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Thirty percent of adults over age 75 have early signs of macular degeneration, and over 50% by age 80. With longevity increasing each decade, the outlook for today's baby boomers is not good. Vision loss can occur over a short period of time, but usually occurs gradually, affecting both eyes at different rates.
There are two forms of age-related macular degeneration, "wet" and
"dry".
Eighty to ninety percent of patients have the "dry" form, which
involves
thinning of the macular tissues and disturbances in its
pigmentation.
Ten to Twenty percent have the "wet" form, which can involve leakage of
serum and bleeding within and beneath the retina, opaque deposits, and
eventually scar tissue. The "wet" form accounts for ninety
percent
of all cases of legal blindness in macular degeneration patients.
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2. What causes macular
degeneration?
Like virtually every degenerative disease of the body, reactive
molecules
known as "free radicals" are likely the root cause of macular
degeneration. Bright sunlight and ultraviolet light contribute to free
radical damage in the macula.
Hereditary, dietary and lifestyle factors determine how well any
individual
is able to control these free radicals and where they will do the most
damage. Diseases such as diabetes and atherosclerosis may
accelerate
the process.
Younger patients can also develop macular degeneration. These non-age related cases also may be linked to heredity, diabetes, nutritional deficits, injury, infection, or other factors such as excess exposure to sunlight. Scientists are undertaking the basic research necessary to determine the causes of these disorders. Finding the cause is the first important step toward prevention and cure.
The following are NOT known to be linked to macular degeneration:
floaters
(moving spots caused by debris floating in the vitreous fluid between
the
lens and the retina); dry eye syndrome; or cataracts. Cataract
surgery,
due to decompression of the eye during the procedure may in some cases
aggravate early macular degeneration.
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3.How is macular degeneration
detected?
Reduced vision noticed by the patient before or during a routine eye
exam may be the first indicator of macular degeneration. While
examining
the retina with an instrument called an "ophthalmoscope" the doctor may
detect the formation of new blood vessels or leaking from blood
vessels, or small deposits
called "drusen" in and under the macula. In addition, the
following
signs may be indicative of macular problems. Anyone experiencing these
symptoms should consult their eye doctor immediately:
4.If I have macular degeneration
in
one eye, will it develop in the other?
Yes, this is usually the case. In the early stages, only one eye may
be affected, but as the disease progresses, both eyes are usually
affected.
Recent research, however, is showing promise for reducing the risk of
developing
macular degeneration as well as slowing its progress using nutritional
factors.
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5.Is there a cure for Macular
Degeneration?
At this time there is no accepted "cure" for macular
degeneration.
In some cases, macular degeneration may be active and then slow down
considerably,
or even stop progressing for many years. Depending on the type
and degree of the condition it is possible to influence the speed at
which
it progresses, and in many cases halt it. This is done through
nutritional
intervention (supplements, avoiding hydrogenated fats, chemical food
additives,
etc.)j, wearing sunglasses, exercise or by doing laser surgery of the
blood vessels or intraocular injections by needle (see below).
After the disease has damaged the vision permanently, we also have
developed
low vision aids and techniques for maximizing the use of peripheral
vision
to help patients adapt better to their loss of central vision.
Educating
susceptible groups about macular degeneration risk factors can reduce
their
risk of developing the disease. We advise that a patient select
an
eye doctor who is knowledgeable about nutritional research and who will
refer you to a retinal specialist should you need laser surgery.
(See Recommended Eye
Doctors
list)
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6.Can nutrition help treat
macular
degeneration?
Absolutely! Some scientists have suggested an association between
macular degeneration
and a diet high in saturated and hydrogenated fats, and other
substances
(including MSG and aspartame). Also, a diet high in Omega 3 fats
and carotenoid pigments, especially lutein, zeaxanthin and lycopene,
may
be protective against the disease. These carotenoid pigments, which are
obtained from eating fresh fruits and dark green, leafy vegetables
(such
as kale, spinach and collard greens), may significantly delay or reduce
the severity of age-related macular degeneration. In the absence
of consuming 5-9 fruit and vegetable servings each day, it is
imperative
to take a quality multiple supplement for the eyes which contains a
minimum of 7mg of lutein
(lutein is converted to zeaxanthin in the retina). Taking
anti-oxidants
like Vitamins C and E and selenium may also have positive
effects.
Zinc in moderate levels is probably beneficial, as well.
Consuming
the wrong form or too much of this mineral can cause digestive problems
and anemia. Zinc in the L-monomethionine or proprionate forms is
recommended. Read the Eye
Research Summaries for more information.
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7.Can surgery help cure macular
degeneration?
Surgery to remove the scar produced by macular degeneration has
occasionally
been successful in younger patients, but less so in older
patients.
If the degeneration is associated with leaking blood vessels in the
center
of the macula, and vision is worse than 20/70, a laser procedure,
called
photocoagulation, is recommended. This rarely improves vision but
generally slows, but does not stop further vision
loss. In fact, laser photocoagulation permanently destroys the
small
spot which is treated. Intraocular injections with a chemical
called Avastin or Lucentis every 6-12 weeks can help dry up leaky blood
vessels (some nutritional supplements have a similar effect)
Retinal transplantation is a new experimental
approach to macular degeneration, but has been extremely unsuccessful,
frequently causing total loss of vision. We caution you strongly
against
having it done to yourself or a loved one.
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8.Is macular degeneration
hereditary?
Macular degeneration appears to be hereditary in some cases.
Since macular degeneration affects most patients later in
life, it is difficult to study successive generations in a family.
Recent
studies of twins indicate that both genetic and non-genetic factors
play
important roles in age-related macular degeneration. Genetic
variants in at least two genes have been discovered which increase
susceptibility by 2.6-4.5X.
Heredity also plays a major factor in one's ability to fight free
radicals
in various parts of the body, which play a part in the development of
macular
degeneration. Fortunately, dietary and lifestyle changes can
sometimes
overcome poor heredity in many of these cases.
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9. Does sunlight affect
macular
degeneration?
Yes. It has been demonstrated that the blue rays of the spectrum seem
to accelerate macular degeneration more than other rays of the
spectrum.
This means that very intense light, such as sunlight or its reflection
off of bright surfaces may worsen macular degeneration. Regular
sunglasses
with UV protection and dark neutral density lenses or lenses that also
block out the blue end of the spectrum (for those who spend a great
deal
of time outdoors) may reduce the likelihood of developing and
progression
of the disease. Again, more research is needed in this area.
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10.Does hypertension and heart
disease
affect macular degeneration?
Yes. Hypertension tends to make some forms of macular
degeneration
worse, especially in the "wet" form where the retinal tissues are
invaded
by new blood vessels. The medications used to treat hypertension
have not been shown to have any direct effect on macular degeneration,
but they may slow progression of the disease by reducing
hypertension.
Likewise, those suffering from atherosclerosis heart disease also are
at
higher risk for developing macular degeneration, and the same nutrients
which protect from heart disease (i.e. the antioxidants), are helpful
for
macular degeneration as well.
It is interesting to note that deficiencies of the vitamins and
minerals
which have been shown to cause heart disease also have been implicated
in macular degeneration risk.
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11.Does smoking or second hand
smoke
contribute to macular degeneration?
Yes. Any type of smoking or exposure to tobacco smoke can greatly
accelerate
the development of macular degeneration. This is especially true
if the smoker consumes few of the carotenoid nutrients, especially
lutein,
with those smokers increasing their risk of developing advanced macular
degeneration by up to 600%..
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12.What kind of basic research
about
macular degeneration is underway at eye research facilities around the
country?
Many eye centers are devoted to the study of eye disease, visual
dysfunction,
and blindness. To work toward a cure for macular degeneration,
they
are studying the anatomy, physiology, and development of the retina at
the tissue, cellular and molecular levels in both healthy and diseased
eyes. Laboratory and clinical researchers work closely together to
devise
new strategies in our fight against macular degeneration. New
optical
technology has been developed to observe and measure the condition
of the eye as well as new techniques to study the vision process.
Research
to develop low vision aids for patients with macular degeneration and
other
eye diseases is also going on.
The National Eye Institute is currently funding the first large
study
on the effects of nutrition and macular degeneration. Other
smaller
studies have shown great promise, even with marginal amounts of
nutritional
supplementation.
(See http://www.eyenutrition.info)
It's important to remember that it costs millions of dollars to get a
drug approved through the FDA, even if it's been proven safe through
years of human consumption. No company can afford to spend that
kind of money to study a nutritional supplement that is not patentable.
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Would it be helpful if people with macular degeneration bequeath their eyes to eye research facilities?
Yes. Donated eyes are in short supply. Both diseased and
healthy
eyes are extremely important for the continuation of eye
research.
If you intend to donate your eyes, we suggest that you inform family
members
and make arrangements with your local eye bank.
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13. What can I do to help prevent and cure macular degeneration?
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