AMD is the leading cause of vision loss in Americans over age 65. Many risk factors have been identified, including multiple genes which pre-dispose to AMD, as well as external risk factors such as smoking and increased body weight. There are two forms of AMD: DRY AMD involves the accumulation of certain deposits called drusen in the macula. 90% of patients with AMD have the Dry type, and most experience some loss of their central vision and mild distortion, where straight lines look wavy or curved. Some patients with Dry AMD develop significant vision loss from geographic atrophy in the macula. 10% of AMD patients develop the WET form, where abnormal blood vessels, called choroidal neovascular membranes (CNVM), develop in the macula, causing fluid to leak into the macula. This leads to sudden changes in central vision, a dark, blurry spot, and increased distortion.
Patients with AMD are asked to monitor an Amsler grid at least weekly, and to report changes on the grid immediately. AMD patients should stop smoking, maintain a healthy body weight, and eat more dark green, leafy vegetables. The AREDS 2 trial clearly showed the benefit of anti-oxidant vitamins in reducing the risk of progression of AMD in patients with moderate AMD. The AREDS 2 formula is available over the counter without any prescription, and includes:
• 500mg Vitamin C • 400 IU Vitamin E • 80mg Zinc as zinc oxide • 2mg Zeaxanthin • 2mg Copper •10 mg Lutein
Currently, there is no cure for AMD. There is no treatment to reverse Dry AMD. If a patient develops Wet AMD, there is very effective treatment, called anti-VEGF (vascular endothelial growth factor) agents. These anti-VEGF drugs (Avastin, Eylea and Lucentis) have completely revolutionized the treatment of Wet AMD, and prevent progressive vision loss in 90% of patients. Anti-VEGF agents are injected into the vitreous cavity in the middle part of the eye, and repeated injections need to be given for maximum effect.