macular degeneration - timeline?

[farmbeachgal]

I was just diagnosed with macular degeneration by my optomotrist when I went to get reading glasses for the first time.  I have an appt to see a retinal specialist, but it's a week away and I have some questions.  I am only 43, and although I am doing what I can by taking the prescribed vitamins and working towards a heart-healthy diet and more exercise, I feel like it's improbable that I can keep loss of vision at bay forever.  What is the timeline with this disease?  I have dry type, but I don't know whether it's beginning, intermediate or advanced.  From what I saw on the photos, I have round yellow drusen in both eyes (not the little pinprick kind).  To my knowledge, this does not run in my family, nor am I a smoker.  I have some weight to lose, but I am not obese.  My BP is normal, but I'm not sure about my cholesterol.  Thanks!

[Mccaskill]

I read your comments and have a question please. I had all the test done by the eye degeneration
specialist. I have the wet and he told me I have to start the shots. I went in and had the
assistant put the numbing shots in my eyes several then prop my eye open. Then the doctor came in and he said he was rubbing a numbing agent on my eye ball. I then had a horrible sharp
felt like a knife ran in my eye  painfull . I am one of those people that are hard to numb up such as at the dentist takes lots of shots. Do you supposed that what I felt was the needle going in my eye? Or was it the medicine being squirted in doing the pain? I have to go and have my
second shot May 10th am am totally gun shy. This is the best doctor but he is the only one in town and is sooooooooo busy that he doesnt have time to really talk to me and I understand.
If you can give me some advice I would appreciate so very much,
Carol in Oregon

[John C Hagan III, MD, FACS, FAAO]

Physicians get in trouble when pressed by patients to tell them what will happen (will I get cancer?), when will it happen (how long do I have to live?), who it will happen to (will my children get this?).

There is so much variablity in ARMD that there is no time line. Most people in their late 80's and 90's have some degree of ARMD (depending on how its defined). Most enjoy acceptable vision.

Don't just accept ARMD based on a diagnosis by a non-MD, non-phyisician optometrist. See an Eye MD ophthalmologist, ideally a retina specialist. Find one near you at www.aao.org.

You can be very proactive and show ARMD down by doing many things. This is from a handout I use in my office:


Prevention and Treatment of Age Related Macular Degeneration
1. The macula is the part of the retina we read with. It is very susceptible to the aging process. Age Related Macular Degeneration (ARMD) is the leading cause of legal blindness in the USA. It never makes the eye totally blind but can cause inability to read, drive and recognize faces. It does not affect the peripheral vision. The disease is caused 90% of the time by three genes. Having the genes does not mean a person will get the disease nor if none of the genes are present does it mean a person will not get the disease. The disease becomes more common as we age. At present there is no available test to determine if you carry any of the ARMD genes. A healthy lifestyle will reduce the risk of ARMD or if it is present will slow it down. If you are related to someone with ARMD you are at increased risk.

2. If you have been diagnosed with “dry” ARMD daily take: AREDS supplements. They are non-prescription and widely available. My recommendation is Preservision WITH LUTEIN TWO PER DAY. Other good brands are Ocuvite and EyeCap also 2 per day ALSO take a good multivitamin. Also take two or three enteric-coated fish oil (omega 3) per day. WE GIVE THIS HAND-OUT TO MOST OF OUR ESTABLISHED PATIENTS AS PREVENTIVE INFORMATION. RECIVING THIS DOES NOT MEAN YOU HAVE ARMD.

3. We know if you have ARMD taking AREDS supplements with a vitamin may slow your ‘dry’ ARMD by as much as 30%. We do not yet know if taking them will prevent ARMD if you don’t already have it. That study is being done and is called the AREDS II. It will likely not be completed and the information available until 2013.  Until them a benefit is presumed not proven.

4. General Rules: Keep your blood pressure down, keep your cholesterol under control (if necessary use medication for blood pressure and cholesterol). Keep your weight down. Obesity makes ARMD worse. DO NOT SMOKE! DO NOT USE NICOTINE PRODUCTS. Eat lots of fruit, fiber, fish, nuts, berries, vegetables, cut down fatty foods, cut down on high calorie processed carbohydrates (example pastries), exercise to tolerance, protect your skin and eyes from ultraviolet light, eat a lot of lutein containing food. (Spinach, kale, collard greens, mustard greens, parsley, dill, celery, scallions, leeks, broccoli, green peas, green beans, green pepper, green olives, tomatoes, pumpkin, brussel sprouts) If you are on coumadin (warfarin) you generally have to avoid these foods. In that case consider taking a 20 mgm lutein supplement daily.

5. Have your eyes checked yearly by an ophthalmologist. This is especially important as you get older, if there is a family history of ARMD, glaucoma or if you are diabetic, hypertensive or have other serious health problems. ARMD is more common in people with fair complexions, light colored eyes (people that sunburn easy) and those working outdoors or with a history of long sun exposure.

6. ARMD is not caused by using your eyes too much nor is it made worse by using your eyes for reading, crafts, computer or not wearing your glasses.

7. If you have ARMD and are unable to read with regular glasses we suggest you visit Nagel’s Low Vision Aids store in Independence Missouri. You should also consider contacting the Missouri Bureau of the Blind, they can acquaint you with possible benefits and services.

8. ARMD does not have to get worse. You can have 20/20 vision and still have ARMD. It is often very difficult to distinguish normal aging changes in the macula from very early ARMD.

9. If you have ARMD we will also give you a booklet on ARMD that explains the two forms “dry” which is 90% of the cases and “wet” which is 10% cases. The wet form accounts for 90% of the cases of legal blindness and the dry only 10%. HOWEVER: DRY ARMD CAN CONVERT TO WET ARMD ANY TIME. If you have a sudden worsening of your vision or distortion of the vision you need to be seen immediately. If you phone our call center [phone] be sure to tell them you have had had a sudden change and need to get in the same day or the following morning. If on the weekend, holidays or night be sure to convey this information to the ophthalmologist on call.

10. If you have ARMD or you have a family history of ARMD and are older than 50 we will give you an AMSLER grid to check your eye for distortion on a daily basis. You can screen an eye with an AMSLER grid in 15 seconds.

11. Wet ARMD which use to almost always lead to legal blindness now can be treated in about 75% of the cases with medications that are injected into the eye to stop bleeding and cause the abnormal vessels (choroidal neovascularization) to regress. It doesn’t always work and often does not undo damage already done but Avastin/Lucentis treatment is truly one of the greatest achievements in Ophthalmology. Having wet ARMD in one eye raises the risk of the same problem in the other eye.


JCH MD

[wndyeliza]

Thank you for this answer, and the information holds true these years later.  I was screened for new lenses 3 days ago including computer scanning of the inside of my eye which led to the diagnosis of macular degeneration and I was given sample vitamins.  My uncle had the same diagnosis, HBP runs in my family and I had a run with it a few years ago.  I was a total sun worshiper in my youth.  I am about 10 lbs over my ideal and have had a long battle with my cholesterol, now whether that is my liver working overtime or my dietary preferences or both, I cannot tell you since I do tend to eat less than most due to medication for migraine
I had noticed a blurred field in my vision that I had dismissed as my glasses or needing new glasses for a short while.  My left eye is my weak eye, I have an astigmatism and when I need a new Rx I see a vertical blur which I can most of the time ignore.  Until now.
My scan showed not only the areas of degeneration, but on a different scan a void (my words) that appears as though "water" was going down a drain if you cut the view down the middle.  It was run twice and will be re-done alone with a dilation.  He has no problem sending me out to outside professionals, he has done it before.  
My eyes are a full strength weaker now in both eyes, and now this.  I am a creative/artsy person my passion and this has put a tweet in my mood lately but I'll figure it out.
You're post did give me the information I needed to dig out of hole I was preparing for the pitty party for one! LOL.
As an LVN Case Manager, I may not be able to go back to work with that job due to all of the computer input, but perhaps I can get a position as a Patient Centered Advocate (my second love) where I can talk more than type.

Thank you for your input,
Wendy

[John C Hagan III, MD, FACS, FAAO]

Thanks JHagan MD

[Noppon]

I can feel your anxiety by reading your post.
I also have eye problem but mine is different from you. (39 years old)
I've been searching the internet where and who can treat my condition.
Pls you try www.retinaandvitreous.com
They are in Oregon and have studied about Macular Degeneration.
I hope they could help.

[ARMDDawn]

I am sorry but, your statement, though prophetic, is not at all helpful and feels dismissive, at best.  I am in the same position as farmbeachgal.  I am aware you do not have the ability to predict the future but, as an expert in the field, I believe you do have the ability to tell us at what point in time a percentage of patients are considered legally blind.
I live alone.  I have a job and a mortgage.  I have no one to help me.  I do not have a large amount of excess money after I pay that mortgage.  It makes a huge difference in what I can do today, if I have an idea as to  whether I am going to be blind in two years or twenty.  Please reconsider your response.

[John C Hagan III, MD, FACS, FAAO]

Life and medicine does not come with a timeline that fits everyone.

JCH IIIIMD

[farmbeachgal]

Thanks, I had read all of that.  I still don't feel like I know any sort of a timeline, but I guess each case is diffeent, and I won't know particulars till I see a specialist.

[John C Hagan III, MD, FACS, FAAO]

This is a great article that will tell you everything you need to know:

http://www.emedicinehealth.com/macular_degeneration/article_em.htm

JCH III MD