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©2019 BY MR SIMON WALKER

Age-related macular degeneration

DAYLIGHT ROBBERY OF CENTRAL VISION

AMD is cruel
The most sensitive part of the retina stops working
Detailed straight ahead clarity of sight is damaged
Dry-type can be slow but relentlessly progressive; wet-type fast and destructive
AMD is related to genetic, general health and environmental factors
Treatment is not just with anti-VEGF injections
Management control needs to target the fundamental cause to save sight
Observations should be regular

AMD is a very common retinal disease. It is age-related but the exact cause is unknown. It has been linked to smoking, a drop off in important protective anti-oxidants (especially lutein, zeaxathin and meso-zeaxathin), high blood pressure and low blood flow direct to the choroid which nourishes the macular - the central most important and metabolically active part of the retina.  Dry AMD is slow and insidious, marked by chemical waste yellow crystal 'drusen' deposits and retinal cell death.  Wet AMD occurs when  a break in the deeper layers of the retina cause abnormal weed-like tufts of weak blood vessels to sprout, which easily leak and bleed suddenly, causing a dramatic drop in vision and terrible scarring.

 

Central clarity of vision lost makes it difficult to read, undertake fine work tasks and see faces; there is threatened loss of the ability to drive and independence. Of some consolation, peripheral navigational vision is not affected in AMD and an otherwise disease free eye will not go totally blind.

Treatment aims to slow AMD progress and preserve central eyesight. A complete halt might be hypothetically possible.  Standard care is with the advice to stop smoking, eat a healthy diet and take vitamin supplements (such as PreserVision, better still Macushield Gold).

Is there any other way to assist the ailing macula? Well, it makes sense to avoid unnecessary over use of the eyes (avoid watching late night movies seen before), and get a good night's sleep (this is when the retina rests, rejuvenates and repairs). Wear good UV sunglasses out-of-doors on sunny days. Have a general vascular check-up for diabetes and blood pressure and cholesterol. I encourage a 24-hour blood pressure record to ensure this is not too high or too low at night. Sometimes aspirin is an option. Other suggested maximum manoeuvres presented here carry some logic but are not conclusively scientifically proven:

a) Ginkgo Biloba – many in the profession believe and some evidence supports an increase in blood flow to the brain and eye. Care is needed if already on blood thinning medicine like aspirin or warfarin and non-steroidal anti-inflammatory drugs.

b) Blackcurrants and bilberries – the neuroprotective anti-oxidant effects of acanthocyanins, new evidence to support an increase blood flow to the eye comes from Japan.

c) Omega 3 fatty acids – fish oil benefits are attributed to anti-inflammatory effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The NATS 2 French study found protection, AREDS II American research did not. 

 

d)Almonds – loaded with magnesium and vitamin E, may help stabilise blood pressure avoiding the highs and lows.

e) If blood pressure is found to be low at times by day it might be the case to try and boost it by adding more salt to food, or more rarely by taking a mild sub-type of steroid tablet called fludrocortisone.

f) If blood pressure drops >20% at night, take a V8 vegetable health drink in the late evenings (salt & fluid load; tastes like tomato juice - better with Worcester Sauce?) and sleeping flat or if anything head slightly down (gravity assisted brain perfusion). For severe drops at a particular early hour, an idea might be to try setting a second alarm clock to disturb from deep sleep slightly.

 

g) Sildenafil – the  active medicine in Viagra; in low dose 20mg daily, inhibits phosphodiesterase-5 and phosphodiesterase-6 in the choroid which increases choroidal perfusion. 

If there should ever be a sudden drop in vision, especially with distortion noticed, be seen by an ophthalmologist pretty darn quick. If wet AMD is occurs the race is on to get to anti-VEGF therapy, a sight-saving straight forward micro-injection via the white of the eye.

 

If dry AMD has done it's worst rehabilitation is required. Technology can make a huge difference. The surgical option of telescopic magnifying lens implants should only be considered if very carefully counselled.

 

Hopefully your AMD becomes stable - if so please let me know! If you wish to show your appreciation please consider a small charitable donation to my Paediatric Clinic Fund. Thank you!