Macular degeneration is a leading cause blindness.  It is a disease that is usually diagnosed in those over 55, affects both eyes and is slowly progressive. Macular degeneration is also known as ARMD (Age Related Macular Degeneration).

Macular degeneration can cause significant loss of central vision, but will not cause complete blindness as it does not affect the side, or peripheral, vision.

Thus, ARMD affects only central vision and may cause blurriness, distortion and non-moving black/grey spots in our vision.  Legal blindness is possible.

The macula is a small area of the retina.  It measures about 1.5 mm x 1.5 mm and gives us our central vision, including reading, our best color vision and is the only place sensitive enough to give us “20/20″ vision.  When we stare at something small, we are moving our eyes so that the image of interest falls on our macula.

The two forms are differentiated by the presence of abnormal blood vessels underneath the retina.  The abnormal blood vessels are called neovascularization.

The dry form does not have neovascularization and is usually more slowly progressive than its counterpart.  Most patients have the dry form, but it is possible for the “dry” to become “wet.”

Both forms involve degeneration of the different layers of the macula.

There are lots and lots of vitamins claiming to be good for macular degeneration, but only one formulation has ever been proven to have an effect.  An NIH based study concluded that the so-called AREDS formula of vitamin reduced the risk of severe vision due to wet ARMD by 25% in those patients.  Only those patients that were of medium to high risk derived any benefit.

Patients with dry macular degeneration or patients with low risk ARMD do not have any reason for taking the vitamins.

Supplements such as lutein, omega 3 fatty acids, Beta-carotene, etc. have never been truly proven to be effective and are presently under study by NIH.  This study, the AREDS 2 Study, will be concluding in a few years.

Symptoms of ARMD include blurry vision, distortion and dark/grey spots in your central vision.  The dark/grey spots correspond to areas of the macula that have significant degeneration and are called “scotomas.”  Scotomas are basically small blind spots.

For those of you already diagnosed, self-monitoring of your vision may be helpful by use of an Amsler grid.  This is an inexpensive, yet sensitive method, for tracking any changes.

Treatments are available for the wet form of the disease and include laser treatment, Photodynamic Therapy (PDT) and intravitreal injections of anti-VEGF medications.  The earlier a problem is diagnosed, the better the outcome.  Currently, anti-VEGF medications are a common way to treat wet ARMD.

There are presently no treatments for dry ARMD.

In general, if you experience any sudden, persistent, changes in your vision, including distortion, please inform your eye doctor.

Any changes in your vision should be reported to your doctor.  If a retina problem is suspected, a thorough, dilated exam of your pupils will allow the best view of the retina.

Further testing may be warranted to confirm the diagnosis.

It isn’t necessary to see a retina specialist, but more important that you be examined.  If needed, your eye doctor may refer you to a specialist.

Randall V. Wong, M.D. is a retina specialist practicing in Virginia.  Get the latest health info on diabetic retinopathy and macular degeneration.

I have been telling my patients for quite some time that omega-3 fatty acids are good for the eyes. These essential fatty acids can help people with dry eye disease.

A recent study also shows that it can reduce the risk of sight-stealing macular degeneration, too:

Two studies released this week in the Archives of Ophthalmology show adults who followed a Mediterranean-style diet high in omega-3 fatty acids found in fish, nuts, and olive oil and low in the trans fats found in baked and processed foods have a much lower risk of developing the sight-robbing disease.

This is one more reason to pay attention to your diet and talking to your doctors about omega-3 supplements if you think you don’t get enough.

Eat well!

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.

(From the MyVisionTest Newsletter)

A new research study published in the May 2008 edition of the British Journal of Ophthalmology finds that lifetime exposure to sunlight is an important factor in the progression of late AMD (age related macular degeneration. They report that an individual’s sensitivity to sunlight exposure may have a role in AMD progression in addition to total lifetime exposure to sunlight.

In this case-control study of 215 Japanese men aged 50 years and older, facial wrinkle length and area of hyper-pigmentation, which are considered to be associated with exposure to the sun, were measured using imaging and computer-based image analysis. Skin tone was also measured on the upper inner arm, which is not exposed to direct sunlight. Early and late AMD association with skin measurements was evaluated.

The researchers found significantly more facial wrinkling and less facial hyper-pigmentation was present in late AMD cases. The relationship between skin tone and AMD risk was not statistically significant.

The investigators conclude that lifetime exposure to sunlight is an important factor in the progression of late AMD. An individual’s reaction to sunlight exposure, as reflected through the development of focal hyperpigmentation on sun-exposed skin, may have a role in AMD progression in addition to total lifetime exposure to sunlight.

WHAT IT MEANS TO YOU: There is good evidence that sunlight exposure plays some role in the development of cataract and macular degeneration. The precise nature of this role remains to be defined, but it makes sense to take appropriate precautions to safeguard your eyes when spending time outdoors. These precautions include a broad brimmed hat and 100% UV filtering sunglasses. For additional protection, consider blue-blocker sunglasses. Those individuals that are most sun-sensitive (ie. burn easily, less hyperpigmentation) appear to be most at risk for the damaging effects of sunlight.

SOURCE: http://bjo.bmj.com/cgi/content/full/92/5/630

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.

Macular Degeneration and other types of macular diseases are very common, particularly in older individuals. Fortunately, it is an exciting time because we are learning more about how these diseases progress and new treatments are being developed.

For people that have macular disease, it is important that they routinely check their vision to see if it has changed or worsened. Most typically, this is done at home with an Amsler Grid.

Dr. Richard Trevino, an Optometrist in Indiana, is currently developing an internet-based technique to monitor macular vision called myvisiontest.com. Not only does the site allow you to test and monitor your macular vision, but there is lots of useful and interesting information.

I recently had an opportunity to discuss My Vision Test with Dr. Trevino:

Dr. B: You have presented professional publications and papers on a variety of subjects during your career. What caused you to become interested in macular function testing?

Dr. Trevino: I have worked at a Veteran’s Administration clinic for the past 11 years, where most of my patients are elderly and macular degeneration is fairly common. Recently, some wonderful new therapies for macular degeneration have become available, making the early detection of choroidal neovascularization more important than ever. I became frustrated at the ineffectiveness of the Amsler grid for home monitoring. I felt there had to be something better. That was my original impetus.

I started researching the topic and encountered a number of technologies that were being investigated experimentally for macular function testing, and which seemed to show promise as an alternative to the Amsler grid for home use.

One technique that I found especially interesting was noise field campimetry. I read research papers that described how people could see their vision defects by staring at television static. I tried this out in our clinic by taking patients with macular degeneration out into the waiting room where we have a television. I would switch to a channel with just static, and ask the patient to tell me what they saw. In many cases they were able to see their defect quite clearly. That lead me to begin adding “monitor vision with television static” to my routine recommendations for patients with AMD.

Although patients could see their vision defects on the television screen, there was no good way for patients to record them for monitoring purposes. That is what lead me to write the computer program. To simulate television static and give people a way to record their defects.

Are you surprised that with the level of personal technology that exists today, the Amsler Grid is still the most common home testing of macular function?

Yes, it was surprising and disappointing to find that there was no good alternative to the Amsler grid. But as I delved more deeply into the topic, I began to recognize the substantial difficulties associated with coming up with a good, affordable home vision test for macular degeneration.

Nonetheless, I strongly believe that it is possible to construct such a test. There are some very smart people working on this problem, and I have been in contact with a few of them. MyVisionTest (MVT) may be the first, but it is definitely not the last word on the subject. Several technologies have been identified as potential candidates for replacing the Amsler grid. Noise field campimetry, the technology that MVT is based upon, is one of them. But more research is sorely needed in this area.

You clearly put a lot of work into MVT . How long have you been developing the site?

It was exactly one year ago, March 2007, that I posted the first version of MVT on the Internet. It has gone through 2 major revisions since that time, and I continue to actively work on it.

In November 2007, I began updating the site daily with news and information about macular degeneration, and information of interest to the low vision community in general. The hope is that this will encourage people to visit the site (and test their vision) more frequently.

One of the biggest problems with any home vision test scheme is getting people to use it regularly. We usually instruct our macular degeneration patients to check their vision daily, and we are lucky if they do it once in a blue moon. I hope that our users, who I believe are Internet-active people, will stop by myvisiontest.com daily as they surf the web to see what’s new, and test their vision while they are there.

Other changes are in the works. I have begun work on a second vision test for macular function testing, one that is not based upon noise field campimetry. Some people have difficulty seeing their vision defects using video static, find the test too complicated, or have problems with the test for other reasons. The new test would be an available as an alternative to the current vision test. I hope to begin beta-testing it within the next few months.

Are you computer savvy enough to do the programming?

Yes. I am a card-carrying computer geek. I have been very actively involved with computers since the mid-1980’s. I began teaching myself computer programming in the early 1990’s, but didn’t really do much with it until 1997, when I started getting involved with computer networking and web site development. Most of my programming experience is related to developing web sites for myself, friends and family, non-profit organizations, and small businesses.

When I decided to develop a vision test for macular degeneration, I consulted some friends that are computer professionals, and asked their advice about the project. But I have done all the programming myself.

Do you have forms of financial support fort or has it primarily been a personal project?

There are Google ads on the site, and I also accept donations to our “Java fund” to help pay the bills. My goal is to have the revenue from ads and donations offset the costs associated with running the site. We got pretty deep in the red last year, and I never expect to make that up. But so far in 2008 we have managed to break even. As long MVT is able to break even financially, then I can continue to offer this service to the public free of charge.

If there was just one thing you’d like all readers to know about macular disease, what would it be?

The single most important thing that I impress upon my patients is that smoking is a major risk factor for the development of macular degeneration. If you or a family member has macular degeneration and you smoke, you are significantly increasing your risk of losing vision to this disease.

Anything else you’d like to add?

This is a very exciting time in the field of macular degeneration research. Almost every day a new research paper is published telling us something new about the disease. There is growing hope that we can understand what causes macular degeneration and discover better treatments or perhaps even a cure for it.

Thanks for your time, Dr. Trevino. Good luck with myvisiontest.com. I’m sure many patients will benefit from the site.

Click here to visit My Vision Test.

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.

Most of my patients live in Florida at least in part because the weather is sunny and pleasant. I talk to many people who grew up in the Midwest or New England and lots of them remark about the how the sun makes them feel good. And this can be true. Lack of exposure to sunlight can result in, among other things, mood changes from Seasonal Affective Disorder.

But according to a new survey by the New England Eye Institute and Transitions Optical, the vast majority of people do not know that sunlight can also harm the eyes. According to the survey, while 3 out of 4 people know that ultraviolet (UV) light can cause skin cancer, only 1 in 20 knew that it can do damage to the eyes.

Living in Florida, this is important and something that I talk about all day with my patients. All sunlight contains UV light, and we Floridians get more UV than other parts of the country. So we need to be especially educated on this topic.

Exposure to UV light can increase the risk of several eye diseases such as:

• Development of cataracts
• Development of macular degeneration
• pterygia (deposits between the whites of the eyes and the cornea)
• skin cancer of the eyelids
• photokeratitis

What you should do to protect yourself:

• Educate yourself. Learn about UV light and your level of risk. You can check the current UV index in Tampa here.
• Have regularly scheduled eye exams to check for signs of eye disease. Many of these conditions start off with no symptoms and can only be detected by a skilled doctor.
• Ensure that your sunglasses are UV rated for protection. Just because they are dark does not mean that they have proper protection. Look for glasses with “UV 400″ or “99% UV A, UV B” on the sticker, rather than just “block UV light.”
• Ensure that your sunglasses wrap around your face to provide the fullest protection possible.
• Order lenses for your non-sunglasses that block UV light. Even clear lenses for everyday wear should protect your eyes, and modern lens materials can provide this.
• If you wear contact lenses outside, consider lenses that offer UV protection. This does not replace sunglasses, which protect your eyelids as well as your eyes, but it is one additional level of protection.

For additional detailed information, see the American Optometric Association’s Statement on Ocular Ultraviolet Radiation Hazards in Sunlight.

Be Well!

Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.