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Macular Degeneration Treatment in San Diego

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Also Serving Oceanside, CA

SDMellgren_NewSEO_9_29_15_JR-3_RB_DB_html_529e6edcMacular degeneration is a gradual or sudden loss of central vision and occurs when the small central portion of the retina, known as the macula, deteriorates.

Age-related macular degeneration (AMD) is the most common form of AMD because this disease advances as a person ages. The most communal detection is through a routine eye exam. Your doctor may look for signs of tiny yellow deposits under the retina. Another way to detect AMD is by looking at an Amsler Grid – a pattern of straight lines that will help to evaluate your central vision (see the charts below).

During the Amsler test, the patient looks at the tiny dot centered in the grid with each of their eyes separately. A patient with any vision disturbances such as macular degeneration, will see wavy lines instead of straights ones. Some lines may even appear to be missing.
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Dry and Wet AMD

There are two types of age-related macular degeneration:
Dry AMD can remain static for years with little or no effect on vision, or it can progress to complete loss of central vision, but usually does so gradually. It occurs from a slow degeneration of the retina and the underlying choroid or blood vessel layer.
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Wet AMD usually occurs rapidly within hours or days with obvious changes in vision, but it can progress slower over weeks. It is called wet because it results from leakage of blood in and around the retinal and choroid.

Early stage wet AMD
Early stage wet AMD
End stage wet AMD with scarring
End stage wet AMD with scarring

Stargardt’s Disease

Hereditary or (juvenile) macular degeneration, also known as Stargardt’s Disease, is less common and more genetic than lifestyle-related. It has more than 25 different forms (the most common form is described below).

Stargardt’s Disease occurs in the first or second decade of life but may not be noticed until later in life and causes a gradual loss of central vision usually resulting in 20/200 vision. Although genetic, Stargardt’s Disease can be delayed when the lifestyle recommendations are followed. Click here for a list.

Symptoms

During the early stages of Stargardt’s Disease, decreased central vision may be experienced, making it more difficult to read, needing more light to read, experiencing eye strain with prolonged use and slower light/dark adaption. In the later stages, one may not recognize faces, may see straight lines as crooked or warped, and lose the ability to read without strong magnification. Fortunately the peripheral vision usually remains intact, leaving one with what is termed “get around vision” meaning one can still see objects and navigate on ones surroundings.

Causes

While the exact mechanism still eludes us, research has revealed that similar to blood vessel degeneration or plaque development, inflammation plays a large role. In the juvenile forms, exact genetic causes and X-linked patterns of heredity have been found. In the age-related form, genetics play a lesser role while lifestyle and age play a more significant role. The same risk factors for heart disease are elucidated in the AMD risk chart below, with more risk for blood vessel disease of the brain stroke, age, smoking, obesity and elevated blood pressure, blood cholesterol and triglycerides.

This condition is the leading cause of blindness in people over 60 years of age. It is being called the new epidemic because it is increasingly diagnosed in younger patients.

IF YOU HAVE: YOUR RISK OF AMD IS:
Cerebrovascular Disease (Stroke) 4.64 times the average risk
Age 65-74 4.54
Current Smoking 2.8-5.4
Body Mass Index (25-30kg/m2) 2.35
Total Cholesterol >6.75mmol/L 2.3
Age 55-65 2.13
More than one child 1.8
triglyceride >2.03mmol/L 1.7
Systolic Blood Pressure >155 1.7
Hyperopia >+1.00 1.7
Fibrinogen level >3.34g/L 1.7
History of vascular disease 1.6
Total Cholesterol >4.6-6.7 mmol/L 1.5
History of cigarette smoking 1.5
Former smoker 1.5
AVERAGE RISK 1.0
PROTECTIVE FACTORS FOR MACULAR DEGENERATION
IF YOU DO: YOUR RISK OF AMD IS:
AVERAGE RISK 1.00
Average Physical Activity 0.70
Fruit Intake (3.5 servings/day) 0.64
Former Estrogen use in women 0.60
High intake of all carotenoids 0.59
Broccoli (4-5 times per week) 0.50
Greater than average physical activity 0.50
Lutein and Zeaxanthin (4-5 times/week) 0.43
Carotenoid levels >2.39 mmol/L 0.40
Current Estrogen use in women 0.30
Spinach (4-5 times/week) 0.14
Treatment

All patients over 60 should have a complete eye examination for a baseline and yearly examinations should be done if one has the symptoms and or a family history of AMD. Close follow-up with your ophthalmologist is best to find and treat the AMD when it turns from dry to wet. Dry AMD has no treatment other than lifestyle. Wet AMD is treated with intraocular injections that stop fluid leakage and if treated early the results are best. Having an Amsler grid test and checking yourself regularly is very helpful in finding new changes.

SDMellgren_NewSEO_9_29_15_JR-3_RB_DB_html_16c9a4aeThe risk for developing AMD is influenced by lifestyle choices. The following chart reveals how you can reduce your risk by managing your life-style choices. The first thing a smoker should consider is seriously quitting, as this is a big risk factor. And certainly if one does continue to smoke nutrition becomes even more protective. The antioxidant vitamins A, C and E have been shown to retard AMD. The AREDS study showed that there is 25 percent less risk of AMD progression with the antioxidants vitamin A, C, E and the minerals zinc and copper. This is the AREDS formula that many ophthalmologists recommend. More studies show that folate, vitamins B-1 and B-12 are protective for AMD. Many studies reveal that the carotenoids lutein and zeaxanthin, if found in high levels in the blood, can reduce AMD progression by 88 percent. The AREDS II study confirms that lutein is protective.

The best recommendation presently for lifestyle to prevent AMD would be to avoid smoking, take a multivitamin with lutein and zeaxanthin, eat as many fruits as vegetables as one can regularly, exercise and maintain an ideal body weight, blood pressure, blood cholesterol and triglycerides. The benefits of following these lifestyle guidelines includes diminished risk for many diseases and better vision, good health and outward appearance.

Contact San Diego Eye Care Center

To schedule a consultation to discuss your eye care needs, please contact our office at (760) 757-1144.