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Chapter 4

Lifting the Fog: Macular Degeneration

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As recently as a year or two ago, it would have been hard to find an article on macular degeneration in the mainstream media. But, since we began writing this book, there have been half a dozen reports on this disease, and we expect to see more as the Baby Boomers continue to age. Today, macular degeneration is the leading cause of irreversible blindness. By the year 2020, an estimated 7.5 million Americans will suffer significant vision loss due to macular degeneration. In all, over 15 million Americans have signs of macular degeneration, with 167,000 new cases added each year. Although there is no effective treatment yet, natural remedies can go a long way in preventing the disease from progressing to the point of vision loss.

What is Macular Degeneration?

How do you know if you have the disease? Macular degeneration is the slow deterioration of the cells in the macula, a tiny, yellowish area near the center of the retina where vision is the most acute. This deterioration therefore affects your central vision, the very vision you use for reading, writing, driving and identifying faces. When you have macular degeneration, straight lines become crooked, distinct shapes are blurry, lines become wavy, and there is fog in the center of your vision. However, your peripheral vision is not affected.

There are two types of macular degeneration: Ninety percent of people with macular degeneration have the dry type, in which small, yellow spots ca lled drusen form underneath the macula. The drusen slowly break down the cells in the macula, causing distorted vision. Dry macular degeneration can progress to the second, more severe type, called wet macular degeneration.

In the wet type, new, abnormal blood vessels begin to grow toward the macula. These new blood vessels may leak blood and fluid that further deteriorate the macula, causing rapid and severe vision loss.

Conventional Treatment

At the present time, there is no effective treatment. Some causes of wet macular degeneration are treated with laser surgery, but the treatment itself may not effectively seal up a leaky blood vessel without at the same time permanently de-

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stroying retinal nerve fibers that pass through the area. According to the National Eye Institute, laser treatment can actually worsen vision, and any ability to slow the progression of disease does not appear until at least a year after surgery. 1

As always, prevention is the best medicine. Since less than one percent of those with macular degeneration have progressed to the point of legal blindness, most are in a position to benefit greatly from prevention.

Risk Factors

Who is at risk for macular degeneration? Everyone experiences the disease somewhat. Long before one becomes aware of the disease, the macula begins to deteriorate. In normal individuals, the macula begins to deteriorate from youth through age 30; deterioration accelerates after the age of 50. By age 65, the incidence of macular degeneration increases.

People with drusen on the retina also are at risk. Drusen begin to appear on the retina between the ages of 30 and 60; after that, the spots form more rapidly, increasing the risk of macular degeneration.

People with macular degeneration in one eye are at high risk for degeneration in the other eye. Within four years of developing it in one eye, 23 percent will develop it in the other eye. Plus, people with the dry form of the disease are at risk for developing the wet form if their retinal arteries become occluded. Any patient with macular degeneration should have an Amsler Grid home test. (See page 72.) This will help them notice the first sign of progressive vision loss.

If you have cataracts, you are at risk for macular degeneration. Dense cataracts are associated with a 50 percent increase in the risk of macular degeneration; slight cataracts increase the risk by 80 percent. But cataract surgery increases your chances of macular degeneration 200 percent because your eyes have less protection from sunlight, which is also a risk factor. In a five-year period, the retinas of patients who had cataracts removed showed accelerated aging equivalent to 30 years of normal aging.2

High-risk patients are blue-eyed, have drusen on their retina (about 30 percent of adults) and a family history of macular degeneration. These people should take preventive measures; they should quit smoking, give up coffee, stay out of excessive exposure to sunlight and eat a nutrient-rich diet.

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Smoking must be completely avoided. Compared to nonsmokers, smokers have 2 1/2 times the risk of developing macular degeneration. 3 The average age at which smokers are affected is 64 versus 71 for nonsmokers, so quitting smoking could add seven years of good vision to your life. What exactly does smoking do? It stresses nerve cells like those in the macula, because nicotine destabilizes nerve

Amsler Grid

Directions for Amsler Grid

Hold the grid at your normal reading distance. Use glasses if needed. Cover your left eye and look at the dot in the center. Observe if all the lines look straight and even, or if any are wavy and distorted. Are any pieces of the grid missing? Now, cover your right eye and repeat the above directions. Recheck as often as your eye care practitioner recommends. If there are any abnormalities, contact your eye care practitioner immediately.