brussel sprouts, Walnuts.
Other nutrients like
Vitamin C and Vitamin E, Zinc, Selenium
Carbohydrates and Glycemic Index
It has been proven that food with lower glycemic index is advised not only for diabetics but also for those who are at risk of AMD. Studies have proven that foods with lower glycemic index lowers the risk of AMD.
Low GI foods include most fruit and vegetables, whole grain cereals and whole grain breads and legumes. Proteins and Dairy food do not have a glycemic index.
Fats and Oils
Limiting the intake of fats and oils has been recommended for a part of generally healthy approach.
Although carrots are a rich source of Vitamin A but as against the common myth they are not really super food for eye health. They are essential as a part of well balanced diet.
Vitamin C and Vitamin E, Zinc, Selenium
Supplements are various vitamins, minerals and other substances which are beneficial for the macular health.
It is important to speak to your health care professional to know the most appropriate supplement for you.
AREDS based supplements
Age Related Eye Disease study is the only long term prospective study which provides evidence for the beneficial role of Supplements for patients diagnosed with Age Related Macular degeneration.
It has been largely suggested for patients with Intermediate form of disease or those with advanced disease in one of the eyes.
AREDS2 formula daily dose
- Zinc – 80mg
- Copper – 2mg
- Vitamin E – 400IU
- Vitamin C – 500mg
- Lutein – 10mg
- Zeaxanthin – 2mg
There are number of supplements available that reflect the AREDS 2 formula. Check the composition prior to starting any of these medicines , if they are in compliance with the above guidelines.
One can have early signs of the disease in the form of drusen without the patient realizing it. Hence stressing the need to get eyes checked regularly.
Noticeable early symptoms include
- Difficulty in reading or any other activity which requires detailed vision
- Appearance of straight lines as wavy or bent
- Unable to identify faces from a distance
- Dark patches in the center of vision
Do not ignore these vision changes as an attribute of increasing age. Sudden onset of any of these symptoms requires eye doctor evaluation.
Early Detection is Critical to Save Sight
For both wet and dry macular degeneration the earlier a diagnosis is made, the earlier steps can be taken to slow disease progression. Conversely, delayed treatment increases the likelihood of losing sight.
Changes to Vision
- Decrease in Visual Acuity
- Good days and Bad days
- Distortion or waviness in vision
- Fluctuating vision
- Phantom vision
- Eccentric fixation
- Paradox of peripheral vision
- Better vision at night
- Decrease in color and contrast sensitivity
This information sheet is designed to help you understand the operation and expected postoperative course. If you know what to expect during the operation you should be more relaxed and able to assist in making the whole procedure much easier for both of us. The operation will be performed under topical anaesthetic in a specially designed operating suite. This is a purpose built operating suite with a state of the art laser technology.
Dilation is necessary for a better view of the back of the eye. Once the patient is dilated the vision may remain blurry for 4-5 hours. Driving should be avoided for this time duration.
Retinal photographs are commonly used for eye examination. They provide a detailed image of the retina and a basis for comparison for future eye examination.
If the ophthalmologist is suspecting a wet form of macular degeneration, an angiogram will generally be used. In this examination a fluorescein Dye is injected into a peripheral vein followed by capturing of photographs of retina and blood vessels via a specialized camera. The procedure takes about 10-15 minutes.
Optical Coherence Tomography
An OCT scan now a days is a standard procedure for diagnosis and ongoing treatment of Wet AMD. This test utilizes light to produce high resolution cross sectional images of the retina
Self monitoring using AMSLER GRID
It is important to realise that checking for vision changes with an Amsler grid does not take the place of a professional eye test.
Early detection of macular degeneration is critical for saving as much sight as possible. The type of macular degeneration determines the treatment.
For WET AMD
Intravitreal injections which are anti VEGF (Vascular Endothelial growth Factor) are used . they reduce the leakage of fluid and blood from the abnormal blood vessels and help in improving vision.
Various injections available are
- Lucentis (Accentrix)
For DRY AMD
There are currently no medical treatments available for dry macular degeneration. Positive changes in diet and lifestyle may slow the progression of disease. It is important to note that dry macular degeneration can turn into wet macular degeneration. If any sudden changes in vision are noticed, it is vital that an eye health professional is immediately consulted.