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Macular Degeneration

We are hearing a lot about macular degeneration as our generations live longer and our diagnostic abilities improve.

First of all, what is it?
1"ARMD,” or age related macular degeneration,” is a deterioration of part of the retina called the “macula.” The retina is neuro-tissue at the back of the eye where light is focused and then transmitted as an image to the brain. The macula is a very small area but accounts for all of our central vision. If the macula degenerates very far, it starts to look like a black or gray spot in the middle of your vision. It seems as though if you could just remove that black spot, all would be well, but the problem is that the spot is there to stay.








2 ARMD can present in different forms, but we can roughly divide it into 2 forms: wet or dry. “Wet” means leaking blood vessels are in play and it is much more devastating in terms of speed of deterioration and amount of progression. Fortunately, the wet variety is only found in approximately 10% of ARMD cases. 

The “dry” variety tends to change relatively slow. It can affect one eye or both eyes, and even to differing degrees between the eyes. 

Another way to think of it is to think of your eye as a sink filling with water. Your eyes need to maintain the proper amount of pressure. If you have "wet" macular degeneration, then the leaking blood vessels act as though the faucet with a sink doesn't shut off, so the pressure builds. With "dry" macular degeneration, the pressure is unable to properly flow out, again, like a sink that won't drain.

The name of “macular degeneration” is slowly changing. It has been previously thought only the elderly had to worry about it, hence the “age-related” ARMD name. Current thinking suggests the degeneration starts several decades before symptoms present themselves. Current estimates are 30 million people world-wide have macular degeneration and this number may double or triple in the next 20 years and that number is climbing.

So, what causes it?
Current theory suggests that the most common cause is the cumulative effect of short light waves (blue light) damage (check out our tab under "warning, "blue light special"). Just as skin cancer has become prevalent from years of sitting in the sun, the macula is also very sensitive to high energy visible light and the effects add up over an entire lifetime. There are also risk factors beyond our control, such as genetics, age, and diabetes.

Now that we know at least some of the causes, is there anything we could be doing?
The risk factors that we can control are the following:
1. Smoking (smoking decreases the carotenoids),
2. Lifetime sun exposure without UV protecting sunwear (exposes the macula to blue light),
3. Excessive (over 2 hours a day)  exposure to LED equipment (smart phones, tablets, Nooks, Kindles, laptops, desktops, flat screen TVs and even high energy light bulbs) (look under WARNING above, under BLUE LIGHT SPECIAL for more information),
4. Diet lacking in antioxidants (dark green leafy vegetables),
5. Excessive alcohol consumption; and
6. Sedentary lifestyle.
These are the big ones, as they lead to a decrease in blood antioxidants and macular carotenoids.

Our bodies do have protective components against the constant assault of blue light. However, problems happen when our bodies no longer produce enough protection in sufficient quantities. One such component is antioxidants. This would include vitamins C, D, and E, as well as zinc. (Smokers should consult with a doctor before taking vitamin E, as new studies suggest taking vitamin E could do more harm than good.) Another component is “MPP,” which stands for “macular protective pigment,” and it is made up from 3 different “carotenoids,” or substances, that are found mostly in the macula. By name they are Lutein (commonly known), zeaxanthin, and meso- zeaxanthin.

Our diets are very important as we get some carotenoids from our diet. Unfortunately, the average western diet contains fewer than 3 mg. of Lutein and zeaxanthin daily. We get even less meso-zeaxanthin which is found nowhere else in the body; it is exclusive to the macula. It is next to impossible to eat enough of the right foods to properly pigment the macula, as up to 20 mg. of carotenoids may be necessary. This would be equivalent to eating a bucket of green leafy vegetables each and every day, or 40 large eggs every day. There are large arrays of eye vitamins (some known as AREDS and AREDS2) that can be purchased over-the-counter.  What you should look for is a specific eye vitamin that contains a ratio of 5 to 1 of lutein to zeaxanthin, with the lutein being at least 20 mg.  After a lot of searching, we found Doctor's Best Lutein with Lutemax 2020.  This product has 20 mg of Lutein and 4 mg of Zeaxanthin (minimum 1 mg meso-zeaxanthin).  

Should everyone be taking eye vitamins?

I can't say that every single person needs to be spending money on an eye supplement. However, if you have risk factors, only you can decide what your vision is worth. It is most critical to take an ARED supplement if you start experiencing symptoms of ARMD. If you have any questions, please feel free to contact my office at 989-269-5393.
Gregory A. Atkins, OD

SMOKERS BEWARE

Read your labels!  Not all eye vitamins, and certainly not all multivitamins are created equal!  If you are a smoker, or have smoked within the last 10-20 years, its probably a good idea to avoid beta-carotene (sometimes found in Vitamin A).  The AREDS original formula has beta-carotene in the product and AREDS2 is specifically for smokers and does not contain beta-carotene.  However, you do not have to purchase a specific vitamin with "AREDS" in the title.  Just read the label and make sure of what is contained in the vitamin and how many constitute a daily serving.

According to www.visivite.com, a large cancer prevention trial (Alpha-Tocopherol, Beta-carotene Cander Prevention Study) showed that beta-carotene may pose an increased risk of lung cancer in smokers.  Also, the National Eye Institute states "...many studies suggest that former smokers maintain some increased risk of lung cancer for years after stopping smoking.  Therefore, it is reasonable to expect that beta-carotene may also slightly increase their risk of cancer, at least for a period of several years.

According to an article by Joshua Dunaief, MD, PhD at the Scheie Eye Institute, University of Pennsylvania, "many studies have determined that smoking significantly increases the risk of AMD, and some research has shown that the risk is at least double that of non-smokers."  Both current smokers and past smokers are at increased risk of developing AMD, but it's likely that stopping now will decrease the risk.  Cigarette smoke contains a mixture of chemicals, absorbed through the lungs.  Some of these are oxidants, which can damage the retina when they travel through the bloodstream.  Experimental mice exposed to cigarette smoke develop retinal degeneration that looks similar to AMD.  Retinal cells grown in plastic dishes can be harmed or killed by cigarette smoke extract.  The cigarette smoke irritates the cells, causing them to activate the immune system, which causes harmful inflammation."


Go to our page "RETINAL PHOTOGRAPHY" to see how Dr. Atkins can diagnose and monitor your macular degeneration.
You can also click this link http://www.allaboutvision.com/conditions/amd.htm for more information.

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