Early Stage Macular Degeneration Advice

Age-Related Macular Degeneration (AMD) is diagnosed into four main stages: 

Early, Intermediate, Advanced, and Wet 

In its early stages, the following signs of macular degeneration can go unnoticed. Though some may experience:

• The gradual loss of ability to see objects clearly
• The shape of objects appears distorted
• Straight lines look wavy or crooked
• Loss of clear color vision
• A dark or empty area in the center of vision

There is no cure for AMD and any loss in vision cannot be restored. As a result, it is important that we focus on doing our part to help prevent the progression of the disease. Studies show that nutrition, proper health control, avoiding smoking, and proper UV protection are pivotal in combating progression at the earliest form of the disease. 

Two carotenoids, lutein (pronounced loo-teen) and zeaxanthin (pronounced zee-uh-zan-thin), filter harmful high-energy blue wavelengths of light and help protect and maintain healthy cells in the eyes. Of the 600 carotenoids found in nature, only these two are deposited in high quantities in the retina (macula) of the eye. Unfortunately, the human body does not naturally make the lutein and zeaxanthin it needs. This is why eating green vegetables is important. Getting daily amounts of lutein and zeaxanthin through your diet can help maintain good eye health.  Significant evidence points to a goal of 10 mg of lutein daily.

Because of the apparent benefits of lutein and zeaxanthin, many nutritional companies have added these carotenoids to their multiple vitamin formulas.  A typical amount of lutein included in a multivitamin is 250 mcg (micrograms).  This is 0.25 mg (milligrams), well short of the 10 mg goal.  Others have introduced eye vitamins that are predominantly lutein and zeaxanthin supplements. It is unknown at this time whether supplements have the same effect as lutein and zeaxanthin obtained through food sources.

Popular lutein and zeaxanthin supplements include:

• MacuHealth with LMZ3 (MacuHealth LLC)
• EyePromise Zeaxanthin (Zeavision)
• ICaps Eye Vitamin Lutein & Zeaxanthin Formula (Alcon)
• Ocuvite (Bausch + Lomb)

The source of lutein in many lutein supplements is marigold flowers, while for zeaxanthin it is often red peppers. If you choose a lutein and zeaxanthin supplement, make sure it's a high quality product from a reputable dietary supplement company.

In addition to diet and proper health control, it is important for early AMD patients to monitor their macular health while away from the doctor's office. The Amsler grid is a great way to self-check any changing irregularities in the retina.

To use the Amsler grid, follow these steps once a day, every day:

1. Wearing any glasses you normally use to read, hold the grid 12 to 15 inches away from your face in a well-lit environment.
2. Cover one eye.
3. Look directly at the center dot with your uncovered eye and keep your eye focused on it.
4. While looking directly at the center dot, notice in your side vision if all grid lines look straight or if any lines or areas look blurry, wavy, dark, or blank.  If you notice any changes, contact your eye doctor right away.
5. Follow the same steps with the other eye.

https://www.aoa.org/diet-and-nutrition/lutein

https://www.mayoclinic.org/dry-macular-degeneration/

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AREDS Vitamins

In large scale clinical trials funded by the National Eye Institute, the AREDS2 formula benefited people with intermediate or late age-related macular degeneration (AMD). There was no tangible benefit for people with early AMD or for people who do not have AMD. Keep in mind though that nutritional supplements cannot prevent AMD. However, the AREDS2 supplements may delay the progression of intermediate to advanced AMD and may help you keep your central vision longer. 

The high levels of vitamins and minerals found in these supplements are difficult to achieve from diet alone. However, previous studies have suggested that people who have diets rich in green, leafy vegetables—a good source of lutein and zeaxanthin—have a lower risk of developing AMD. In the AREDS2 trial, the participants who benefited most from taking lutein + zeaxanthin were those who did not get much of these nutrients in their diet. Within this group, those who received lutein/zeaxanthin supplements had a 26% reduced risk of developing advanced AMD compared with those who did not receive the supplements.

Bausch & Lomb produced the formulations for the clinical trials and their Preservision AREDS2 products are the supplements we recommend. They are available without a prescription online and at the major pharmacies and grocery stores.

https://www.nei.nih.gov/research/clinical-trials/

https://www.preservision.com/

Hordeolum (Stye)

The medical name for a stye is hordeolum (or hordeola if there are more than one). Styes are a very common type of infection of the eyelid. Usually, only one eye is affected, although you can develop more than one stye at a time, even on the same lid. There are two types of stye: external styes and internal styes, depending on the gland that is infected. 

Most styes occur for no obvious reason, although if your eyelids are itchy or rubbed a lot this may make an external stye more likely. The usual bacteria that causes the infection is called Staphylococcus aureus. It is a common gram-positive bacteria that is found on healthy skin; however, it can occasionally get into the small glands of the eye, where it causes infections such as spots, abscesses, and styes.  

The treatment for these conditions begins with hot compresses. Typically microwavable masks that hold heat for 10-15 minutes tend to work better than wetting a washcloth.  Apply the heat several times per day.  If your eye care provider finds inflammation and infection more widespread around the affected gland, oral antibiotics or prescription ointments might be warranted. Styes tend to recur, so keeping eyelids as clean and dry as possible will help to prevent future infections from forming. 

For more information visit:

https://www.mayoclinic.org/diseases-conditions/sty/symptoms-causes/syc-20378017

Glaucoma

Glaucoma is a group of progressive, painless eye diseases that can cause blindness. With all types of glaucoma, the nerve connecting the eye to the brain is damaged, often due to high eye pressure.

There are many types of glaucoma, however the most common type of glaucoma (open-angle glaucoma) often has no symptoms other than slow vision loss. Angle-closure glaucoma, although rare, is a medical emergency and its symptoms include eye pain with nausea and sudden visual disturbance.

At this time glaucoma has no cure, however treatment can slow vision loss and help preserve the vision we have. Treatment options include eye drops, medications, and surgery. Regular eye examinations are very important, as early detection of the disease results in the best chance for preserving vision. 

For more information:

https://www.preventblindness.org/glaucoma

Age Related Macular Degeneration

AMD, or age-related macular degeneration, is a leading cause of vision loss for Americans age 50 and older. It affects central vision, where the sharpest vision occurs, causing difficulty in conducting daily tasks such as driving, reading, and recognizing faces. Central vision becomes distorted and wavy.  Peripheral, side, vision remains clear. Age is a prominent risk factor for age-related macular degeneration.  The risk of getting AMD increases from 2% for those ages 50-59 to nearly 30% for those over the age of 75.  

The most common form of AMD is “dry” AMD. This is caused by the appearance of small yellow deposits called drusen, which form under the retina (the sensor of the camera in the back of the eye). These are accumulated waste products of the retina, which can grow in size and stop the flow of nutrients to the retina. This will cause the retinal cells in the macula that process light to die, causing vision to become blurred and distorted. This form of the disease usually worsens slowly. Currently, the only treatment for dry AMD, which in many people show no symptoms or loss of vision, is dietary vitamin and other supplements. A study has found that a certain combination of vitamins (vitamins C and E, lutein, zeaxanthin, and zinc), known as AREDS (Age-Related Eye Disease Study) vitamins, can slow the progression of dry AMD in people with a moderate level of disease. However, these vitamins do not cure AMD.  

“Wet” AMD generally causes more rapid and more serious vision loss. In this form of the disease, tiny new blood vessels grow under and into the retina. These blood vessels are fragile and often break and leak, causing a loss of vision.   

The key to slowing or preventing vision loss is regular eye exams. People age 50 or older should get a complete eye exam and follow-up with eye exams every year or as indicated by the eye doctor. Smokers, those with a family history of macular degeneration, and patients with heavy sunlight exposure are also at higher risk for developing AMD. It is important to maintain a routine schedule of eye exams even if there are no noticeable vision problems. 

https://www.preventblindness.org/AMD-age-related-macular-degeneration

Dry Eye

Dry Eye Disease is a chronic condition, which has no cure and is exacerbated by a number of lifestyle factors. The risk of Dry Eye increases with age. Other risk factors include patients who have undergone refractive surgery, have severe allergies, are on certain medications, or are contact lens wearers. Those with rheumatoid arthritis and many other diseases are also at increased risk. Approximately 6 million women and 3 million men have moderate to severe symptoms of Dry Eye in America. Women who are pregnant, on certain types of birth control, taking hormone replacement therapy, or experiencing menopause also have increased rates of Dry Eye.

If you have dry eye, you may experience some of the following symptoms:

• Feeling a burning or stinging in your eyes
• Feeling like there are particles in your eyes
• A gritty, sandy feeling in your eyes
• Itchiness
• An intermittent bout of blurry vision that is helped by excessive blinking                                                                      

In order to replace the missing moisture in your eyes, you can use over-the-counter tear replacements called "artificial tears." Artificial tears come in different brands with different ingredients. Typically drops that come in bottles contain preservatives, which can be harsh on the front surface of the eye. As a result, preservative-free artificial tears (also over-the-counter) are a great way to get good lubrication without the threat of corneal damage.  For patients that prefer using a bottle, the Refresh and Optive brands use the most forgiving preservatives.

Other treatment options include the use of a humidifier to help keep natural moisture in the air so your eyes will not dry out as quickly. You should make sure to avoid circulating air blowing on the face in the car, at work, or during sleep as this can exacerbate dry eye signs and symptoms. Smoking cessation has been shown to dramatically help reduce dry eye as well. 

When using a computer, remember to blink often and give eyes a rest from staring at screens, tablets, and phones. We typically use the 20-20-20 rule: after staring at something for 20 minutes, give yourself a 20-second break, while looking at something 20 feet away. You can also apply a warm compress for 15 minutes per day to help promote tear flow and soothe irritated eyes. Be sure to not use harsh soaps or cleansers on or around the eye area, as these may exacerbate dryness and inflammation.

Allergy Eye Drops

Pataday has been one of the most successful prescription medications for eye allergy and is now available without a prescription!  The catch is the price.  Here is our current advice:

Good:  Alaway (Bausch & Lomb)  One drop twice a day, priced around $14 for a 10 mL bottle.

Best:  Pataday (Alcon)  Twice Daily, blue label, around $16 for a 5 mL bottle.

Pataday is also available as a more concentrated Once Daily, red label, around $18 for a 2.5 mL bottle!  2.5 mL is a surprisingly small amount.

For someone with mild symptoms, Alaway is a good value.  For more significant symptoms, Pataday Twice Daily is a great choice.  We rarely see the need for the more concentrated Once Daily, especially for those who get two drops on the cheek for every one in the eye!