Age-Related Macular Degeneration
Age-related macular degeneration is an eye disease that affects central vision. As the name suggests, age is a major risk factor for this disease and it is the leading cause of blindness in North American adults over the age of 50. It's estimated 2.5 million Canadians suffer from some form of AMD.
How is AMD detected?
AMD can be detected during a routine eye exam. At your eye exam, your Optometrist will perform a dilated check of your eye health using a special microscope. This allows them to look directly onto the back your eye to observe for any signs of AMD. OCT imaging of the back of the eye is used to visualize the affected areas and layers at the back of the eye. An Amsler grid or visual field test can be used to detect the extent of functional vision loss. Your vision is assessed and questions related to AMD risk are explored.
What is Age-Related Macular Degeneration?
Age-related macular degeneration is an eye disease that affects central vision. The central vision is affected as a result of metabolic waste build up at the center part of the back of the eye called the macula. The macula is responsible for detailed vision necessary for activities such as reading, driving, and recognizing people’s faces. AMD can progress slowly in some individuals and rapidly in others. Therefore, it is important to get routine eye exams to detect it early on. There are two types of AMD, dry and wet. Dry AMD is the most common form of AMD accounting for 90% of all cases. It is the milder form resulting in degeneration of the central macular tissue that generally develops slowly over time. Dry AMD can develop into wet AMD at any time. Wet AMD is less common and accounts for 10% of all cases. It is characterized by leakage and bleeding of weak blood vessels under the macula and symptoms progress rapidly. AMD does not necessarily affect both eyes; it can also affect one, or both at different rates of progression. Read more about the different types of AMD and the treatment options below.
What are the symptoms of AMD?
AMD is a progressive disease, often accompanied by worsening symptoms over time. In the early stages, AMD may be symptom-free and can only be detected in an eye exam. As the disease progresses, the most common initial symptoms include blurred central vision, particularly noticeable while performing tasks that require seeing detail, such as reading. Glasses cannot correct for this blurred spot. In the intermediate stages, the blurred area may increase in size and interfere with various daily activities such as driving. Other symptoms of AMD include straight lines appearing wavy or distorted, and dark spots or missing areas in vision. In its later stages, there is a complete loss of central detailed vision. Patients experience no pain with AMD. AMD does not necessarily affect both eyes; it can also affect one, or both at different rates of progression. Because AMD affects central vision, it does not lead to total blindness. However, in advanced stages it can significantly compromise quality-of-life. Individuals with an increased age are at an elevated risk for developing AMD. Other risk factors include smoking, extensive UV light exposure, family history of AMD, and cardiovascular disease.
How can I prevent and treat AMD?
~Lifelong UV protection by wearing UV protective glasses and smoking cessation can reduce the risk of developing AMD. ~Living a healthy lifestyle with healthy diet and routine exercise will reduce the risk of AMD. ~Keep your blood pressure in control and reduce your intake of fatty foods. ~A diet rich in antioxidants such as vitamins C, vitamin E, zinc, copper, lutein, zeaxanthin, and omega 3 fatty acids may help prevent AMD. These antioxidants can be found in fruits and leafy green vegetables. ~Routine eye exams are important in the early detection and prevention of AMD. Early signs of AMD can be found during an eye exam even if no symptoms are noticed. Upon detection, the optometrist will discuss ways to minimize the possibility of vision loss. In the early stages of AMD, treatment options include dietary supplements with the AREDS2 formula, self-monitoring of vision at home with an Amsler grid, and routine eye exams to monitor for progression. An Amsler grid is a test provided by the optometrist that allows you to monitor for vision changes at home between routine eye exams. AMD is an eye disease that can cause sudden changes in vision when it turns into the wet form. If changes in vision are noticed, contact your optometrist, as timely treatment can limit the extent of vision loss. In the later stages of AMD, treatment options include eye injections to prevent further leakage of blood vessels in order to minimize vision loss. Patients with vision loss due AMD can benefit from low vision aids. Your optometrist can prescribe magnifying devices to enhance your distance and near vision. These aids will not restore sight, but will allow people to maximize their remaining vision and provide improved functional vision to help people go about their daily activities.
Monitor your vision!
There are usually no symptoms in the early stages of dry AMD. As a result, regular eye exams are essential. In intermediate dry AMD, you may notice a slight blurring in the field of central vision. You can detect these changes or distortions in your vision at home using a simple visual tool called an Amsler grid, pictured to the left. Follow the link below to download your own at-home Amsler grid. If you notice any changes, report them to your Optometrist immediately.
Stages of Age Related Macular Degeneration
Dry AMD
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Dry age-related macular degeneration is a gradual deterioration of the macula as the retinal cells die off and are not renewed
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In the early stages of dry AMD, your Optometrist may notice small fatty deposits called drusen when looking at the back of the eye
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85-90% of AMD cases are Dry
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Patients who suffer from this condition are advised to improve their lifestyle habits and take dietary supplements (nutraceuticals) that may slow down the progression of the disease
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Prescribed nutraceuticals do not improve the loss of visual acuity
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Macumira is Canada's 1st Clinically Proven and Health Canada Approved treatment for Dry AMD, see more about this treatment below
Geographic Atrophy (Late Stage Dry AMD)
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Geographic atrophy (GA) is the scientific term for late stage dry aged-related macular degeneration (AMD). It is called geographic atrophy, as the damage to the macula tends to start as patches of damage (or atrophy) that look like islands on a map when a doctor looks at the back of the eye
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At the geographic atrophy stage, cells in the retina near the macula start to die, creating areas of death or atrophy which cause vision loss. This underlying damage to the macula is irreversible
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There are very few treatments available at this stage but there are new studies underway and treatments awaiting Health Canada approval
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The Optometrist's goal is to prevent progression of AMD to the geographic atrophy stage using supplementation and other available treatments
Wet AMD
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Wet age-related macular degeneration is when new, abnormal blood vessels grow under the retina. These vessels may leak blood or other fluids, causing scarring of the macula
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The presence of blood or fluid is why it is known as “wet” AMD. Wet AMD develops from the dry form, and it can develop at any point in the progression of dry AMD — from early to late
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You lose vision faster with wet AMD than with dry AMD
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10-15% of AMD cases are Wet
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Treated by intraocular injections every 4-6 weeks for the duration of a patient’s life with the hope of slowing down the progression
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Injections do not improve or cure wet AMD
Introducing
MacuMira!
MacuMira improves vision for patients affected by dry age-related macular degeneration. It is Canada's first clinically proven and Health Canada approved treatment for Dry AMD.
How does MacuMira work?
The retina is the light-sensitive tissue at the back of the eye that makes sight possible. It is composed of many cell types that work together to send a visual signal to the brain. When light hits the retina, photoreceptor cells create an electrical signal that moves through the layers of retina and travels up the optic nerve to the brain. The layer under the photoreceptors is called the retinal pigment epithelium (RPE), and these cells are responsible for providing nourishment and maintenance to the photoreceptors.
In AMD, photoreceptor and RPE cells are damaged leading to vision loss. AMD primarily causes damage to cells in the macula, which is the small, central portion of the retina responsible for detailed, central vision.
MacuMira utilizes a painless micro current therapy delivered across closed eyelids to stimulate Retinal Pigment Epithelium (RPE) cells, leading to improved cellular function and clearance of macular waste.
What is the treatment plan?
MacuMira’s treatment protocol consists of an initial Loading Phase with four treatments over ten days, followed by the Maintenance phase consisting of one treatment every 2-3 months. Many patients experience immediate results and ongoing visual improvement.
What does each treatment entail?
Treatments are safe, pain-free, and non-invasive, conducted in-office and lasting 32 minutes. You'll relax in a reclining chair while wearing the MacuMira headset. A member of our friendly staff will be on hand to monitor you and ensure the eye cups stay in place. You might feel a gentle buzzing sensation over your eyes, but many patients enjoy listening to music or taking a nap during the session.
MacuHealth
MacuHealth’s triple carotenoid formula contains a 10:10:2 ratio of Lutein, Meso-Zeaxanthin and Zeaxanthin that has been shown in clinical trials to increase macular pigment density, which
contributes significantly to visual function. Macuhealth can also be used for contrast sensitivity enhancement and is currently being studied for sports vision optimization. Macuhealth is usually recommended for AMD prevention or for patients with early onset changes, patients with family history of AMD or high risk factors.
MacuHealth+ is an eye health formulation that contains the only carotenoids found in the retina: Meso-Zeaxanthin, Lutein, and Zeaxanthin. These carotenoids, along with a low level of zinc and powerful co-antioxidants, have been shown to support visual health. Macuhealth Plus+ is recommended for patients who have mild to severe AMD.
MacuHealth and Macuhealth Plus+ contain all three of the carotenoids found in the retina vs only one or two in over the counter alternatives. If you are interested in MacuHealth supplements, contact our office to consult your Optometrist on which supplement may be best for you!
Dry AMD Treatments
Supplements
A large study found people with certain drusen may slow their dry AMD by taking these vitamins and minerals daily: Vitamin C (500 mg), Vitamin E (400 IU), Lutein (10 mg), Zeaxanthin (2 mg), Zinc (80 mg), and Copper (2 mg). Our office carries MacuHealth and MacuHealth+ vitamins with these ingredients. Contact us if you are interested in taking Macuhealth supplements!
Healthy Lifestyle & Diet
A healthy lifestyle with a balanced diet may help slow or prevent dry AMD from advancing into later stages. Consuming dark leafy greens, yellow fruits and vegetables, fish, and a balanced, nutrient-rich diet have been shown beneficial for people with AMD. Get regular exercise. Many activities that protect your heart health may also protect your vision health. Speak with your doctor before starting any new exercise program. Quit smoking. Smoking increases your risk of developing AMD and of the disease progressing.
MacuMira
MacuMira is Canada's first clinically proven and regulatory approved treatment for Dry age-related macular degeneration. It is a pain-free, non-invasive treatment that can help improve vision in a few short treatments. Read more below!
Ongoing Research
There are currently no approved treatments in Canada for dry AMD once it reaches the Geographic Atrophy stage, but there are several potential treatments being tested in clinical trials. These include drugs and cell replacement therapy. Increased lighting, magnification or other low vision devices can help maximize your vision. See some of the clinical trials that are underway at the bottom of this page!
Wet AMD Treatments
Supplements
For those diagnosed with wet AMD, it's advisable to continue taking the same supplements recommended for dry AMD. This is important because individuals with wet AMD are at a higher risk of developing dry AMD in their other eye. Prioritizing these supplements can help support overall eye health and potentially reduce the risk of progression.
Healthy Lifestyle & Diet
A healthy lifestyle with a balanced diet may help slow or prevent AMD from advancing into later stages. Consuming dark leafy greens, yellow fruits and vegetables, fish, and a balanced, nutrient-rich diet have been shown beneficial for people with AMD. Get regular exercise. Many activities that protect your heart health may also protect your vision health. Speak with your doctor before starting any new exercise program. Quit smoking. Smoking increases your risk of developing AMD and of the disease progressing.
Anti-VEGF Drugs
Vascular endothelial growth factor (VEGF) is produced in the body and encourages new blood vessels to form. In wet AMD, the amount of VEGF increases and leads to uncontrolled growth of blood vessels in the eye. Anti-VEGF treatments block VEGF from working and can prevent and, in some cases, reverse vision loss. These treatments are delivered by an injection into the eye. They are usually the first treatment option for wet AMD.
Photodynamic Therapy
Very rarely is photodynamic therapy prescribed for treatment. During photodynamic therapy, a drug called verteporfin is injected into your arm and travels to your eye’s blood vessels. A laser then activates Visudyne, and together this can reduce blood vessels leaking. This form of combined drug and laser therapy is sometimes used with anti-VEGF treatments for specific types of wet AMD.