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Age Related Macular Degeneration (AMD) at Alabama Eye & Cataract Center at UAB Highlands in Birmingham, AL

By Marc Michelson, M.D.

About Age Related Macular Degeneration (AMD)
Age Related Macular Degeneration (AMD) is a degenerative eye condition in which the central portion of the retina, called the macula, is damaged as a result of changes occurring in the small arteries supplying oxygen and nutrients to the retinal tissue. There are two main types of Age Related Macular Degeneration: “Dry Macular Degeneration” and “Wet Macular Degeneration” each of which can cause loss of central vision to differing degrees and at different rates. Age Related Macular Degeneration (AMD) the leading cause of legal blindness for those aged 55 and older in the United States, affecting more than 10 million Americans in some fashion and recent national data indicates that more than 2 million people over the age of 50 are affected by late AMD. Although AMD is incurable, with early detection and diagnosis there are a number of treatment options that have proven to prevent further vision loss from the disease and in many cases may actually help recover some lost vision.

Diagnosis & Testing of Age Related Macular Degeneration (AMD)
Early detection, diagnosis, testing and treatment are the keys to preventing vision loss from Age Related Macular Degeneration (AMD). As with many eye conditions and diseases, it is often possible to detect early signs of macular degeneration during your regular eye examination. It is also important that you become familiar with the symptoms that may indicate the early presence of macular degeneration. If at any time you experience “distortion” or “twisting”, “shadowing” or “bending” of objects in your vision, you should schedule an appointment at Alabama Eye & Cataract Center immediately. Be sure to let the receptionist know that you are experiencing these symptoms.

If you are over the age of 40-45 and you have a family history of macular degeneration, we recommend that you have a thorough eye examination, including a dilated retinal evaluation, each year. Please be sure to tell our staff if you have a family history of macular degeneration.
During your eye examination, eye drops will be put in your eyes to dilate your pupils in order to carefully examine the macula and retina using various types of instruments and sources of high magnification.

The Amsler Grid Test
Although the Amsler Grid Test appears relatively simple, it is very useful in detecting small changes in your vision that can result from the accumulation of just a minimal amount of fluid under your macula. We may ask you to take an Amsler Grid home and use it to check for slight changes in your vision. If this is necessary, the doctor and staff will supply you with an Amsler Grid and detailed instructions on how to use it.

                Description: Amsler's Chart

Vision Loss from Age Related Macular Degeneration
As the name implies, Age Related Macular Degeneration (AMD) only affects the macula which is the area of the retina responsible for providing central vision. Central vision is the sharpest or clearest area of your vision and is required for the precise vision needed for activities such as seeing fine detail of faces, reading and recognizing colors as well as the central or “straight ahead” vision necessary for driving. The visual effects of macular degeneration can be relatively minimal with a mild “dimming” or “distortion” of your central vision, or very profound resulting in a complete loss of your central vision.

Treatment of Macular Degeneration
We are very fortunate to have a number of possible treatment options that may help to slow or even halt the progression of vision loss. However, patients must understand that once the macula has been damaged, there is no treatment that currently can reverse that damage and the associated loss of vision. Early diagnosis and treatment to prevent or halt vision loss must be the approach that we take. Currently there are some treatment options available for certain types of macular degeneration that include anti-Vascular Endothelial Growth factor (VEGF) injections such as Lucentis® and Eyelea® for Wet Macular Degeneration and the prescription of diet vitamin supplements.

Vascular Endothelial Growth Factor Inhibitors (VEGF)
Lucentis® and Eylea® Injections
As a result of advanced cancer research in the area of “angiogenesis” or new blood vessel growth, considerable information has been gathered and applied to the treatment of Wet Macular Degeneration. Researchers discovered that a specific protein called “Vascular Endothelial Growth Factor” (VEGF) causes the growth of new blood vessels or “neovascularization” to occur in the eye. From this work, drugs that can be injected into the eye in order to slow or stop the growth of new blood vessels have been developed. Lucentis® and Eylea® have been developed and FDA approved with specific indications to treat Wet Macular Degeneration. Each of these drugs works by inhibiting Vascular Endothelial Growth Factor (VEGF) so that there is little or no stimulus to grow new blood vessels in the retina. Lucentis® and Eylea® Injections are intravitreal injections-that means an injection that is placed directly into the Vitreous of the eye. Generally they need to be repeated every four to six weeks. Clinical studies of these anti-VEGF Injections indicate that when given to patients who have evidence of new blood vessel formation monthly, over 90% of patients will maintain their vision.

Age Related Macular Degeneration & Diet
It is believed that nutrition may play a role in the likelihood of developing macular degeneration. Studies indicated that people who have a diet that is rich in fruits and vegetables-particularly green leafy vegetables-have a considerably lower incidence of Macular Degeneration. The Age Related Eye Disease Study (AREDS), which was sponsored by the National Eye Institute, showed that taking high levels of antioxidants and Zinc could reduce the risk of developing Age Related Macular Degeneration by about 25%. This is not a cure, but we need to consider this information as a possible way to help patients who are at risk for Age Related Macular Degeneration prevent vision loss.

NOTE: A VERY SPECIFIC FORMULATION WAS USED IN THIS STUDY

Before patients begin taking any course of vitamin or antioxidant supplements, you should fully discuss the risks and benefits with your eye doctor who in consultation with your family physician or Internist, will determine whether this is safe and effective for you to try.
Macular Degeneration is a complex eye disease.

Prevention of Age Related Macular Degeneration (AMD)
Patients can also help to decrease their risk of developing age related macular degeneration (AMD) by not smoking, moderating alcohol consumption to less than 15g per day, eating a heart-healthy diet rich in fish, fruit and green leafy vegetables, avoiding foods with trans fats, exercising and controlling blood pressure and weight.

With early detection and diagnosis of macular degeneration it may be possible to have a number of treatment options available to help preserve your vision.

If you or someone you know would like to learn more about the types of age related macular degeneration (AMD), the treatment of AMD or needs an appointment for a macular degeneration eye exam, please call Alabama Eye & Cataract Center at 205-930-0930 to schedule an appointment.