Sane Steps May Save Your Precious Central Vision
Dr. Sidney Schreiber, a cardiologist from Scarsdale, N.Y., was in his mid-70's and still working in the lab and caring for patients when he noticed that he could not see clearly with his right eye.
A visit to his ophthalmologist produced a discouraging diagnosis. Dr. Schreiber had macular degeneration, a rapidly progressive form at that, and within three years he lost 90 percent of his vision, leaving him functionally blind.
An estimated 10 million Americans have this progressive retinal disease, though most are not as severely affected as Dr. Schreiber, and some are not yet aware that they have the painless condition. It afflicts one person in four older than 75 and is the leading cause of legal blindness in Americans over 55.
The numbers affected will continue to climb as the population ages, prompting an escalating race to develop more effective treatments and, perhaps, even preventives, including measures based on recently identified genetic factors that raise the risk of developing the disease.
A Familiar Regimen
Meanwhile, there is much that people can do now to ward off this disabling condition or slow its progress. Interestingly, the very same steps that lower the risk of high blood pressure, heart disease, diabetes and some cancers can also help protect the eyes.
Though peripheral vision remains intact, macular degeneration robs people of their central vision, making it hard or impossible to read, write, drive, watch television, see the time, recognize faces and see where they are going.
Still, many who are seriously afflicted manage to pursue active lives. The late Don Knotts, a co-star of "The Andy Griffith Show" and "Three's Company," was 57 when his disorder was diagnosed. But he continued to work almost until his death on Friday at age 81.
"I got pretty depressed for a while," the American Macular Degeneration Foundation quotes him as saying. "And then one day I said to myself, 'I bet a blind person would give his right arm to have the vision I have.' "
Although most patients are over 55 when found to have what is commonly called age-related macular degeneration, some develop macular disease as children or young adults. Marla Runyan was in the fourth grade when she was struck with a juvenile form of the disease. Yet she finished college and competed twice in Olympic running events despite being legally blind.
Dr. Schreiber, the cardiologist, was an accomplished artist when macular degeneration forced him to abandon his hobby and his career. Like Mr. Knotts, he lapsed into a serious depression for nearly two years, emerging only after a visitor from Lighthouse International showed him all he could do with low-vision aids.
Encouraged by his wife, Freda, who became his eyes, he gradually resumed his favorite activities, with modifications. He visits museums (his wife reads the legends aloud), listens to recorded books ("I've never been so well-read"), gardens (though he sometimes pulls up flowers instead of weeds) and has resumed painting, his artistic talent apparently intact judging from a recent rendition of poppies in a vase.
He has even been able to put his medical training to good use. Now 84, he is scientific director of the American Macular Degeneration Foundation, which sponsors research and provides support and information. It also publishes a quarterly newsletter and has produced the helpful "Hope & Cope" DVD, both available for a $25 contribution. The foundation can be reached at P.O. Box 515, Northampton, Mass. 01061-0515 or at (888) 622-8527. Its Web site is www.macular.org.
The macula is a dense collection of light-sensitive cells in the middle of the retina along the back of the eye. These cells are used for the "straight-ahead" vision needed to read, sew, drive and see fine details. Most cases of macular degeneration begin and remain in one or both eyes as what is called the dry form of the disease. Yellow deposits called drusen form under the retina, increasing in number and size until they destroy macular cells and blur central vision.
The disorder can progress so slowly that deteriorating vision is not noticed until it is quite advanced. But as it worsens, more light may be needed to read and faces may become hard to recognize. Far less often, macular degeneration occurs as the wet form, leading to a rapid loss of central vision when abnormal blood vessels grow under the retina and leak blood and other fluids, raising the macula off the wall of the eye. In about 10 percent of cases, dry macular degeneration eventually develops into the wet form.
Looking for Early Signs
Dr. Schreiber said: "I might have had the dry form for 10 years, for all I know. It's probably my fault for not seeing an eye doctor every year."
Which raises a critical point. Early signs can be readily detected by a thorough eye exam in which the pupil is dilated, allowing the doctor to examine the retina and optic nerve for signs of trouble. People 50 and older should have such exams yearly, or twice a year with signs of disease.
A simple test can be done in any doctor's office (or at home) to detect vision distortions that might not otherwise be noticed. It uses a graphic device called the Amsler Grid, a box of cross-hatched lines with a black dot in the center. Covering first one eye, then the other, a person stares at the black dot. If any of the straight lines appear wavy or missing, that could be a sign of macular degeneration.
Prevention and Treatment
The established risk factors offer strong clues to avoiding or delaying onset of the condition. They include smoking, obesity, high blood pressure, sedentary living, overexposure to sun and a diet deficient in green leafy vegetables and fish.
Other risk factors are being a woman, farsighted or Caucasian and having light eye or skin color, cataracts and a family history of the disorder. Two factors, oxidation and inflammation, appear to cause macular injury. Studies sponsored by the National Eye Institute found that daily consumption of a high-dose formula of antioxidants and zinc could reduce the risk that early macular degeneration would advance.
Various products sold over the counter contain this formula or one like it: 500 milligrams of vitamin C, 400 I.U. of vitamin E, 15 milligrams of beta carotene, 80 milligrams of zinc oxide and 2 milligrams of copper. Smokers should avoid products containing beta carotene, which may increase their risk of lung cancer.
In addition, most experts recommend a supplement of lutein, zeaxanthin or both, carotenoids found in dark green leafy vegetables like spinach and collards. Twinlab makes a supplement, Ocuguard Plus, that contains lutein.
Several drugs, Visudyne by QLT and Novartis and Macugen by Eyetech Pharmaceuticals and Pfizer, have also been shown to slow deterioration of eyesight in wet type macular degeneration. One Visudyne patient in six is said to have shown improved vision, a most exciting advance. Another drug awaiting approval, Lucentis by Genentech, may also help.