Questions & Answers

There is no evidence that eating peanuts can cause macular degeneration. The only proven vitamin regimen to decrease the risk of dry macular degeneration progression is the AREDS formulation, which does contain vitamin E. There is evidence that taking too much vitamin E can increase overall mortality, but the tolerable upper intake level is 1000 milligrams/day and the AREDS formulation contains less than half that amount (400 international units—which equals 400 or fewer milligrams depending on the exact form of vitamin E used). However, it is important that you make your decision based upon discussions with your personal doctor(s), who are familiar with your medical history and current medication regimen, all of which could impact their assessment concerning supplementation.

There is really no concrete evidence as to whether or not vegetable oils versus animal oils can increase the risk of macular degeneration. Studies in the literature have been mixed; therefore, specific recommendations one way or another are not made at this time. What we do know about diet and macular degeneration suggests that continuing to supplement your diet with fish, green and yellow vegetables, and complex carbohydrates (wheat breads, for instance) has been shown to lower risk of developing this disease. AREDS formula nutritional supplements have also been shown to decrease the risk of progression to more advanced forms of age-related macular degeneration.

Retinal telangiectasias are a separate entity from macular degeneration. Did you have dry macular degeneration in one eye and wet macular degeneration causing leakage in the other eye? If so, it sounds like you were only treated with photodynamic therapy. The newest therapies for wet macular degeneration include anti-VEGF injections (Lucentis and Avastin), but you should ask your retina specialist more about your specific conditions and which treatments he or she would recommend.

If you are referring to Lisch nodules on the iris, these do not have any correlation to macular degeneration. Lisch nodules are benign growths on the iris that do not affect vision.

The answer to your question really depends on the severity of both diseases. For example, current recommendations suggest that individuals with diabetes without retinopathy should be examined yearly, while patients with mild, moderate and severe non-proliferative diabetic retinopathy should be seen at 9, 6, and 3-4 month intervals, respectively. Based on the severity of the dry macular degeneration and whether or not you have retinopathy associated with the diabetes, your eye doctor can provide you with specific recommendations.

Generally, once vision declines as a consequence of dry macular degeneration, it does not improve significantly. Dry macular degeneration causes poor vision as a result of atrophy and degeneration of the retinal pigment epithelium, which is not known to regenerate. However, if you had any diabetic retinopathy that affected your macula, that may be reversible and your vision can improve as macular edema improves.

Yes, there are several forms of juvenile macular degeneration (JMD), and all are inherited. The most common form of JMD is Stargardt's disease, also called fundus flavimaculatus or macular dystrophy, which normally develops in the childhood or teen years. Best disease or vitelliform macular degeneration is the second most common form of JMD; symptoms usually occur between birth and age 7. People in their thirties or forties can develop genetic forms of macular disease such as Sorsby's fundus dystrophy, Behr's dystrophy and Doyne's honeycomb retinal dystrophy. Finally, myopic macular degeneration can occur in people who are severely near-sighted due to extreme elongation of the eyeball. This condition can result in macula tears and bleeding beneath the retina.

There are two forms of AMD, dry and wet. If dry AMD reaches the advanced stages, there is no treatment currently available that will prevent vision loss. However, a specific high-dose formula of antioxidants and zinc may delay or prevent intermediate dry AMD from progressing to the advanced stage.

The wet form of AMD can be treated with Lucentis® (or Avastin®), Macugen®, photodynamic therapy and laser photocoagulation.

• Lucentis (ranibizumab injection), approved by the U.S. Food and Drug Administration (FDA) in 2006, is an antibody fragment that binds to and inhibits the biologic activity of human vascular endothelial growth factor (VEGF). VEGF is a protein believed to play a critical role in the formation of new, abnormal leaky blood vessels, which can damage the macula (area of the eye responsible for central vision). Lucentis is injected into the vitreous portion of the eye (the clear jelly-like substance that fills the eye from the lens back to the retina). Since VEGF is continually produced in AMD, ongoing, routine administration of Lucentis is required. Lucentis can prevent further vision loss in most patients and improve the vision of some. Avastin is manufactured by the same pharmaceutical company, Genentech, Inc., that makes Lucentis. It is a blood vessel growth inhibitor used to treat colorectal cancer, but is not approved for AMD. However, physicians have successfully used small doses of Avastin as an AMD therapy by injecting it into the eye at regular intervals over the course of months or a year.
  
  
• Macugen (pegaptanib sodium injection), approved by the FDA in 2004, blocks vascular endothelial growth factor (VEGF), a protein that promotes blood vessel growth. In clinical trials, patients receiving Macugen were less likely to progress to legal blindness and experience severe vision loss. Macugen is injected into the vitreous portion of the eye (the clear jelly-like substance that fills the eye from the lens back to the retina). Macugen is routinely administered since VEGF is continually produced in AMD.
  
  
• Photodynamic therapy (PDT) was approved by the FDA in 2000 as a treatment for wet AMD. In PDT, Visudyne®, a light-sensitive drug, is injected into a vein in the arm. The drug enters the bloodstream and is absorbed by the abnormal blood vessels growing underneath the macula. A low-intensity, non-thermal (“cold”) laser is then directed at the retina for a little over a minute. This activates the Visudyne allowing it to destroy the abnormal vessels and inhibit new growth. The cold laser does not damage the retina or other cell layers that overlie the abnormal vessels. PDT may help to stabilize vision, but it will not restore lost vision and is not likely to improve vision. Treatments are typically administered every 3 months and as many times as needed to prevent re-growth of the abnormal vessels (potentially 6-7 treatments over 2-3 years). One treatment normally takes about 20 minutes and is relatively painless. PDT is most effective in treating predominantly classic, subfoveal AMD in which the blood vessel growth and leakage borders are well defined and occur under the center of the fovea (small region at the center of the macula that is dense in light-sensitive cells and provides the sharpest vision). Other light-sensitive drugs are being evaluated. Researchers are also studying the use of verteporfin in combination with other therapies.
  
  
• In photocoagulation, the first treatment that was used for wet AMD, a laser is focused on the abnormal blood vessels growing beneath the retina to seal or destroy leaking blood vessels and potentially prevent further vision loss. While photocoagulation can decrease the chances of moderate to severe vision loss, it does not restore lost vision, so early treatment is critical. It is not possible to treat those with “subfoveal” AMD in which the abnormal blood vessels are located under the fovea, in the center of the macula. Almost 90% of AMD is subfoveal, so only a small percentage of patients are candidates for this procedure. Photocoagulation laser surgery can be performed on an outpatient basis. The patient remains awake during the entire process. Eye drops are used to numb the eye and dilate the pupil, then a high-energy laser is focused on the abnormal blood vessels. The laser heats and destroys the abnormal blood vessels and prevents them from leaking. This can help prevent or slow further damage. However, it can also scar parts of the macula and result in some central vision loss. In addition, the blood vessel leakage may reoccur, and it is not always possible to repeat photocoagulation treatment.

For those with permanent vision loss, there are a variety of low vision aids and coping strategies that can improve the quality of life. The "Resources" section of this website includes information on low vision aids and organizations.