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Macular degeneration, when is it official?

I know a few small drusens does not make one AMD.  What gives one an official diagnoses of AMD?  Other than drusen what else goes wrong with the eye?
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177275 tn?1511755244
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A Healthy Lifestyle May Prevent You From Going Blind Due to Macular Degeneration

Prepared for MedHelp.com AAO eyecare forums by
John C. Hagan III, MD, Fellow American Academy of Ophthalmology

If there is anything that modern medical research confirms it’s that the good and bad choices you make about your lifestyle (diet, exercise, smoking, alcohol, etc.) have a major effect on how long you live, how well you live and even whether your vision will fail long before you die.
This article will focus on prevention and treatment of age related macular degeneration (ARMD). Recent studies suggest that many of these recommendations may prevent or slow the development of cataracts and enhance your general health. The macula is the most sensitive part of the retina (the sight forming tissue on the back of the eye---much like the film in a camera). The macula (FIGURE OF NORMAL MACULA) is used for reading, looking at computer screens, driving, recognizing faces and all fine vision. Its structure provides ultra-sharp vision that the peripheral retina cannot produce; however this delicate architecture also predisposes it to the effects of age and disease. (Think of how a pair of blue jeans wears out in the knees first)
There are two forms of macular degeneration “dry” (non-exudative), which accounts for 90% of the cases but only 10% of the eyes that end up “legally blind”. (FIGURE OF DRY ARMD)  Legal blindness means the best possible vision, even with glasses, is 20/200 or worse. (IF POSSIBLE A VISION TESTING CHART WITH 20/200 CIRCLED OR LETTERS SMALLER THAN 20/200 BLACKED OUT) The peripheral or side vision is not affected by macular degeneration so the eye is not totally blind. (IF POSSIBLE A PICTURE OF WHAT A CENTRAL BLIND SPOT LOOKS LIKE) The other form is “wet” (exudative) macular degeneration which occurs only 10% of the time but causes 90% of the cases of legal blindness. (PICTURE OF WET MACULAR DENERATION).  Wet macular degeneration develops when dry macular degeneration suddenly worsens as tiny blood vessels (‘neovascularization’) break through into the macula causing bleeding and scar formation.
ARMD was once thought to be an unpreventable part of aging. The Human Genome Project has discovered that 3 genes cause 90% of ARMD.  Testing is not possible for these genes outside a few major genetic research centers. However even a person with all three genes may not get ARMD if they take preventive steps; likewise a person with none of these genes may get severe ARMD if they are smokers.
The things that are recommended to reduce the risk of ARMD or to prevent dry ARMD from worsening or turning into wet ARMD are, for the most part, the same things a cardiologist or family physician would recommend to reduce the risk of heart disease, cancer and promote general health.
This starts with a great diet: fruits, vegetables, fiber, fish, berries, nuts; low in saturated fats; low in high calorie processed carbohydrates (e.g. pastries; commercial crackers/chips) and green tea as a preferred liquid refreshment. Lutein is a substance of great importance to macular health. The body cannot make lutein.  Lutein is found in dark leafy greens (spinach, kale, ‘greens’, broccoli, etc.) Lutein content of foods is easy to find on the internet.  Both obese and overweight people have higher rates of ARMD than their normal weight counterparts. Nothing tastes as good as slim feels.
Smoking or using tobacco/nicotine products is one of the worst things you can do to your eyes. It more than doubles the risk of getting ARMD, increases the risk of dry ARMD worsening or turning into wet ARMD. If you are serious about protecting your health and vision, you must stop smoking completely. Trying to smoke “a little” is like trying to be “a little” pregnant. It just doesn’t work.
ARMD is related to skin pigmentation and sun exposure. In general the darker the skin (and iris color—dark brown) the less ARMD; the lighter the complexion (those that sunburn easily) and with blue-gray-green iris color the higher the risk of ARMD.  For sun exposure wear a hat with a bill, sunglasses that block UV and infrared light and high SPF sun block on face and exposed skin.
It is known that for people with dry ARMD that certain supplements slow disease progression. This was demonstrated in the AREDS 1 Study (Age Related Eye Disease Study).  An AREDS 1 supplement contains extra vitamin A, C, E, zinc and copper. It is meant to be taken with a multivitamin. AREDS 1 original formula does not contain lutein and omega-3s (usual source fish oil); nor were they tested on individuals that did not have ARMD to see if they were preventive. A new study AREDS 2 is underway that has lutein and omega-3s in it to see if this formulation prevents ARMD. Also vitamin A (beta-carotene) has been removed. People that smoke should not take vitamin A as it increases the risk of lung cancer.  There are many quality pharmaceutical companies that make and sell these products; all are over-the-counter and require no prescription. Unfortunately the AREDS 2 study has years to run before its completion.  The minimum for a patient with ARMD is a multivitamin and 2 of the AREDS 2 capsules per day. People with a strong family history of ARMD or multiple risk factors should consider this combination also.
After age 40, regular eye examinations are important to detect early signs of ARMD as well as glaucoma (pressure damage) and cataracts (clouding of the lens of the eye). People with ARMD are asked to test their eyes at home with an Amsler Grid to look for distortion that might indicate ARMD.
Ophthalmologists (MD physicians that specialize in medical and surgical care of the eyes) have made major discoveries into treating wet ARMD. This usually consists of injections of medications into the center of the eye where they cause the bleeding vessels to wither away without damaging surrounding tissue. (PICTURE OF INTRAOCULAR INJECTION OF VEGF INHIBITOR) About 75% of the time the vision can be kept from getting worse, so starting treatment when there is little blood is critical.
To summarize, there is treatment for both wet and dry age related macular degeneration but a healthy lifestyle that does not include obesity or tobacco products maximizes the chance for good vision all your life. May you live to see your children’s children’s children and see them clearly!

Dr. Hagan thank you for that explanation.  It was very informative.  However, what actually happens to the eye when you start losing central vision?  Does the retina get damaged due to drusens?  I know that with wet blood vessels cause the problem.  What happens with.  Do drusens cast large shadows?
Dr. Hagan thank you for that explanation.  It was very informative.  However, what actually happens to the eye when you start losing central vision?  Does the retina get damaged due to drusens?  I know that with wet blood vessels cause the problem.  What happens with dry.  Do drusens cast large shadows?
As ARMD gets worse the central (reading) vision gets worse and often distorted. Drusen do not cast shadows.   Hard macular drusen  do not injure eye.  Soft drusen are considered a precusor of ARMD.
20703499 tn?1552601915
Macular degeneration is still not completely cured because it is age-related.  but there are many treatments that delay the progression of macular degeneration and even improve vision.
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What exaxtly happens the eye?  Retina?  Macular?  Etc.
Dr. Hagan.
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