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Macular Degeneration
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How To

Frequently Asked Questions

Macular Degeneration

Age-Related Macular Degeneration (AMD).
How will my daily life change?
Will I go completely blind from AMD?
Will I become legally blind?

Is there more than one type of AMD?
How did I get this disease - are there risk factors?
Is AMD hereditary - will my children be affected?

Will both eyes be affected?
Are there any current or promising treatments?
Is there anything I can do to enhance the vision I have left?

How many people are affected by AMD?
Where can I get more information about AMD?

What would you do if you were me?

Vitamins
UV filters.
Protection from excess sunlight.
How to use the Amsler Grid.

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Age-Related Macular Degeneration (AMD)
AMD is a condition in which the macula is damaged and central vision is lost. The macula is the special area of the retina used for detailed vision (central vision). When the macula is damaged, reading and similar detailed vision activity is difficult.

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How will my daily life change?
Because dark or empty spaces block your center of vision you may have difficulty driving, doing detailed work and reading fine print. Faces may appear blurred. Straight edges and lines may appear wavy. However, with the use of low vision aids, and rehabilitation, you can learn new ways to cook, read, write letters and live an active life.

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Will I go completely blind from AMD?
No. You will never go totally blind from AMD. AMD affects only the central vision. Around the macula is the retina responsible for side vision (peripheral vision). The side vision lets you know what is around you. You will be able to walk around, dress yourself and do most daily tasks. Peripheral retina is not affected by AMD and there is no loss of side vision.

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Will I become legally blind?
If the disease progresses, you may be declared "Legally blind". "Legally blind" are terrifying words but they do not give an accurate picture of the situation. The situation is not nearly as bleak as those words imply. You will be "partially sighted" rather than blind. Because you may not be able to do certain things, such as driving, laws have been passed to help with such handicaps. Legally blind is not the same as totally blind.

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Is there more than one type of AMD?
There are two forms of AMD. About 10% of patients have the "wet" form. Nearly 90% of patients have the less sight-threatening "dry" form.

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How did I get this disease - are there risk factors?
The cause of AMD is unknown. Smoking is the only proven risk factor. Excessive sun exposure, high blood pressure and a diet low in certain vitamins, minerals and antioxidants have been suspected. They have not been proven to predispose to AMD.

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Is AMD hereditary - will my children be affected?
There is an increase in AMD among children of AMD patients. This is one more reason why your children, after age 40, should have regular eye exams at least every other year.

Your children will reduce their risk, if they:

  • Do not smoke.
  • Protect eyes from excessive sunlight (UV filters on eyeglasses and/or sunglasses).
  • Eat green vegetables.
  • Maintain an adequate vitamin intake.
  • Have a dilated eye exam at least every other year after age 40.
  • Have an eye exam immediately if their vision becomes distorted.

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Will both eyes be affected?
About 40% of patients with wet AMD in one eye will develop AMD in the other eye within 5 years. Conversely, in 60% of patients the other eye is not affected. We cannot predict who will, or who will not develop changes in the second eye. We cannot predict the extent of vision loss. Dry AMD often involves both eyes but it tends to cause less disability than the wet form.

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Are there any current or promising treatments?
There is currently no treatment for the dry form of AMD. The retina specialist may treat some patients with wet AMD.

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Is there anything I can do to enhance the vision I have left?
Yes. Many options are available. If you need help, we will arrange an appointment with the Low Vision specialist at.

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How many people are affected by AMD?
AMD is one of the more common causes of significant vision loss. About 8 million Americans have AMD.

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Where can I get more information about AMD?
AMD Alliance is an international organization devoted to help AMD patients and their families. You may contact them at www.amdalliance.org or call 1-877-AMD-7171.

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What would you do if you were me?

  • Stop smoking (the only clearly proven risk factor).
  • Control high blood pressure and high cholesterol.
  • Eat a healthy diet (include dark green vegetables such as spinach).
  • Take vitamin supplements (see "Vitamins").
  • Protect eyes from excess sunlight (hat, even on cloudy days; UV filters).
  • Check the Amsler grid daily (call us if you notice a change).
  • Have eye exams every 6 months (immediately if vision change is noticed).
  • Consult Low Vision specialist.
  • Contact a local support group through the AMD Alliance (www.amdalliance.org or call 1-877-AMD-7171). The AMD Alliance web site contains great amount of information of interest to AMD patients.

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Vitamins.

High doses of anti-oxidant vitamins and zinc significantly slow the rate of vision loss due to macular degeneration (AMD). This was proven by the Age-Related Eye Disease Study (AREDS). The high dose vitamins used in the study are known as "AREDS formula" or "AREDS vitamins". This formula consists of (approximately): Vitamin C 500 mg; E 400 IU; A 15 mg; Zinc 80 mg (Zn) and Copper 2 mg (Cu).

There are several trade names for AREDS formula vitamins (I-Caps; Ocuvite Preservision, ProtectRx, Visivite, Viteyes, etc). They are essentially similar and are sold over-the-counter. Some products require you to take 2 tablets twice a day; other products require 1 tablet twice a day.

Lutein, Zeaxanthin, Lycopene, DHA/EPA (Omega-3 fatty acids), B6 and B12 and folic acid may be useful, but their usefulness is still unproven; research is continuing. Incidentally, omega fatty acids (such as those in flaxseed and salmon oil) are useful in people with dry eyes and are considered good for the heart.

AREDS vitamins do not prevent development of AMD; they slow its progress.

AREDS vitamins will not restore vision already lost to AMD.

Most patients can use their regular multivitamins in addition to AREDS vitamins (consult your regular doctor in case of doubt). Recommendations are different for smokers and non-smokers. In our example we are using I-Caps but other manufacturers have similar products.

If you are a non-smoker I-Caps AREDS formula, green (or blue with Lutein and Zeaxanthin) plus any of the common daily multivitamins (such as Centrum, One-A-Day, etc).

Do not use another AREDS formula vitamins (I-Caps MV, Ocuvite Preservision, ProtectRx, Visivite, Viteyes, etc) instead of regular daily multivitamins.

Patients diagnosed with lung cancer and smokers (even those who quit smoking some years ago) should not take high doses of vitamin A (beta carotene). If you are a smoker or have been diagnosed with lung cancer:

Use vitamin A (beta carotene) free AREDS formulas.

Consider something like I-Caps MV (purple) which contains all AREDS vitamins except vitamin A, plus regular multivitamins (no need to take other multivitamins such as Centrum, One-A-Day, etc).

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UV filters.
Used on glasses and sunglasses. Ideally sunglasses should block all UV light (UVA, UVB and UVC). Ask for 100% UV protection, if available. Our prescriptions for glasses always carry a request for UV filters. The lens implants we use for cataract surgery block UV light.

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Protection from excess sunlight.
Glasses and sunglasses should have UV filters, as close to 100% protection as possible. Sunglasses may be of any color (gray is best for driving). Polarizer and antireflective coatings may be added to glasses to reduce glare. If you spend much time outside, consider wraparound sunglasses or wear a broad-brimmed hat.

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How to use the Amsler Grid.
Check the Amsler Grid daily (first thing in the morning is a convenient routine) Hold Amsler grid at eye level (consider taping it to the bathroom medicine cabinet door). If you wear reading glasses, put them on. Cover one eye and focus on the center dot. Check for any new wavy, broken or distorted lines or blurred or missing areas of vision. If you notice a change, contact us immediately.

To print the Amsler Grid, go to the How To page.

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