Questions & Answers

Your ophthalmologist is probably correct that either zinc oxide or zinc gluconate could be used. There is one limited study in the literature that suggests that zinc may be better absorbed orally as zinc gluconate rather than as zinc oxide. However, you are correct in that the AREDS study only referred to zinc oxide and the strongest evidence for the efficacy of zinc in the treatment of dry AMD is in the zinc oxide formulation.

There is no known association between cardiovascular exercise as you have described above and increased risk of retinal complications from myopic degeneration. However, any exercise that increases your risk for direct trauma to your eye (for example, boxing, martial arts, etc.) may put you at increased risk for retinal damage. If you suffer blunt trauma to your eye, your myopia puts you at higher risk for complications such as retinal tears, retinal detachment or retinal dialysis. You should consult with your ophthalmologist on his or her recommendations for your specific case.

You are exactly right—genetics play a major role in predicting whether or not a person will develop macular degeneration, and there certainly are other likely, unrealized causes yet to be discovered. Many researchers have been working on finding the genes which may be responsible for increasing the risk that a person will develop age-related macular degeneration. Much of this research has been conducted in families of patients with macular degeneration, comparing their gene profiles with either patients with the disease that have no apparent familial link, and/or with persons who do not have the disease at all. Though a few genes have been identified, things are still not very clear. For example, there are genes that appear to increase the risk of developing the disease for example, in the American population, may not have any effect in Japanese or other populations.

Then, to further try to determine what makes some patients develop the "wet" form of the disease whereas others don't, makes things even more complicated. However, there is work being done in this area as well. In fact, in August 2008 there was an article published in Science (volume 321, number 5893, pgs.1146-7) entitled: "Genetics: first gene for severe dry macular degeneration." So while much more work remains to be done, there are researchers thinking along the same lines that you are, trying not only to identify changes in genes that may increase or decrease a person's risk of developing the disease in general, but more specifically, searching also to determine which genes predispose some patients to the "wet" macular degeneration versus others who never develop this form of the disease.

There have been and still are a number of investigators studying the composition of not only the blood components but the fatty tissues around the eye as well to see whether or not a clear distinction can be made in the different constituents found in the eyes of patients with macular degeneration versus those who do not have macular degeneration. In fact, just to give one example, there is great interest in comparing blood lipid profiles between these two groups, as lipids (including cholesterol) have been found to be a major component of drusen deposits. So yes, there are studies underway to assess whether there are differences in not only blood components but also in blood flow parameters of age-related macular degeneration sufferers versus patients who do not have the disease.

Alternative treatments as you have listed above have not been studied or proven to be of benefit in any scientifically rigorous clinical trials for macular degeneration, and I therefore cannot comment on the efficacy or lack thereof concerning these proposed therapies.

The conjunctiva, the clear layer over the white wall of the eye, contains many blood vessels that are fragile. These are the same blood vessels that bleed when you strain or cough, or even rub your eye vigorously. The red "splotch" on your eye is likely a subconjunctival hemorrhage, essentially a small bruise under the conjunctiva. It will fade within a week or so, and is not an uncommon side effect of the injection. It should not be painful. If you have increasing eye redness with eye pain or floaters, those could be signs of intraocular infection related to the injection and you should see your eye doctor immediately for a complete exam.

It would probably be best if you waited until your shingles outbreak resolved before you had any type of laser procedure performed on your eye. Reactivation of the herpes zoster virus around the eye can often be associated with intraocular involvement (lesions on the cornea, and intraocular inflammation). These can be exacerbated by the laser procedure and by the use of corneal contact lenses which are often used to perform the laser procedure.

Usually, the YAG laser procedure is performed after cataract surgery when lens fibers grow along the capsule that contains the lens implant. The procedure is only performed when the patient's vision is affected by this opacity.

It is possible that the ophthalmologist did not have a clear view of the retina prior to performing this procedure, and thus was unable to diagnose macular degeneration. Essentially, it is as if the patient is looking out through a dirty window (the cataract), and the doctor looking into the patient's eye is also looking through the same dirty window.