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by Dr. Merrill J. Allen, Dr. Steven M. Beresford, Dr. Francis A. Young.
UNDERSTANDING MACULAR DEGENERATION Macular degeneration is a painless degenerative eye disease associated with the aging process, and is the most common form of vision loss in older Americans. What happens is the cells in the central part of the retina responsible for seeing small details gradually die. Macular degeneration usually happens so slowly that the person is not aware of it. In some cases, however, macular degeneration occurs quickly and typically leads to loss of central vision in both eyes. Several risk factors have been identified, the most important of which is the aging process, which appears to trigger the disease through poor circulation to the retina. Other risk factors include smoking, obesity, ultraviolet light, genetics, race, and gender, with Whites more susceptible than Blacks, and females more susceptible than males. By far the most important of these secondary risk factors is smoking, which seems to reduce nutrition to the retina by constricting the blood vessels at the back of the eye. Macular degeneration occurs in two forms, known as “dry” and “wet”. About 90% of macular degeneration is the dry form and the other 10% is the wet form. The wet form is much more serious and is usually preceded by the dry form. DRY AND WET MACULAR DEGENERATION Dry macular degeneration typically marks the early form of the disease and is characterized by yellow spots known as “drusen” in the central part of the retina. Drusen are clumps of dead cells and deteriorating tissue, and where they occur there is vision loss. This typically takes the form of dark, fuzzy, or distorted areas in the central field of vision when looking straight ahead. Wet macular degeneration typically marks the advanced form of the disease and occurs when new blood vessels grow under the retina and leak blood and other fluids into the eye. The new blood vessels seem to be an unsuccessful attempt by the body to deliver more nutrients to the retina, and the leakage usually causes permanent scarring and major irreversible loss of central vision. SIMPLE TEST FOR MACULAR DEGENERATION Eye doctors can often detect macular degeneration before visual symptoms appear by means of a retinal examination. However, a simple test that you can use to detect vision loss is called the Amsler grid and is shown below. You can do it right now. Here’s how: a) If you need glasses for reading, do the test with them on. b) Cover one eye with your hand and look directly at the dot in the middle of the grid. c) Keep looking directly at the dot. You should see a perfect grid with all the lines straight, all the intersections at right angles, and all the squares the same size. You should be able to see all the corners and all the sides with no missing areas. d) Repeat the test with the other eye covered.
If any of the lines are wavy, distorted, or very fuzzy, or if there are any dark or missing areas, you may have vision loss and should contact your eye doctor for a retinal exam. At the present time, macular degeneration can’t be cured by drugs or any other form of medical treatment. Wet macular degeneration is often treated by trying to stop the abnormal blood vessel growth with a laser, but this always kills healthy retinal cells and usually makes matters worse. Fortunately, two drugs have appeared on the market that are effective treatments for wet macular degeneration. The first drug is called Lucentis and is injected into the eye. The other drug is similar and is called Avastin. The cost of a single dose of Lucentis is more than $2,000, whereas the cost of a single dose of Avastin is about $150. Clinical studies are now being designed to compare the relative effectiveness of these drugs. Our own investigations and a recent major clinical trial (the AREDS study) by the National Eye Institute suggest that it is possible to halt and even reverse dry macular degeneration before it progresses to the wet form. We have done this with a small number of patients but were unable to achieve a total cure. Nevertheless, the results are an exciting development. But first, let’s discuss the AREDS study. Many researchers like ourselves reported in the early 1990s that they were getting good results by treating macular degeneration with various nutritional supplements. Based on these reports, the National Eye Institute carried out a major clinical trial called AREDS (Age Related Eye Disease Study) using almost 5,000 patients in various clinics throughout the USA. What they found was that the nutritional formula used in the AREDS trial lowered the risk of vision loss by about 25%. Since then, the AREDS formula has been incorporated into most of the “eye multivitamins” currently available at pharmacies and health stores. But much more can be done. Although important, the National Eye Institute’s investigations usually lag behind cutting edge research by 5 to 15 years because they merely build upon positive reports by leading researchers. Bearing this in mind, the National Eye Institute recently embarked on another major investigation known as AREDS 2. The goal is to determine if other nutrients including omega-3 fatty acids (from fish and nut oils), and lutein and zeaxanthin (from green leafy vegetables), can exert a similar beneficial effect. In our opinion, there’s no need to wait for the results of the AREDS 2 investigation, which are expected to take at least five years. There’s abundant evidence that the supplements are effective and we recommend taking them immediately if you have macular degeneration or want to reduce your risk. Green leafy vegetables such as broccoli, cabbage, or kale will give you lutein and zeaxanthin. Fish and nuts will give you omega-3 fatty acids. We also recommend taking two herbal extracts called vinpocetine and ginkgo biloba, which have also been shown to exert a positive effect. But even more can be done. One factor that has been totally overlooked is that no matter how many nutrients are in the blood stream, they are of no value whatsoever if they don’t reach the affected tissues. In fact, the evidence suggests that poor blood flow to the retina is the major cause of macular degeneration– not the lack of nutrients! This means that in addition to taking the AREDS formula and the other recommended nutrients, therapeutic eye exercises should be used to boost circulation and help the nutrients reach the retina. The Power Vision Program provides you with the best techniques currently available for doing this and may reverse the disease in some cases. |
