By Valerie Moulds, O.D., Board Certified Optometric Physician
We are seeing more cases of macular degeneration than ever, in large part due to the growth of the aging population. Approximately 7 million Americans have some form of this disease, but will not realize it until they begin to suffer vision loss. Macular degeneration is the leading cause of blindness in the elderly.
The ability to treat this disease, especially the wet form of macular degeneration, is much better than it was 10 or 20 years ago. The biggest obstacle to helping these patients, however, is bringing them into the office sooner rather than later. When the disease is caught early, patients are able to maintain their quality of life longer because they are able to hold on to their central vision for a longer period of time thanks to the new treatments that are available.
Risk factors for macular degeneration are multiple in nature. A positive family history can significantly raise the risk factor for a patient, particularly if it is a first-degree relative. Other risk factors include uncontrolled blood sugar, poor diet, being overweight, and smoking. Also, any lifestyle that increases your risk for cardiovascular disease will also increase your risk for macular degeneration. Increasing age, as mentioned previously, is another important risk factor.
Some doctors are now measuring pigment density in the macula to help assess the risk of developing macular degeneration. Macular pigment helps to protect the photoreceptors from the damages of ultraviolet light; in essence, the more macular pigment, the healthier the macula will be. Increasing your intake of the pigments lutein and xeoxanthin are important in improving your macular pigment density. Daily intake of 6 mg of combined lutein and xeoxanthin are considered the minimum daily requirement. These pigments are also found in broccoli, spinach, and kale. At least four servings a week are recommended to achieve adequate lutein/xeoxanthin dietary levels.
Another way to detect macular degeneration before it presents physically is through testing dark adaptation. This test determines how long it takes the patient to adjust from bright to dim light. We know that dark adaptation is more difficult for patients with macular degeneration, and may account for night vision complaints. Dark adaptation may be used in the future to determine the efficacy of injectable treatments for wet macular degeneration or the nutritional benefits in early macular degeneration.
The eye doctor may choose to scan the macula with an instrument called an OCT. This has become the standard of care with any disease affecting the macula. It can show subtle changes in the macular tissue over time, including cholesterol deposits called drusen, and even pockets of fluid under the macula that may not be discernible on visual examination. The sooner blood or fluid (wet macular degeneration) is detected near or under the macula, the better the chance of having it treated successfully, thereby preserving as much central vision for the patient as possible.
Follow-up and education are just as important as treatment-related decisions in any patient with macular degeneration. The majority of patients will have the dry form of macular degeneration – meaning that there is no leakage of blood or fluid that needs to be treated. These patients will primarily require education on lifestyle changes to preserve their vision. This will include conversations on nutrition and smoking cessation. Monitoring their condition at home will also need to be discussed. All macular degeneration patients should have an Amsler grid at home that they look at daily to monitor for any changes in their central vision. If they do not, they should ask their eye doctor for one.
There are more options available now to detect macular degeneration and offer hope to our patients, as we are able to arrest this disease at earlier stages. This will enable us to give timelier and more accurate information to our patients so they can take a more active role in their treatment. If you have not seen your eye doctor in the last year, make an appointment today; finding this condition early can make all the difference in your quality of life down the road. Eye Specialists of Mid-Florida has invested in high quality OCT scanners in all of our offices so all of our doctors can perform a good assessment of your macula. If there is any question of wet macular degeneration beginning, Dr. Neil Okun, our macular specialist, is readily available for consultation and treatment if needed.