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Macular degeneration an eye-opening experience

My late father had age-related macular degeneration for which he received laser treatments, and my 94-year- old mother is currently undergoing injections for the same condition. When my ophthalmologist friend suggested an Amsler eye-grid test to check for AMD and I found that I had distorted vision, I grabbed my phone and made an appointment to see my ophthalmologist.

What is AMD?

The macula is a central area in the back of the retina, the part of the eye that gathers light information and sends the data to the brain, which allows us to form images. When damage occurs to the macula, central vision may be blurred, and objects may not appear to be as bright. According to the National Eye Institute, over two million people in the U.S. have AMD; the majority are Caucasian. Because women have a longer life expectancy, 65 percent of the cases occur in women.

According to Dr. Michael Reynard, associate clinical professor of ophthalmology at UCLA, the leading risk factors for AMD are smoking, ultraviolet light exposure, race and family history. UV light exposure and race are related factors because fair skin and blue eyes are associated with less retinal pigment, which protects us against damage from UV light. I am blue-eyed and fair-skinned, which heightened my concern about developing AMD.

Diagnosis

One method to check for an abnormality of the macula is the Amsler grid, a test that can be done at home. It can be found online at amd.org/the-amsler-grid. It’s important to follow the instructions carefully, and particularly to check one eye at a time. The test is considered abnormal if there are missing, blurred, or wavy lines. When I checked myself at home, I noticed an unmistakable defect of my left eye, which prompted my eye appointment. After approximately 30 minutes of testing and examination, my ophthalmologist sat down and reviewed all of the findings with me.

Loss of vision

Having witnessed my parents’ near loss of vision, I am well aware of the anguish of an AMD diagnosis. Even with early and intermediate AMD, many people will not experience any symptoms. Surprisingly, the prognosis with early AMD is good. According to the NEI, if someone has early AMD in just one eye, only 5 percent will go on to develop advanced AMD after 10 years.

Late AMD is a different story: There are two types: geographic atrophy (dry AMD), and neovascular AMD (wet AMD). Ninety percent of those with late AMD have the dry form, for which there is no treatment, and 10 percent have the wet form, which can be treated. My mother has the late wet form and is currently being treated with injections into her eye, which miraculously so far have staved off complete blindness.

Prevention

Like most medical conditions, it’s always better to prevent something serious than to treat it after the fact. First of all, don’t smoke and avoid UV light. Reynard says high-quality eyeglasses such as polycarbonate high-index lenses will protect against UV light. Those who wears contacts or do not wear glasses should wear UV400 sunglasses. He advises avoiding reading in bright sunlight without sunglasses because the sunlight can reflect off the page directly into one’s eyes.

In a nutrition study in the American Journal of Clinical Nutrition, those who adhered closely to a Mediterranean diet had a 26 percent reduction in progression to advanced AMD over 13 years, compared with those who did not. Reynard especially recommends a diet of broad leafy vegetables such as kale, such vegetables as red and yellow peppers, and foods that are high in antioxidants such as blueberries.

I was lucky, at least for now. I was diagnosed with a retinal scar, not AMD. My ophthalmologist advised me to do the things I’m already doing: eat broad-leafy greens, exercise regularly and avoid UV light exposure. He wants me to check myself with the Amsler grid weekly, and return in one year. In the meantime, if I do develop AMD, I hope there will be even better early detection and treatment options. Thanks to Israeli retina scientists, I have an optimistic vision of our future ability to combat AMD.

saliman-jerry
Dr. Jerry Saliman

Dr. Jerry Saliman is a contributing wellness writer for the Peninsula Jewish Community Center in Foster City. He retired from Kaiser South San Francisco after a 30-year career and is now a volunteer internist at Samaritan House Medical Clinic in San Mateo.