Wednesday, April 28, 2004

Macular degeneration, nutrition and visual rehabilitation

Macular degeneration is the leading cause of irreversible vision loss in Caucasian Americans who are 50 years of age or older. At least six million Americans are already living with vision loss from macular degeneration and, according to the National Eye Institute, 200,000 more Americans every year lose significant vision from this disease. In fact, legally blind Americans over 65 already far outnumber everyone under 65 who is blind or visually impaired. These numbers will increase as the baby boomers age.

The macula is the small center area of the retina, the area that is responsible for detail vision. In both types of macular degeneration, wet and dry, the macula gradually deteriorates. Only 10 percent of those with macular degeneration have the wet form, in which new, abnormal blood vessels form beneath the macula and then leak, causing damage to the photosensitive cells. The wet form usually progresses more rapidly than the dry form, but its progress can sometimes be slowed with laser treatments. For laser treatment to be effective, however, the new blood vessel development needs to be diagnosed early. Ninety percent of those with macular degeneration have the dry form, which progresses more slowly than the wet form. The only current treatment to help retard the progress of the dry form is nutritional supplements, which also are recommended for those with the wet form of macular degeneration.

A study sponsored by the National Eye Institute has shown that a combination of 400 milligrams of vitamin E, 500 mg of Vitamin C, 25,000 IU of beta carotene, 70 mg of zinc and 2 mg of copper helped reduce the risk of developing advanced macular degeneration and delayed progression of the disease in 25 percent of those who took them. For more information on this study, called the Age-Related Eye Disease Study (AREDS), visit the National Eye Institute’s Web site at www.nei.hih.gov/amd. Other studies have suggested that eating lots of dark green leafy vegetables containing lutein, like kale and spinach, and lots of fish may help reduce the risk of macular degeneration. People at highest risk for developing macular degeneration as they age are smokers, those who are fair, and those who have parents or siblings with the disease.

It is important for people with macular degeneration to know that it does not cause total blindness. Peripheral vision — vision just off center and all the way out to the sides — is preserved. With tools and training, virtually everyone with macular degeneration can use that residual vision to continue to read, for example, and do many of their home and community activities. Studies have shown adult vision loss is associated with more depression than even heart disease and cancer. However, those people who have the tools, techniques and training to do the daily activities they need and want to do on their own are not depressed, in spite of their vision loss. Macular degeneration is not only about drugs, lasers and vitamins, but it is also about living fully with vision loss and making the most of the vision that remains through rehabilitation.

If you, a friend or a family member have lost vision from macular degeneration, ask your Eye M.D. about visual rehabilitation services, and check the low vision resources on the American Academy of Ophthalmology’s Web site, www.aao.org. Another source is the Macular Degeneration Partnership, www.amd.org.

— Lylas G. Mogk, Eye M.D.

(Dr. Mogk, director of the Visual Rehabilitation and Research Center of the Henry Ford Health System, is a media spokesperson for the American Academy of Ophthalmology, chair of the Academy’s Vision Rehabilitation Committee, the Academy’s representative to the American Medical Association’s Committee on Older Drivers and a member of the National Transportation Research Board’s Committee on Older Drivers. She is the co-author of a book for patients and families, titled “Macular Degeneration: the Complete Guide to Saving and Maximizing Your Sight.”)