Macular Degeneration Research and Symptoms

Age related macular degeneration (ARMD or AMD) is a continuous, slowly progressive eye disease. One cause of the disease is a deficiency of nutrients needed in the metabolism of vision. The deficiencies are small at first, but as nutrients are used up the damage increases and loss of sight speeds up.  This process produces oxidants which deplete more nutrients, causing more damage to the cells and producing more oxidants. This cycle speeds up until the cell loses its function and dies.
 
These signs and symptoms come on slowly and gradually over months to years. If the patient has some awareness of it, he/she is often told or assumes that it is the result of aging and nothing can be done. 
 
Our research had indicated a treatment program using antioxidant supplements can reverse these symptoms and improved vision. In order to decide on the proper treatment, it is important to understand the causes of this disease. The cause has to take into account all the signs, symptoms and physical findings presented with the time line of the disease. 
 
Macular degeneration is associated with many factors including medications, hormones, smoking, diet, nutrition, surgery and diseases of the GI tract, and geographic location. These components must be included in the disease management for treatment and prevention of macular degeneration. 
 
AMD Types

Age related macular degeneration incidence increases with age. It is unusual for a person to develop age related macular degeneration before the age of 50. However, by age 75 one third of the US population shows signs of macular degeneration. It progresses very slowly and insidiously. There are two types, dry and wet. 92% are dry and 8% are wet. In the beginning there is only one type, dry. The wet group is responsible for fast and severe loss of sight. Macular degeneration starts with a thinning and loss of normal color of the macula. The wet group has capillary leakage, bleeding and new blood vessel formation. When leakage, bleeding and new blood vessels form the dry becomes the wet form. Antioxidant treatment, change of medications, diet and personal habits started at the first signs of macular degeneration can stop its progression and prevent the onset of wet type.

AMD Diagnosis

Age related macular degeneration is diagnosed with an eye examination. The patient who is over 50 years of age has fat deposits called drusen found in the retina, decreased central vision, and changes of the retinal pigment epithelial layer (the back layer of the retina) will be diagnosed with early age related macular degeneration. One problem with this diagnosis is that the presence of drusen does not necessarily mean a patient has macular degeneration. A very large study called the Framingham study revealed that 35% of all adults have drusen, however, less than 1% have age related macular degeneration. Another problem is that macular degeneration is present before patients notice any central vision loss. And a third problem is that macular degeneration is present in many people before the age of 50. These findings represent more advanced macular degeneration. The macular degeneration disease management program needs to be started immediately and adhered to rigorously. 

Drusen are an end product of macular degeneration due to abnormal intracellular metabolism. Presently some eye doctors are destroying drusen with a laser. To laser these drusen, does not effect the cause of macular degeneration and can cause vision loss. Drusen have been noted to disappear with a change of diet, medication, nutritional supplements.
 
Early Symptoms of AMD
 
Some earlier diagnostic findings for age related macular degeneration are a) a thinning and a change of color of the macula; b) loss of contrast sensitivity; and, c) prolonged recover from a photo stress test. All macular degeneration patients have a thinning and change of color of the macula of the retina (loss of lutein). All AMD patients lose contrast sensivity. All macular degeneration patients show a slow recovery of the macula when it is exposed to bright light called a photo stress test. A test called the electroretinogram (ERG) measures the electrical charge produced by the retina from a flashing light. In AMD this test shows there is a smaller electrical charge produced from the same amount of light and it takes longer to recover than in normal retinas. 

Daily activities are affected with the onset of macular degeneration. The changes are so subtle and insidious that the patient may not notice the changes in his/her vision. Most macular degeneration patients first have vision changes at night. They do not feel as comfortable driving at night, even though a visual acuity test may show them to still be 20/20. Many eye examinations at this time may find that a small change in eyeglasses does not relieve the patients' symptom and the macular changes are not enough to diagnose macular degeneration. This symptom of more difficulty with night vision is a practical test of contrast sensitivity. 

Frequently, the patient will have one eye more advanced than the other. These patients may not notice any night vision difficulty at these early stages because one eye makes up for the loss in the other. At this time or within months the patient also notices that when they come inside from being outside in the bright sun for an hour or two they find the house dark inside and want to turn on the lights. At this same time the patient will notice lights from oncoming cars leave them momentarily blinded. Also, a sudden exposure to a bright light like a flash bulb or strobe light leaves an after image that lasts more than 2 minutes. These daily occurrences are examples of an abnormal photo stress test. Examination of the macula at this time may show a loss of normal color, thinning and possible changes in the pigmented epithelial layer of the macula. Drusen may or may not be present. All these changes may be so subtle that they may not be found with the usual eye examination. This is because the macula and retina at the very earliest stages of macular degeneration look very similar to other aging eyes without macular degeneration. As AMD progresses the findings on examination become more obvious. The color of the macula becomes paler with larger drusen, small micro hemorrhages and scaring. The patient notices more difficulty reading; brighter light bulbs are needed to increase the contrast of the print on the paper. Light pastel colors are more difficult to tell apart. Driving in reduced light conditions such as dusk, dawn and night become more hazardous because of the difficulty seeing clearly. This difficulty is caused by the loss of contrast sensitivity. 

When your eye doctor does make the diagnosis of age related macular degeneration you will be given an Amsler grid. You are told to look at the grid daily in the same place and lighting. If you notice any distortion of the lines you should call your eye doctor and report it. Distortion of the lines indicates a change in the macula. This change may be due to new blood vessel growth. Your eye doctor may want to laser these new blood vessels because these new blood vessels will cause more visual loss. Macular degeneration causes the loss of your central vision. So the main objective is to save this vision. If the laser causes loss of this central vision then the sight is lost due to treatment and not the macular degeneration. In either case the central vision is lost. Thus, laser treatment should be done only if the central macular area can be spared and vision kept.

Disease Management

The time to begin management and treatment of macular degeneration is when it is first diagnosed. Treatment begins by providing the macula with enough nutrients to stop the destruction of the cells, repair the cells, and return them to normal metabolism. If this can be done in time, normal function will return to the macula cells and normal vision will return to the eye. 
 
To replenish the nutrients we have to decide two things. What caused the loss of the nutrients and what nutrients need to be replaced? 

The loss has to come from anything that can reduce the nutrients in the blood supply or cause an interruption of the blood supply to the macula. This includes diet, medications, surgery, environment, and geographical location. 

Identifying the nutrients that need to be replaced is a daunting task. We know that certain vitamins and minerals are needed for vision, some of these same nutrients act as antioxidants. Oxidants are normal by-products of vision cells. The oxidants must be neutralized to protect the vision cells, called cones and rods. Uncontrolled oxidants cause cell injury and death. As oxidants cause injury to the cells more oxidants are produced from the injury, this continues until the cell dies and scar tissue is formed. The vitamin and mineral antioxidant nutrients must be able to prevent: loss of macular pigment, leaking capillaries, micro-hemorrhages, and the formation of new blood vessels. And, at the same time, repair any injured cells. 

This series of events (loss of retinal pigment, edema, leaking capillaries, micro-hemorrhages and the formation of new blood vessels) occurs in macular degeneration as it gets progressively worse. We have shown that this progression can be stopped and even reversed with early diagnosis and treatment.