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Focus On: Dry Age Related Macular Degeneration


Reason for visiting clinic:

58 year old male in for his routine two year check with no vision complaints


Vision:

Right eye: 20/20

Left eye: 20/30 (two lines worse than 20/20)


Findings:

Drusen (small yellow areas of lipids) in the macula area of both eyes - more so in the left than right. 



Normal Retinal Photo (Right Eye): The two important structures here are the darker area that does not have any vasculature around it (the macula) and the red/yellowish area on the left side (the optic nerve) (Source: http://www.retinareference.com)

Retinal Image of the Left Eye showing drusen (yellow spots) within the macular region (Source: http://www.retinareference.com)

Diagnosis:

Dry Age Related Macular Degeneration (ARMD)


What is it?

Macular degeneration is the leading cause of irreversible blindness among the elderly in developed nations (1). ARMD affects the macula. This is an area belonging to the tissue at the back of the eye known as the retina. It is responsible for our central vision and allows us to see fine detail. This gives us 20/20 vision. Peripheral vision is not affected in macular degeneration. It is often seen in both eyes, but one eye may be worse than the other. There are two forms of macular degeneration: dry ( as in the above case) and wet. Wet ARMD, also known as neovascular macular degeneration, affects vision much more quickly and drastically. It will be discussed in the next post. 

Along with using a slit lamp microscope in office, your eye doctor may also run an additional scan called Ocular Coherence Tomography (OCT). This allows for the entire ten layers of the retina to be imaged using light. This helps for further analysis as only the top layer can be seen with a microscope.  

OCT Imaging of a normal eye. The depression in the centre is the macula. There are 10 individual layers in the retina that can be imaged. (Source: http://www.retinareference.com)

Image of retina with drusen - notice there is no central depression and the elevations in the bottom layer - these represent the drusen seen in the retinal photo (Source: https://www.octscans.com/age-related-macular-degeneration.html)

Treatment:

Although there is no cure for macular degeneration, more frequent appointments to monitor for progression and possible vitamin supplementation, like Vitalux, are often recommended. Your doctor may also give you an Amsler grid to take home which can alert you to possible signs of progression or wet macular degeneration. Smoking cessation and dietary changes will also be recommended if applicable.

A normal amsler grid vs. the appearance of an amsler grid with some who may have advanced to the wet form of macular degeneration. (Source: http://www.eyereview.com/grid_for_macular_degeneration_-_amsler_grid_test_for_macular_degeneration.html)

Is it Hereditary? 

There is no one gene that has been associated with developing macular degeneration. It is thought to be a combination of genes that leads to an increased risk of macular degeneration (1).


Contributing Factors:

Aging, lifestyle, diet and smoking.

Smoking has been shown to increase the risk of developing late stage macular degeneration by 2.4-4.5 times (2).

Smoking cessation significantly decreases risk for developing macular degeneration (Source: www.safetysign.com)

Being over the age of 74 is also shown to increase risk three times compared to individuals between the ages of 65-74 (3).

Finally, cardiovascular disease, hypertension and being female can increase the risk of developing macular degeneration (4).


Prevention:

Smoking cessation and dietary changes are the best defense in preventing macular degeneration. With regards to dietary changes, a diet rich in leafy greens, fatty acids and fish/omega-3's has been shown to be beneficial - think along the lines of the Mediterranean diet (2).

For more information go to:

More Information on AMD

Nutrition Recommendations for Macular Degeneration


Sources:

1. https://www.reviewofoptometry.com/article/food-for-thought-diet-genetics-and-amd

2. https://www.reviewofoptometry.com/CMSDocuments/2017/10/maculogixi.pdf

3. https://www.ncbi.nlm.nih.gov/pubmed/17270675

4. http://eyewiki.aao.org/Age-related_macular_degeneration

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