Age-related macular degeneration is something all ages should know about
Lauren Scott’s 83-year-old mother, Lorraine Callandrillo, was diagnosed with macular degeneration four years ago. Scott, who lives in Clifton, says her mother’s disease has been progressing slowly: “She can still read, but it’s becoming more difficult for her. She’s really been keeping on top of it, though. She wears her sunglasses and she’s been taking vitamins — a formula called Ocuvite, that her doctor recommended.”
Scott, who is 51, hasn’t had her own eyes checked in more than a year. “And that was only because I had a stye. Otherwise, I don’t think most people go for eye checkups. And even if they do, it’s probably not for macular degeneration — to them that’s an old person’s disease.”
Michael Hellegers of Totowa is 32 and was told by his ophthalmologist six years ago that he was at high risk for the illness, which is also known as AMD — age-related macular degeneration. “I’ve always had bad vision, so I do go for regular exams,” Hellegers says. “But I was surprised when my doctor told me he was very concerned about my right eye. And macular degeneration? My grandmother had it really bad. I knew older people got it, but my doctor said that, based on the images he’d taken, I was absolutely going to get it.”
On his doctor’s advice, Hellegers got prescription sunglasses, began taking vitamins and changed his eating habits, adding more fruits and leafy greens to his diet. “At my last doctor’s visit,” Hellegers says, “I was tested again. He showed me the old and new images, side by side, and said the condition was almost completely reversed. So it’s not just an old person’s thing. And it makes sense to be tested early for it.”
In the late 1980s, former first lady Claudia “Lady Bird” Johnson, who died in 2007, became one of the first well-known people to talk publicly about her macular degeneration. Today, actresses Judi Dench, Joan Plowright and Roseanne Barr are all coping with the illness and have discussed their varying degrees of vision loss. (Barr, who is 63, also has glaucoma.)
The U.S. National Eye Institute describes AMD as a disease that “causes damage to the macula, a small spot near the center of the retina and the part of the eye needed for sharp, central vision, which lets us see objects that are straight ahead.”
AMD progresses slowly in some patients, who may experience a gradual loss of vision over many years. In other patients, the disease strikes quickly and can lead to complete loss of vision in the affected eye or eyes. (AMD does not necessarily occur in both eyes at once. In certain cases, known as wet AMD, small blood vessels behind the retina rupture and cause bleeding.)
Risks for the disease include a history of smoking (which damages blood vessels throughout the body), elevated blood pressure and cholesterol levels and a poor diet. It is far more common in Caucasians than it is in African-Americans and Latinos, according to the National Eye Institute. And researchers suspect there is some hereditary risk, although this has yet to be proven.
“It’s important to remember that there are many different forms of macular degeneration and no one knows what truly causes it,” says Dr. Swati Parekh, chairwoman of ophthalmology at St. Joseph’s Regional Medical Center in Paterson, who adds that most people, even those at high risk, are unaware of the disease until they’re diagnosed with it.
“Many patients we see were never tested before for the disease,” Parekh adds. “They may see an eye doctor to get a new pair of glasses, but you can really only check for macular degeneration with more detailed tests, like a dilated retina exam, in which drops are used in the eyes.”
Parekh says adults over 50 should have a thorough eye exam once a year for early detection and then every six months — or as needed — when there has been a diagnosis of AMD, or other conditions such as glaucoma, cataracts or diabetic retinopathy.
“Roughly two percent of people over 80 have macular degeneration that we know of,” Parekh says. “And with more and more people hitting that age, we expect the numbers to double. But many people are never diagnosed. I see older people who come in all the time with family members and say, ‘I’m losing my vision now, but that’s normal because I’m old.’ Well, actually, no, loss of sight is not normal.”
One test for the disease is something people can do on their own. The Amsler grid, a tool for detecting AMD, can be downloaded from the Internet at several sites, including amd.org/free-amsler-grid (the grid, consisting of horizontal and vertical lines, can help monitor changes in someone’s central visual field).
Older patients, or patients of any age who are concerned about their vision, should get a dilated eye exam. It’s relatively quick and will provide your doctor with an almost-perfect view of the back of your eye.
Today, more and more ophthalmologists, Parekh among them, also recommend the use of vitamin formulas sometimes called AREDS, after the Age-Related Eye Disease studies done in 2001 and 2006. (The first formula combined vitamin C, vitamin E, beta carotene, zinc and copper. After the second study, known as AREDS2, was completed in 2006, the formula was changed. Omega-3 fatty acids and the antioxidants lutein and zeaxanthin were added; beta-carotene was removed; and the zinc dose was lowered.)
Bausch and Lomb makes both Ocuvite and PreserVision AREDS 2. Other formulations include Lipotriad Visionary, Pro-Optic AREDS 2 and Macular Health’s Visual Advantage.
The most common treatment for advanced macular degeneration involves the injection of a drug called a vascular endothelial growth factor (VEGF) into the eye to help promote the growth of new blood vessels. Patients should know, however, that the price of these drugs varies widely. According to a 2014 report by Business Insider, the cost of Avastin was $55 per dose, while Lucentis was $2,023 per dose.
While drug therapy won’t help all cases, Parekh says results have generally been positive. “Things are really changing now,” she says. “Twenty years ago, we had no treatments for macular degeneration. Today we have options, but detection is so important. After 50, having an eye exam every year can make a big difference.”