Age-related macular degeneration affects central vision in older Americans

Mar 11 2010

Indianapolis resident Harry Traugott was an active retiree, participating in community events, driving and even teaching English as a second language at two community centers.

He’d been diagnosed with age-related macular degeneration (AMD), but the disease had not caused significant vision loss. It wasn’t until he had trouble seeing while driving, watching television and reading that he realized the disease had progressed.

"I finally quit driving about two years ago," said Traugott, who will be 93 this month. "It started with one eye and the other was OK, but then it got bad, too."

Traugott is typical of the more than 10 million Americans who develop age-related macular degeneration. AMD is a progressive disease caused by the breakdown of the macula in the back of the eye. The macula is responsible for sharp center vision necessary for reading, driving, watching television, recognizing faces and doing close-up work. Vision loss can be gradual and many people don’t realize they have a problem until the disease has caused significant loss.

That’s why the Eugene and Marilyn Glick Eye Institute at the IU School of Medicine is observing Age-related Macular Degeneration Awareness Month with the American Academy of Ophthalmology’s Eye Smart campaign (http://www.geteyesmart.org/).

While most people with AMD suffer gradual vision loss, Gina Drey had a more immediate problem. The Indianapolis resident, who will be 62 this month, woke up one morning and realized she could not see out of her left eye.

"I was seeing dark spots when I closed my other eye," she said. "I couldn’t see letters. It was quite a sudden change."

All adults should pay close attention to their vision – and any subtle changes in their sight, says Anh-Danh Phan, M.D., a retina specialist at the Eugene and Marilyn Glick Eye Institute at the Indiana University School of Medicine.

"As with most age-related vision problems, many people are unaware of slight vision losses and don’t realize their vision has been compromised until it’s too late," she said. Sudden onset of the disease is not uncommon.

"Dry AMD is the most common form of AMD, with 90 percent of patients experiencing this type of the disease," Dr. Phan said. "Dry AMD occurs naturally, as we age, and is most common among Caucasians. Wet AMD, which is more serious and requires immediate evaluation, occurs when abnormal blood vessels grow in a layer beneath the retina, leaking fluid and blood."

Both types are painless and cause a loss of central vision, or blind spot. Peripheral, or side vision, remains unchanged, said Dr. Phan.

Some patients, like Drey, experience both variations of the disease. "My diagnosis is that I have dry AMD in one eye and wet AMD in the other eye," she said.

Various treatments are available depending on the type and severity of the disease. Traugott and Drey are receiving injections into the eye of a drug that stops the progression of the disease. Other treatments include photosensitive therapy (Visudyne or PDT) and traditional laser. Almost all patients should be on vitamins specially formulated for the eye, Dr. Phan said.

Drey’s condition has yet to slow her down. "I’m a part-time secretary so I do work at a computer. And I do cross stitch, needlepoint and hand sewing. I’ve done this for a long time and I really enjoy it. I haven’t had any problems so far," she says, noting that she still drives without any problems.

Traugott now depends on his wife to do the driving. He uses low vision aids, such as a hand-held lighted magnification device to read the newspaper, something he calls "very helpful."

"I can see what I’m doing now – and I’m able to read," he said, noting that reading was always one of his favorite pastimes.

"I have a little trouble watching the TV, but I can read. I can get books in large type print," Traugott said. He’s hopeful that his current treatment regimen will stave off blindness.

Both Drey and Traugott encourage people to see an eye doctor at the first sign of a problem.

"Definitely go to a doctor and have your eyes checked," Traugott said.

"It’s important to understand that if you have sudden problems, like blurriness or spottiness or halos, that you need to get to your doctor to get it checked out," said Drey.

Dr. Phan said there are risk factors for developing age-related macular degeneration, including:

• Age – over age 50 is when most cases are noticed.

• Smoking – it may increase the risk of AMD.

• Race – Caucasians are more likely to lose vision from AMD than members of any other race.

• Family history – those with a family history of AMD are more likely to develop the disease.

• Medical conditions such as hypertension and obesity.

While age-related vision problems will affect most people, Dr. Phan said there are lifestyle choices that can be made that might significantly slow down the onset of the disease.

"If you smoke, stop smoking. Eat a healthy diet rich in leafy greens. Talk to your doctor about vitamin supplements. Control your blood pressure, cholesterol and blood sugar if you are diabetic,' she said.

The National Eye Institute warns that vision loss is becoming a national health concern. The NEI estimates that by the year 2020, 5.5 million Americans over age 40 will suffer from blindness or vision loss.

For a simulation of how vision changes with age-related macular degeneration, click here.