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Medical Edge Newspaper Column from Mayo Clinic

MACULAR-DEGENERATION SCREENING A MUST AFTER AGE 50

DEAR MAYO CLINIC: I would like information regarding macular degeneration: how or if it changes with age, what the treatment options are, etc. I am 50 years old and do notice I have more and more trouble reading the phone book, but isn’t that normal? What tests should I ask my doctor for? — Kansas City, Mo.

ANSWER: At age 50, presbyopia (pres-by-OH-pee-a) — not macular degeneration — is the most likely cause of your problem. Presbyopia, or difficulty focusing up close, is a normal part of aging. As we grow older, the natural lenses of the eyes become harder and less elastic — and therefore harder to focus. As a result, you might need reading glasses to clearly see the phone book.

Because you are concerned about age-related macular degeneration (AMD), I’ll give some background on this disease, which is the leading cause of legal blindness in the United States. The macula is located in the center of your retina and is responsible for producing central, straight-ahead vision.

If its cells are damaged by disease or degeneration, your central vision may decrease. Macular degeneration develops painlessly, typically affects both eyes, and can cause people to have difficulty reading small print or seeing distant objects in the central vision. Macular degeneration takes two forms, wet and dry.

Wet AMD occurs when abnormal blood vessels behind the retina start to grow under the macula. These new vessels tend to be very fragile and often leak blood and fluid, which raise the macula from its normal place at the back of the eye. Loss of central vision from this form of macular degeneration occurs rapidly.

Dry AMD occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye. As dry AMD gets worse, you may see a blurred spot in the center of your vision. Over time, as less of the macula functions, central vision in the affected eye can be lost gradually.

People age 50 and older should see an ophthalmologist annually for a refraction and complete eye examination, including evaluation for signs of AMD. Tell your doctor whether you have a family history of AMD, because that puts you at higher risk for developing the disease.

Typically, the ophthalmologist will examine your macula with the
ophthalmoscope/biomicroscope. More sophisticated tests such as a fluorescein angiogram, indocyanine angiogram or ocular coherence tomography will be done only if the doctor finds changes in the macula.

If there are signs of degeneration and/or pigment changes in the macula, your doctor will take photographs to document the condition and use them to monitor the progression of the disease. However, ophthalmologists can’t predict individual rates of progression. To play it safe, get your central vision checked every year to detect changes as early as possible.

The National Eye Institute’s Age-Related Eye Disease Study recently found that taking a specific high-dose formulation of antioxidants (vitamins) and zinc significantly reduces the risk of advanced AMD and its associated vision loss. Slowing AMD’s progression from the early stage to the advanced stage will save the vision of many people. However, the vitamins may have side effects or interact with other drugs, so patients should be sure to discuss this with their primary-care doctor.

If you are diagnosed with AMD, treatment will be determined by the form of macular degeneration:

— Dry AMD: So far only vitamins with minerals and lutein have been proven to retard progression. They do not cure the disease.

— Wet AMD: Selected cases of the wet form of macular degeneration may be amenable to laser photocoagulation to stop the abnormal leaking of fluids that is disturbing vision; photodynamic therapy; intraocular steroid injections; transpupillary thermotherapy; or drug injections into the eye to stop blood-vessel growth.

In all scenarios, the most important thing is that you seek out an eye-care specialist who is skilled, experienced and up-to-date on AMD treatments, clinical trials and research.

Helmut Buettner, M.D., Ophthalmology, Retinal and Vitreous Surgery, Ocular Oncology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Treatment of Macular Degeneration
Appointment Information
More Information on Macular Degeneration

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.