Dry macular degeneration is a common eye disorder among people over 50. It causes blurred or reduced central vision, due to thinning of the macula. The macula is the part of the retina responsible for clear vision in your direct line of sight.

Dry macular Degeneraton may first develop in one eye and then affect both. Over time your vision may worsen and affect your ability to do things such as read, drive and recognize faces. Early detection and self-care measures may delay vision loss due to dry macular degeneration.

Symptoms

Dry macular degeneration symptoms usually develop gradually. They may include:

Visual distortions
Reduced central vision
The need for brighter light when reading or doing close work
Increased difficulty adapting to low light levels, such as when entering a dimly lit environment
Increased blurriness of printed words or images
Decreased intensity or brightness of colors
Difficulty recognizing faces

Dry macular degeneration usually affects both eyes. If only one eye is affected, you may not notice any changes in your vision because your good eye may compensate for the weak eye. And the condition doesn't affect side (peripheral) vision, so it rarely causes total blindness.

Dry macular degeneration is one of two types of age-related macular degeneration. It can progress to wet (neovascular) macular degeneration, which is characterized by blood vessels that grow under the retina and leak. The dry type is more common, but it usually progresses slowly (over years).

Your Treatment Options

The following dietary or lifestyle choices can reduce the supply of oxygen and vital nutrients to the retina and eventually lead to the death of cells in the retina and macula:

Smoking can decrease blood supply by causing a narrowing of the blood vessels and a thickening of the blood, much the same as in a heart attack or stroke.
High saturated-fat diets can cause plaque buildup along blood vessel walls, including the macular vessels, which impedes blood flow.
A lack of antioxidants, such as vitamin C, vitamin E and lutein may increase the ability of plaque to stick to the blood vessel walls and promote the damage of the tissue.

With macular degeneration there is typically a loss of vision in both eyes. The initial symptom may be a distortion of vision in one eye, causing straight lines to appear wavy. Eventually, loss of central vision worsens, making it difficult to see at long distances, read up close, see faces clearly or distinguish colors. Peripheral vision (what you see out of the corners of your eyes) is not affected.

Recommended Lifestyle Changes

Don’t smoke and avoid exposure to second-hand smoke.
Protect your eyes. Be sure to wear sunglasses that contain UV protection.
Follow a diet that is very low in saturated fat and rich in antioxidants, focusing on vegetables, fruit, and legumes including soy, whole grains and fish. Carotenoids are phytochemicals found in certain fruits and vegetables. The carotenoids lutein and zeaxanthin accumulate in the eye as macular pigment to preserve visual acuity. The more lutein and zeaxanthin in your eyes, the less likely you will suffer from macular degeneration. Choose brightly colored produce such as corn, squash, broccoli, carrots, oranges, peaches, spinach and kale. Only 6 mg. of lutein per day decreases AMD risk by 43%.
Eat antioxidant-rich berries, especially blueberries, frequently.
Increase your intake of antioxidants such as vitamins C and E, lutein and zinc.

Nutrition and Supplements

Try to choose foods or take supplements that contain vitamin C, vitamin E and lutein, as well as zinc. Vitamin C-rich foods include citrus fruits, melons, tomatoes, potatoes and broccoli. You can get vitamin E from soybeans, greens, fish, wheat germ, nuts and seeds. Dietary sources of zinc are legumes (peas, dried beans, garbanzos/chickpeas, black-eyed peas, lentils and soy products) and whole grains. The carotenoid pigment lutein is found naturally in spinach, kale, collard greens, romaine lettuce and peas. Other protective compounds are the red and purple pigments found in berries and other fruit. Eat berries, especially blueberries, often. You can also get these pigments into your diet with supplements of bilberry, grape seed extract or pine bark extract. My recommendations for daily vitamin E are to take 400-800 IU of natural mixed tocopherols, or at least 80 mg of natural mixed tocopherols and tocotrienols. People under 40 should take 400 IUs a day; people over 40, 800 IUs.

Anti-VEGF Drugs

For people with the wet form of macular degeneration, doctors can use therapies to either remove or control the blood vessels growing beneath the eye. One such therapy uses anti-VEGF drugs.

According to the American Academy of Ophthalmology, doctors use a very small needle to deliver the drug into the tissues within the eye. The eye is numbed before the procedure, so patients don't feel pain. It can be performed on an outpatient basis, so people can go home the same day the procedure is done.

The drug used in this therapy was originally designed to help people with cancer. In order to grow, cancer cells need a heavy dose of blood. The vessels that carry blood need the chemical VEGF to grow. The medication blocks the production of VEGF.

Using this drug in the treatment of wet macular degeneration ensures that new, unusual blood vessels cannot grow beneath the macula of the eye, which can keep the disease from progressing.

Unfortunately, as authors writing for The Lancet point out, people with macular degeneration need repeated injections of the medication, as the drug wears off in time. Each injection can be expensive, as can the procedure used to deliver the drug. Some insurance companies balk at the cost of this procedure, and they may not cover it for all patients.

Photodynamic Therapy

Some medications work as soon as they hit the tissues within the body, but others need a form of activation in order to do their work. In photodynamic therapy, doctors use lasers to make an eye medication work to combat macular degeneration.

This treatment is appropriate for people with wet macular degeneration, according to Mayo Clinic. Doctors inject a drug into an arm vein, and then shine a laser on abnormal eye blood vessels. When the drug enters these blood vessels, it is activated by the laser, and the blood vessel is closed.

This is considered a revolutionary form of therapy, according to the American Macular Degeneration Foundation, as the laser used is not likely to damage healthy parts of the eye. It is focused only on damaged portions of the eye, amending what is broken while leaving everything else alone. It cannot cure macular degeneration or stop future damage, but it may help to preserve the vision people have now.

Stem Cell Implants

Doctors are also experimenting with the use of stem cells to assist with macular degeneration. A stem cell is a type of cell that is undifferentiated, meaning that it can become any type of cell within the body. Doctors are looking for ways to use these cells to either replace or heal damaged cells that cause macular degeneration.

In one form of therapy, described by Healthline, doctors line stem cells on a supportive structure, and they surgically implant that structure into the retina of the eye. In time, those stem cells grow into new retinal tissue, integrating with the tissue that is already there. The researcher quoted in this article felt that the early results were promising, as people tended to tolerate the surgery well and one patient in four had an improvement in visual acuity.

In a second study published in the New England Journal of Medicine, researchers describe pulling stem cells from people's bodies and using those cells on a supportive structure inserted into the eye. Instead of relying on embryonic stem cells, which makes some people uncomfortable, these researchers were using people's own bodies to help them to see clearer. At one year after the procedure, researchers said, visual acuity hadn't worsened. This seems to indicate the surgery helped to halt the progression of the disease.

It is important to note that both of these studies were small, and more must be done to determine how well this works in a larger group of people. But early results are certainly exciting.

What Therapy Is Right for You?

When you're living with macular degeneration, it's vital to work with an eye doctor you can trust. We can connect you with that doctor. At NVISION, we have qualified and compassionate doctors who can explain your diagnosis and your treatment options. Contact us and find out more.

New England Journal of Medicine.

Next Steps for Macular Degeneration

Some people with the dry form of AMD can develop the wet form. If you've got the dry form now, it's important to keep a check on your vision. Perform a vision check one a week, testing each eye separately. Follow the directions for using an Amsler Grid Chart, which you can place on your refrigerator, or you can view it on a tablet or computer. Let your doctor know if you have any changes.

If you have the wet form of macular degeneration, even if it's been treated, you should test your vision to see if any blind spots grow bigger or if any new blind spots appear. New blood vessels can emerge months or years after you had injections or laser treatment.

If you only have AMD in one eye, your doctor will do regular eye exams on your other eye to check for signs of new problems.

What's the Outlook?

People rarely lose all of their sight from age-related macular degeneration. You may have poor central vision, but even with advanced AMD you'll still be able to see things to the side, outside your direct line of sight. And you'll still be able to do many of your regular daily activities.

With the severe form of either wet or dry AMD, your central vision may decrease to less than 20/200 in both eyes. Even though you'll have peripheral vision, your vision problems meet the definition of legal blindness.

The dry form of AMD, which is much more common, tends to get worse more slowly, allowing you to keep most of your vision.

Sometimes, even after you get treatment for wet AMD, the condition can come back. Test your vision regularly and follow the recommendations of your doctor. The right treatment not only slows your vision loss, but it can improve your vision.

Prevention

The earlier you get a diagnosis of AMD, the greater the chance that treatment will help.

See your eye doctor if you have any symptoms of AMD, and make sure you keep a regular schedule of eye exams.

Try these prevention tips:

Check your sight every day by looking at an Amsler grid -- a pattern of straight lines that's like a checkerboard. It can help you spot changes in your vision.
Stop smoking, eat a balanced diet that includes leafy green vegetables, and protect your eyes with sunglasses that block harmful ultraviolet (UV) rays.
Supplements with antioxidants plus zinc may lower your odds of getting AMD, according to the Age-Related Eye Disease Study.
If you're over 65, your vision exams should include testing for AMD.

ARMD Updates

Western Diet Linked to Late Age-Related Macular Degeneration

Consumption of a Western dietary pattern is associated with an increased likelihood of developing late age-related macular degeneration, according to a study published online Dec. 6 in the British Journal of Ophthalmology.

FRIDAY, Dec. 13, 2019 (HealthDay News) -- Consumption of a Western dietary pattern is associated with an increased likelihood of developing late age-related macular degeneration (AMD), according to a study published online Dec. 6 in the British Journal of Ophthalmology.

Shruti Dighe, from the State University of New York in Buffalo, and colleagues examined the correlation for dietary patterns and food groups with the incidence of AMD during 18 years. Incident AMD was determined using retinal photographs taken at visits 3 and 5 among participants from the Atherosclerosis Risk in Communities study (any AMD, 144; early AMD, 117; and late AMD, 27).

The researchers identified Western (unhealthy) and Prudent (healthy) dietary patterns. There was no significant association between either dietary pattern and incidence of any AMD or incidence of early AMD. The incidence of late AMD was increased for participants with a Western dietary pattern score above versus below the median (odds ratio, 3.44; 95 percent confidence interval, 1.33 to 8.87; P trend = 0.014). Among participants with a Prudent dietary pattern score above versus below the median, the risk for developing late AMD was decreased, although not significantly (odds ratio, 0.51; 95 percent confidence interval, 0.22 to 1.18; P trend, = 0.054).

"We believe that these results, along with the current knowledge regarding chronic disease prevention and findings from the literature, will aid in making recommendations regarding a vision-healthy diet inclusive of plant foods and limited in processed meats, red meats, foods rich in saturated fats, simple sugars, and refined grains," the authors write.

AMD

Amsler Grid to test for Macula

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