Vision 101: Local MDs answer questions about sight-threatening macular degeneration

March 26, 2013

What's it likeAge-related macular degeneration (AMD) is the leading cause of central vision loss in Americans age 50+. Although it affects white people more than blacks, a study in East Baltimore showed that AMD was the third leading cause of bilateral (both eyes) blindness in blacks after cataracts and glaucoma. Whatever the risk rate, it is important to know that AMD can affect quality of life, independence and happiness. Self-education, prompt diagnosis and advanced treatment are key to protecting your vision and lifestyle. The ophthalmologists at Eye Care Specialists help our readers by answering the following questions.

What is macular degeneration?

“AMD is a condition in which the macula, a highly sensitive area of the retina responsible for central and detail vision (about the size of this “O”), is damaged. There are two forms of AMD. Both cause loss of central or straight-ahead vision (as needed for driving, reading and recognizing faces) but, fortunately, not side vision,” explains Daniel Ferguson, MD, a partner at Eye Care Specialists, where thousands of AMD patients are diagnosed and treated each year. “’Dry’ AMD is more common (90 percent of cases), progresses slowly, and is caused by a thinning of macular tissue. ‘Wet’ AMD is less common, can progress quickly, and is marked by the growth of abnormal new blood vessels under the macula, which can leak fluid and blood. This leakage can create scar tissue which causes blind spots and profound loss of sharp central vision. The earlier it is detected, the better the chances of preserving vision.”

Who is most at risk for AMD?

Brett Rhode, MD, private practitioner in Milwaukee and West Allis and Head of Ophthalmology at Aurora Sinai Medical Center, explains that although the exact cause is unknown, the following are culprits behind AMD:

• Aging

• Circulatory problems

• Heredity

• Light eye color

• Race (white ethnicity)

• Smoking (increases risk 3-4 times)

• Gender (being female)

• Sun exposure

• A diet high in fat and low in vitamins, minerals and antioxidants

How fast does sight deteriorate?

“Dry AMD usually does not cause rapid vision loss, and many patients retain good sight throughout life. Others may need to use magnifiers and aids. Wet AMD tends to cause a rapid and profound loss of sharp central vision, which may result in legal (less than 20/200 vision), but not total, blindness (because some side vision remains). Without treatment, about 70 percent of wet AMD patients become legally blind within two years,” states Ferguson.

What are some of the warning signs for AMD?

AMD usually develops gradually and painlessly, and good vision in one eye can mask problems in the other. As AMD progresses, however, signs may become obvious. If you suddenly notice any of the following symptoms, see an eye care specialist as soon as possible.

• Difficulty reading or doing close-up work • Faces, clocks and printed words appear blurry

• Distortion of lines, colors, sizes and edges

• Straight lines in a landscape appear wavy

•Blind spots (dark or empty spaces) in the center of vision “Don’t assume you simply need new glasses and then wait to make an appointment. A comprehensive eye exam is necessary to evaluate the presence, type and severity of AMD and whether or not treatment would be beneficial,” advises Mark Freedman, M.D., a leading local eye surgeon, continuing education lecturer, and partner at Eye Care Specialists.

What treatments are available? Rhode explains, “If dry AMD is diagnosed, we may recommend vitamin supplements, healthy omega fatty acid intake, sun protection, and avoidance of smoking, as measures to prevent or slow progression. If wet AMD is diagnosed, we review the risks, benefits and candidacy for injections of special medications (Avastin, Eyelea or Lucentis). These revolutionary drugs inhibit growth of the abnormal blood vessels that cause wet AMD.” He adds, “Although there are NO guarantees, we have seen remarkable results with injection treatment. In the past, there wasn’t much we could do. But, with regular injections (about every 4-8 weeks), we are able to stop the progression of wet AMD in 90 percent of our patients and even have up to 30 percent gain improvement in vision.” (Injections are also used to treat diabetes-related vision damage.)

What else can be done if you have AMD? “Besides following your eye care specialist’s treatment plan, you can utilize low vision aids (handheld and closed circuit TV magnifiers, telescopic devices, talking books, etc.), contact support/transport services, and learn new ways to perform activities. These steps will help you stay independent and productive,” notes Freedman.

Are there any tips for preventing vision loss?

“Sight-robbing conditions often develop gradually and painlessly, and good vision in one eye can mask problems in the other,” explains Daniel Paskowitz, MD, PhD, an eye care specialist with credentials from Harvard and Johns Hopkins. “A professional eye exam is the only way to accurately detect eye diseases.” Paskowitz recommends the following steps to protect vision:

• People age 40-64 should have a thorough dilated eye exam every 2-4 years and every 1-2 years after age 65, especially if you have a parent or sibling with an eye condition, like AMD, glaucoma or diabetic eye disease.

• If you notice a problem with your vision (especially straight lines appearing wavy or blind or dark spots) don’t ignore it. Call your eye specialist immediately to see if you should come in for an exam.

• Wear sunglasses and hats with brims. Prolonged or frequent UV-light exposure may be a factor in developing AMD and cataracts.

• Avoid smoking. Smoking can increase the risk of AMD by 3-4 times, as well as raise other eye disease risks. Second-hand smoke is also a threat to vision. • Proper nutrition and supplements. Although high-dose combinations of vitamins and minerals cannot cure AMD or restore vision, studies show they may be key to protecting existing vision. Ask your eye care specialist if and what kind of supplements may be helpful for you. • Have a blood sugar test every 3 years to screen for diabetes after age 45. Diabetes can increase the risk of other eye conditions, including cataracts and glaucoma.

Free educational booklets & information Eye Care Specialists’ doctors are dedicated to the diagnosis and treatment of AMD, glaucoma, diabetic eye disease, and cataracts. They frequently lecture to the public and fellow physicians and have written their own series of booklets on these conditions. Call 414-321-7035 for FREE copies or to schedule an appointment for a thorough eye screening (usually covered by insurance or Medicare) at their offices on 7th & Wisconsin Avenue, Mayfair Road across from the mall, or 102nd & National. They also offer information at