About Macular Degeneration
Age-related macular degeneration (AMD) is an epidemic in the United States. According to research published by the American Academy of Ophthalmology, AMD is responsible for almost half of the cases of severe vision loss in people over 40, and is the leading cause of blindness in people over 60. It shows no sign of letting up, either — statistics indicate that the number of people with AMD will likely increase by as much as 50 percent by the year 2020.
The loss of vision associated with late-stage AMD can have a tremendous effect on a person’s quality of life. Simple tasks such as driving, reading and interacting with others become difficult with the visual impairment caused by AMD. In order to slow or stop the progression of macular degeneration and prevent a decline in quality of life, intervention is critical.
Causes and Risk Factors of Macular Degeneration
The macula is a small area of the retina essential to capturing fine details and color. In AMD, the macula gradually deteriorates and experiences pathological changes. Yellow deposits of cell debris called drusen may form. The light-sensitive photoreceptor cells of the retina, and the retinal pigment epithelium, which acts as their supporter, eventually die.
What causes macular degeneration? Many believe that the retina — especially the macula — is susceptible to oxidative stress, which occurs when there is an imbalance between the generation and elimination of a byproduct known as reactive oxygen species. Because the retina has high oxygen consumption, high concentration of photosensitive cells and constant exposure to focused light, it is at a heightened risk of oxidative stress. For reasons we don’t understand, the aging process diminishes our natural levels of the vision protective pigments known as lutein and zeaxanthin by up to 50 percent. This reduction in macular pigment promotes excessive inflammation and impairs our innate ability to fight reactive oxygen species and oxidative stress. The process gradually destroys the retina, and in intermediate and advanced cases reduces the eye’s ability to see the details of life clearly.
Older adults, women, Caucasians and individuals with a family history of macular degeneration are more likely to develop the disease. Other risk factors include smoking, hypertension, obesity, high cholesterol levels, exposure to short-wavelength light and poor diet.
Signs and Symptoms of Macular Degeneration
Since macular degeneration affects central vision (as opposed to peripheral vision) someone with AMD may notice blurriness when looking at something in their direct line of sight. For example, as the macula starts to degenerate, the outline of an image may be clear, but not the fine details — like a face without the eyes. Another indication of the macula’s deterioration? Straight lines start to appear wavy.
Macular degeneration is categorized by early, intermediate and advanced stages.
Early stage AMD: multiple small or non-extensive intermediate drusen or pigment abnormalities.
Intermediate stage AMD: one or more large or irregularly shaped drusen or geographic atrophy of the retina which does not involve the center of the macula. Blind spots may develop.
Advanced stage AMD: geographic atrophy of the center of the macula where macula cells begin to die, or neovascular complications (wet stage). Large portions of central vision may become blurrier.
Types of Macular Degeneration
Dry macular degeneration is far more common than wet macular degeneration, accounting for nine out of every 10 cases. The dry form, which occurs when cells in the macula degenerate over time and lose function, is less damaging than the wet form. In wet macular degeneration, abnormal new blood vessels grow under the macula, leaking blood and fluid.
Diagnosing Macular Degeneration
Macular degeneration is detected through a comprehensive dilated eye exam with an eye doctor. The eye exam may include other tests, such as the Amsler grid test or a fluorescein angiogram, to examine the health of the retina.
Preventing the Progression of Macular Degeneration
Many experts believe that macular pigment is crucial to the health and protection of the retina. Research dating back as far as 1996 shows a link between a lower concentration of lutein and zeaxanthin — the primary components of macular pigment — and age-related macular degeneration.
One way to boost the amount of macular pigment is through dietary modification. According to the Age-Related Eye Disease Study (AREDS), people at a high risk for developing wet macular degeneration who took a dietary supplement containing vitamins C and E, beta-carotene and zinc actually lowered their risk of the progression of macular degeneration by 25 percent.
The follow-up Age-Related Eye Disease Study 2 (AREDS 2) tweaked the formula; this study found that removing Vitamin A and lowering the zinc levels reduced potential side effects, and adding lutein and zeaxanthin enhanced the protective effects found by the first study in reducing the risk of progression from intermediate to advanced AMD. AREDS 2 did not study the effects of lutein and zeaxanthin administered in early AMD1.
A number of other studies have shown that supplementation with lutein and zeaxanthin in the early stages of AMD can improve macular pigment levels, electroretinogram (ERG) patterns (retinal health) and contrast sensitivity (vision)2. This may help reduce the risk of progression into more advanced stages of AMD. It is estimated that proper macular pigment levels may improve eyesight 20 to 30 percent3.
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1 AREDS2 Research Group. “Lutein/Zeaxanthin and Omega-3 Fatty Acids for Age-Related Macular Degeneration. The Age-Related Eye Disease Study 2 (AREDS2) Controlled Randomized Clinical Trial.” JAMA, published online May 5, 2013.
2 Ma L, Yan SF, Huang YM, et al. “Effect of lutein and zeaxanthin on macular pigment and visual function in patients with early age-related macular degeneration.” Ophthalmology, November 2012.
3 Annie Stuart. “Nutrition in the Fight against Eye Disease” EyeNet, August 2013