Macular degeneration: Causes, types, risk factors, ways to prevent irreversible vision loss

When the central part of the retina, known as the macula, begins to break or wear down with age, macular degeneration occurs and this age-related macular eye disease may get worse over time. Retina is the light-sensing nerve tissue at the back of the eye and macular degeneration happens when aging causes damage to retina’s small central portion or macula, which is the part of the eye that controls sharp straight-ahead vision, making it the leading cause of severe, irreversible vision loss in people over age 60. 

Types:

Dr Vidya Nair Chaudhry, Senior Consultant, Ophthalmology and Refractive Surgery at Aakash Healthcare in Delhi’s Dwarka, shared, “There are two types of AMD: nonexudative (dry) AMD, which is characterized by the accumulation of drusen, yellowish deposits under the retina that eventually lead to the loss of central vision, and exudative (wet) AMD, which is characterised by fluid leakage or bleeding in the macula, resulting in central vision loss.”

Causes:

According to Dr Vidya Nair Chaudhry, smoking is one of the leading causes of severe AMD vision loss. She said, “When compared to non-smokers, it hastens the progression of the disease by up to five times. Smoking reduces the effectiveness of treatments by increasing the number of oxidants in the bloodstream and eyes. For people with AMD, quitting smoking is arguably the most modifiable risk factor.”

Solutions:

Dr Neeraj Sanduja, MBBS, MS – Ophthalmology, Ophthalmologist, Eye Surgeon, revealed, “Although macular degeneration is almost never a totally blinding condition, it can lead to a permanent loss of your central vision.” He suggested ways to prevent age-related macular degeneration:

1. Quit smoking – “Rules 1, 2, and 3 are stop smoking,”. Smoking may double a person’s risk of developing AMD. And the habit exposes you to dangerous free radicals and unstable molecules that can cause cellular damage and keep nutrients from reaching the retina. The sooner you can quit, the better.

2. Know your family history – People with a first-degree relative affected by AMD have a much greater risk of developing it, too. Those with family ties to the disease should be vigilant for potential symptoms that include difficulty recognizing faces, struggling to adapt to low light, and seeing straight lines that appear wavy.

3. Eat leafy greens – Load up your plate with spinach, kale, and Swiss chard, among other green veggies. “They have a lot of antioxidant vitamins,”. Those nutrients help protect against cellular damage from free radicals, which can contribute to eye disease. It is recommended that family members eat foods containing high levels of lutein and zeaxanthin rather than take supplements. These foods also contain hundreds of other phytochemicals that are likely to be helpful. Foods such as egg yolk, yellow corn, orange or yellow peppers, kale, broccoli, spinach, kiwi, grapes, zucchini, and squash have high levels of lutein and/or zeaxanthin and are thought to be protective. People who eat a diet rich in fruits and vegetables, as well as twice-weekly meals of fat-rich fish like salmon, sardines, tuna, or mackerel, have a lower risk of AMD. Conversely, people who eat red meat every day have an increased risk of AMD. It is possible (although not proven) that this results from too much iron getting into the retina.

4. Take supplements – Patients with deficient diets might consider multivitamins. And people at risk of advanced AMD should ask their doctor about a specialized blend of supplements known as AREDS. The macular degeneration vitamins are “not a treatment or cure but can decrease your risk of getting the more severe forms of AMD,”. AREDS2 showed that a formula containing 10 milligrams (mg) of lutein, 2 mg of zeaxanthin, 500 mg of vitamin C, 400 International Units (IU) of vitamin E, 80 mg of zinc oxide, and 2 mg of cupric oxide can reduce the risk of disease progression by 25 percent.

5. Wear sunglasses – Such eyewear offers protection from UV and blue light that can cause retinal damage from repeat exposure (the American Macular Degeneration Foundation recommends wearing a pair with a “UV 400” label).

6. Maintain healthy blood pressure and weight – Poor blood circulation due to hypertension can also restrict blood flow to the eyes, thus contributing to AMD. Losing weight is a proven way to lower blood pressure; even small gains help — especially if you already have hypertension.

7. Test yourself with an Amsler grid – The tool that helps doctors detect vision problems related to macular damage can be used at home. If, after staring at the paper grid, you notice that the central part of your vision in one eye has become darker or the grid lines are wavy, call your doctor. Keep your Amsler grid in a place that reminds you to check it daily.

As per Dr Siddarth Sain, Senior Consultant, Sharp Sight Eye Hospitals, “Macular Degeneration is a common condition — it’s a leading cause of vision loss for older adults. It doesn’t cause complete blindness, but losing your central vision can make it harder to see faces, read, drive, or do close-up work like cooking or fixing things around the house.” He too listed tips to reduce your risk of macular degeneration:

1. Having regular eye checkups – You should see your ophthalmologist every two to three years if you’re between the ages of 45 and 60, and every year if you are 60 or older. Seeing your ophthalmologist regularly can help you monitor and protect your eye health, especially important if you are at risk for macular degeneration or other eye diseases.

2. Wear sunglasses – Breaking out the shades is perhaps the easiest thing you can do to help prevent macular degeneration. As per the doctors, direct sun exposure has been associated with AMD and other damage to the eyes.

3. Quit smoking – Stop smoking to reduce the risk of getting macular degeneration. Smokers are up to four times more likely than non-smokers to have age-related macular degeneration.

4. Eat green leafy vegetables – Dark, leafy greens in particular can play a big part in the prevention of macular degeneration. As per the ophthalmologist, increasing the frequency of intake of spinach, collard greens, or kale (all of which are high in carotenoids) could lower the risk of AMD. You should also add more fatty fish to your diet. People who eat fish at least three times a week were less likely to have develop or have macular degeneration.

5. Keep your blood pressure and cholesterol in check – Focusing on maintaining a healthy weight, along with good blood pressure and cholesterol, is important for maintaining the health of your eyes.

Dr Vidya Nair Chaudhry advised, “Regardless of how long or heavily you smoked, quitting cigarettes reduces your risk of AMD by a year for every year you are smoke-free. People with early AMD should be in retina specific anti-oxidants. Also, good UV filters in spectacles should be used to prevent AMD or it’s progression. Wet AMD needs to be treated early with anti VEGF injections in the eye to prevent macular scarring.”