Macular Degeneration

The types of macular degeneration are as follows:

​​​​​​​Dry (Atrophic) Macular Degeneration:

Most common form (about 85-90% of cases).
​​​​​​​
It occurs when the light-sensitive cells in the macula slowly break down over time. This results in a gradual blurring of central vision.
Symptoms: Vision distortion blurred or blind spots in the center of vision, and difficulty seeing in low light.
In more advanced cases, drusen (tiny yellow deposits) form under the retina, and the macula becomes thinner, leading to vision loss.

Wet (Neovascular) Macular Degeneration:

Less common, but more severe than the dry form. It occurs when abnormal blood vessels grow under the retina and macula, leaking fluid or blood. This can cause rapid and severe central vision loss. Symptoms: Sudden central vision distortion or loss, seeing wavy or bent lines, and dark spots in the central vision. Immediate medical attention is necessary to slow or prevent further damage

Risk Factors:

• Genetics: Family history of macular degeneration increases the risk.

• Smoking: A major risk factor, doubling the likelihood of developing AMD.

• Race: Caucasians are at higher risk of developing AMD compared to other ethnicities.

• Obesity and cardiovascular disease: These conditions may increase the risk or speed progression.

• Prolonged sun exposure: UV light damage can contribute to the condition.

• Diet: a diet high in antioxidants and carotenoids can help slow down and prevent macular degeneration.

Carotenoids are a class of naturally occurring pigments found in plants, algae, and some bacteria. These pigments are responsible for the vibrant red, yellow, and orange colors seen in many fruits and vegetables. They also play an important role in human health, particularly for eye health due to their antioxidant properties and ability to filter harmful blue light. The carotenoids most associated with eye health and AMD prevention are lutein, meso-zeaxanthin and zeaxanthin. These carotenoids are naturally found in high concentrations in the macula (the part of the retina responsible for central vision) and contribute to the formation of the macular pigment, which protects the eyes from oxidative stress and light-induced damage.

Role of Carotenoids in AMD Prevention:

Lutein Zeaxanthin Meso-Zeaxanthin
These carotenoids accumulate in the retina, especially in the macula, where they help filter high-energy blue light and protect the delicate retinal tissue from damage caused by light exposure.

They also have powerful antioxidant properties, neutralizing free radicals that can damage the retina and macula, which are exposed to a lot of oxidative stress due to light exposure and metabolic activity.

Lower levels of carotenoids in the macula are linked with an increased risk of AMD and other vision problems.

​​​​​​​Macular Pigment Optical Density (MPOD):

MPOD refers to the density of the macular pigment in the eye. Higher MPOD levels are correlated with lower risk of developing AMD.
Increasing dietary intake of lutein, meso-zeaxanthin, and zeaxanthin can raise MPOD levels, offering better protection against macular degeneration. We are excited to now have a way of measuring your carotenoid level in our office through a test called LifeMeter. This is a quick painless test that measures your carotenoid level in your skin which has been shown to be marker for your level of carotenoids in your retina. You can get a base line reading and then make changes to your diet and add a supplement like MauHealth to improve your level of retina carotenoids.

Oxidative Stress Reduction:

The macula is particularly susceptible to oxidative damage due to its high exposure to light and oxygen. Carotenoids, acting as antioxidants, help reduce this oxidative stress, which is one of the contributing factors to AMD.

Sources of Lutein and Zeaxanthin:
These carotenoids are found in a variety of foods, particularly green leafy vegetables and other colorful fruits and vegetables:

• Lutein: Spinach, kale, broccoli, peas, and corn.

• Zeaxanthin: Orange peppers, corn, eggs, and oranges.

• Egg yolks are especially rich in both lutein and zeaxanthin and are thought to have a high bioavailability, meaning they are easily absorbed into the body.

Supplements and the AREDS2 Study:

AREDS2 Formula:

• 10 mg lutein

• 2 mg zeaxanthin

• Plus, other ingredients like vitamin C, vitamin E, zinc, and copper.

This supplement formula is recommended for patients at risk of or with AMD to help reduce the progression of the disease, especially in those with lower dietary intake of carotenoids.

Recommendations for AMD Prevention:

Increase dietary intake of foods rich in lutein and zeaxanthin, especially dark green leafy vegetables like kale, spinach, and collard greens.
Consider supplements if dietary intake is inadequate or if you are at higher risk for AMD (e.g., family history, age, smoking).

Antioxidant-rich diet: Incorporating a broader range of antioxidants (like vitamins C and E, zinc, and omega-3 fatty acids) in your diet may also help protect against AMD progression.

Protect your eyes from blue light: Since carotenoids help filter blue light, reducing exposure to screens and sunlight without protection may further enhance AMD prevention efforts.

In conclusion, maintaining high levels of lutein and zeaxanthin through diet or supplements is one of the key strategies for preventing or slowing the progression of macular degeneration, especially in individuals at risk for or already experiencing AMD.

Diagnosis

Optical Coherence Tomography (OCT): Produces detailed images of the retina to detect any thinning or fluid build-up.
Fluorescein angiography: A dye is injected into the bloodstream, and images of the retina are taken to detect leaking blood vessels in wet AMD.

Treatment

There is no cure, but progression can be slowed by:
Vitamins and supplements (AREDS2 formula): A specific blend of antioxidants and zinc has been shown to slow progression in certain patients.
Lifestyle changes: Quitting smoking, eating a diet rich in leafy greens and omega-3 fatty acids, and wearing sunglasses to protect against UV light.

Wet AMD:
Anti-VEGF injections: Medications like Lucentis, Eylea, or Avastin block vascular endothelial growth factor (VEGF), which is responsible for abnormal blood vessel growth and leakage. These injections are typically given regularly to prevent further vision loss.
Photodynamic therapy (PDT): A light-activated drug is used to close off abnormal blood vessels in the eye.

Laser surgery: ​​​​​​​
Laser surgery: A laser is used to destroy abnormal blood vessels, though this is less commonly used due to risks of damaging healthy tissue.

How Macular Degeneration Affects Vision:

Central vision loss: People with macular degeneration experience blurry, distorted, or dark areas in their central vision, making tasks like reading or recognizing faces difficult.

​​​​​​​Peripheral vision remains: Most people with AMD retain some peripheral vision, meaning they can see things around the edges of their field of view.

Summary:

Macular degeneration is a leading cause of vision loss in older adults. While dry AMD progresses slowly and typically leads to gradual central vision loss, wet AMD can cause rapid and severe vision changes. Early detection through regular eye exams and lifestyle adjustments can help slow progression and maintain quality of life. For wet AMD, anti-VEGF injections have been highly effective in preserving vision.