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Age-related macular degeneration (AMD) is a chronic eye disease that affects more than 10 million Americans. It is the leading cause of vision loss in people over 60 in the United States, and the number of people with AMD rises as they get older.
Macular degeneration affects tissue in the part of your retina that is responsible for central vision, called the macula. It causes blurred vision or a blind spot in the center of your vision, and can interfere with reading, driving, and other daily activities. You may first notice symptoms when you need more light to see up close.
There are two forms of AMD. Dry AMD affects about 85% of those with the disease and causes gradual loss of central vision, sometimes starting in one eye. Wet AMD, which accounts for 90% of all severe vision loss from the disease, often involves a sudden loss of central vision. Most people with the wet form of AMD previously had the dry form.
Signs and Symptoms
Symptoms of dry AMD include:
Symptoms of wet AMD include:
What Causes It?
The macula, a part of your eye's retina, is made of cells, called rods and cones, which are sensitive to light and are needed for central vision. Underneath the macula is a layer of blood vessels called the choroids, which provides blood to the macula. A layer of tissue on the retina called the retinal pigment epithelium (RPE) keeps the macula healthy by transporting nutrients from the blood vessels to the macula and moving waste products from the macula to the blood vessels.
As you get older, the RPE can thin and not move nutrients and waste back and forth as efficiently. Waste builds up in the macula, and cells in the macula become damaged from lack of blood, affecting your vision.
With dry AMD, RPE cells lose their color and do not get rid of waste products from the rods and cones. As waste builds up, the rods and cones deteriorate.
With wet AMD, blood vessels grow underneath the macula and leak fluid or blood. Researchers do not know exactly what causes the new blood vessels to grow, although they think that it may be the breakdown in waste removal. That could explain why people with the wet form almost always start out with the dry form. The new blood vessels interfere with getting nutrients to the macula, and the rods and cones start to break down.
Who is Most At Risk?
People with the following conditions or characteristics are at risk for developing AMD:
What to Expect at Your Provider's Office
Your eye doctor can screen you for AMD as you get older. However, if you have any changes in your central vision, or in your ability to see colors, you should see your doctor right away. Your doctor may use several methods to test you for AMD including:
There is no known cure for AMD, however, there are things that can help slow vision loss. Certain procedures and medications may stop the wet form of the disease from getting worse. Adding antioxidants to your diet may help prevent the wet and dry forms of AMD and slow their progression.
The dry form of AMD can progress to the wet form. If you have dry AMD, you will test your eyes daily at home using an Amsler grid. Let your doctor know immediately if there is any change in your vision.
Wear sunglasses, hats, and visors when exposed to the sun.
For wet AMD, a type of medication called antivascular endothelial growth factor (anti-VEGF) can be injected into your eye to stop new blood vessels from growing. Two such drugs are approved to treat AMD:
Surgical and Other Procedures
Surgical and other procedures may help some cases of wet macular degeneration.
Photocoagulation (laser surgery): In photocoagulation, doctors use a laser to seal off blood vessels that have grown under the macula. Whether this procedure is used depends on:
Photodynamic therapy, is often used to seal off blood vessels that are under the center of the macula. Using photocoagulation on that location would result in permanent central vision loss. With photodynamic therapy, the doctor gives you a drug that stays in the blood vessels under the macula. When a light is shined in your eye, the drug closes them off without damaging the rest of the macula. Photodynamic therapy slows vision loss but does not stop it.
Complementary and Alternative Therapies
Supplements are a valuable treatment for dry AMD. They may also help prevent both wet and dry types. However, you should not try to self treat vision problems. See your doctor first for a diagnosis and treatment plan.
To treat AMD
The National Eye Institute recommends that people with intermediate AMD in one or both eyes or with advanced AMD (wet or dry) in one eye but not the other take this formulation each day. However, this combination of nutrients did not help prevent AMD, nor did it slow progression of the disease in those with early AMD. The doses of nutrients are:
Ocuvite PreserVision is formulated to contain the proper amounts of these nutrients. People who already take a multivitamin should let their doctor know before taking this formulation. Zinc can be harmful at a high dose, like the 80 mg used in this formulation, so be sure to take this combination only under your doctor's supervision. Zinc can cause copper deficiency, so a small amount of copper is added to the nutrients.
In the study, 7.5% of people who took zinc had problems including:
compared to 5% of the people in the study who did not receive zinc.
To prevent AMD
One study found that taking vitamins B6, B12, and folic acid reduced the risk of AMD in women over 40 with a history of, or at risk for, heart disease. The doses used were:
Folic acid can mask a vitamin B12 deficiency. Talk to your doctor before taking these vitamins at these doses.
Women who are pregnant or breastfeeding are advised to eat up to 12 ounces a week of a variety of fish and shellfish that are lower in mercury. Talk to your doctor before taking fish oil supplements if you are at risk for AMD. Fish oil may increase your risk of bleeding, especially if you already take bloodthinners, such as warfarin (Coumadin) or aspirin.
The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner.
Severe AMD can cause legal blindness. Low vision aids may help if you have partial blindness. Sometimes blood vessels build up underneath the retina, causing the retina to become detached or scarred. If this happens, the chances of preserving your central vision are poor. This condition, called subretinal neovascularization, happens in about 20% of cases of AMD. It often comes back even after laser treatment.
Your eye doctor will see you regularly to monitor your vision and eye health.
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Review Date: 12/9/2014
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M. Editorial team.
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