Questions & Answers

The National Eye Institute’s Age-Related Eye Disease Study (AREDS) found that taking a specific high dose formula of antioxidants and zinc (500 milligrams of vitamin C, 400 International Units of vitamin E, 15 milligrams of beta-carotene, 80 milligrams of zinc as zinc oxide and two milligrams of copper as cupric oxide) may delay or prevent intermediate AMD from progressing to the advanced stage. There is no evidence, however, that the AREDS formula benefits people with early stage AMD. Patients with intermediate AMD in one or both eyes or advanced AMD (dry or wet) in one eye but not the other eye should consider taking the formula. Consult a physician before taking any supplements; the AREDS formula may be contraindicated for certain medical conditions or may react negatively with some medications.

Some limited studies appear to indicate that eating a diet high in carotenoids, antioxidant vitamins (such C and E), and omega-3 fatty acids may reduce the risk of developing age-related macular degeneration (AMD); however, more research is required before definitive statements can be made.

Carotenoids are compounds that are found in plants, which have been associated with protection not only from macular degeneration, but from cancer, heart disease, diabetes, and a number of other medical conditions. Dark green, yellow and orange fruits and vegetables, especially those high in the carotenoids known as lutein and zeaxanthin, appear to provide the best protection for AMD. Lutein and zeaxanthin are the primary pigments in the macula and are thought to protect the retina from ultraviolet light.

Lutein is found in spinach, collard greens, kale, broccoli, papaya, oranges, kiwi, mango, green beans, peaches, sweet potatoes, lima beans, squash, red grapes, and green bell pepper.  Yellow corn, honeydew melon, squash, oranges, mango, kale, apricots, peaches, and orange bell pepper are good sources of zeaxanthin.

Foods abundant in vitamin C include green peppers, citrus fruits, tomatoes, broccoli, strawberries, yams, leafy greens, and cantaloupe.

Vitamin E is found in eggs, fortified cereals, fruit, wheat germ, green leafy vegetables, nuts/nut oils, vegetable oils, and whole grains.

Wild salmon, sardines, walnuts, and flaxseed oil are good sources of omega-3 fatty acids.

Age-related macular degeneration (AMD) is a major cause of visual impairment in the U.S. Approximately 1.8 million Americans age 40 and older have advanced AMD, and another 7.3 million people with intermediate AMD are at substantial risk for vision loss. The government estimates that by 2020 there will be 2.9 million people with advanced AMD.

The goal of laser treatment for wet macular degeneration is to target the abnormal blood vessels (choroidal neovascularization) that cause visual loss when they bleed and leak fluid. I am not certain which type of laser therapy you are receiving; however, the most common type that is FDA-approved for treatment of macular degeneration is known as "cold laser," or photodynamic therapy (PDT). A photosensitizing drug is injected into the patient's vein, and a laser applied to the retina activates this drug, which then causes damage to the surrounding abnormal blood vessels.

The visual side effects of this vary between patients, but can include visual field defects and blurred vision. The visual field defects are usually not as severe or permanent compared to standard laser photocoagulation. Also, leakage from the abnormal blood vessels can recur after treatment, and also cause decreased vision, which is why multiple PDT treatments may be required.

Note that the PDT drug causes your skin to become sensitive to sunlight, and it is recommended that you wear dark sunglasses after the procedure and avoid direct exposure to sunlight for 5 days.

If you are having standard laser photocoagulation (much less common than PDT), which directly causes destruction of choroidal neovascular lesions, the procedure will result in scarring of the area of retina that was targeted, and will also result in a permanent visual field defect.

Without more information, it is difficult to answer your question. At your age, you most likely do not have age-related macular degeneration, but rather a macular dystrophy, myopic degeneration (which occurs in patients who are very near-sighted), or another macular condition that typically affects younger patients. The AREDS study showed that vitamin supplementation reduced the risk of progression in a subset of patients with age-related dry macular degeneration. That formulation has not been studied in patients with other types of macular disease. It is always prudent to check with your doctor before taking these or any other supplements to ensure there is no conflict with any other prescribed medications or conditions you may have.

Marijuana has not been studied in patients with advanced dry macular degeneration. There are cannabinoid* receptors in the human retina and retinal pigment epithelial cells, but more research is needed before recommendations can be made for or against marijuana as a therapy for macular degeneration.

*compounds present in marijuana

Cataract surgery is one of the most successful and frequently performed surgeries in the United States. Approximately 99% of patients have some visual improvement after cataract surgery. However, no surgery is without risk, and potential complications of cataract surgery include retinal detachment, macular edema, infection, etc. Moreover, in patients with other eye conditions that may limit visual potential (in your case, macular degeneration), removing the cataract may in fact not significantly improve your vision. It is your physician's responsibility to advise you on his/her opinion as to whether or not removing the cataract will help your vision. It might also be helpful to obtain a second opinion from a qualified ophthalmologist concerning your question.

If you are seeing a large black spot or floater in your vision, you should have a dilated eye exam as soon as possible. It could be something as benign as a vitreous floater, or could be more serious, such as bleeding in your eye.

The telescopic implant is still under investigation. Early studies show that it can potentially improve visual acuity in patients with macular degeneration. Basically, it is a specially designed lens that is implanted behind the iris of the eye and helps to magnify images for central vision. The manufacturers believe that it may be beneficial to patients with other types of macular diseases as well, but it is not widely used at this time. Stem cell transplantation for degenerative retinal diseases is a relatively new therapeutic strategy and is still in an early stage of development. As of now, it is not offered in standard clinical practice, and more studies need to be performed before its benefit is proven.