Science & Research

Macular degeneration affects people differently. Many persons with the disease are able to drive normally for many years after being diagnosed, whereas others may not be able to do so. Whether or not your mom should continue to drive or not must be based on her own individual circumstances. The best recommendation is to make sure she is getting frequent eye examinations so that her visual acuity can be accurately tested by an ophthalmologist, who can then make recommendations on whether or not she may be able to continue driving safely. It is known that persons with macular degeneration often report increased glare when driving in sunlight. Glare may become an a more complicated problem when driving at night, due to the glare from headlights on top of the fact that contrast sensitivity is also reduced. There are special glasses and/or lenses that can help reduce glare and somewhat improve contrast sensitivity when driving; however, you should seek the advice of her eye doctor.

Unfortunately, there is no treatment for dry macular degeneration. However, scientists worldwide are working on developing new strategies for treating the disease. As such, there are a number of investigational treatments currently being explored, such as rheopheresis (a blood filtering technique); however, none are FDA-approved as of yet, nor are they available for use in the general public. Thus, much more work must be done in this area. The National Eye Institute's AREDS study demonstrated that supplementation with specific anti-oxidant vitamins and minerals can slow the progression of the disease significantly. Thus, advising patients with dry macular degeneration to maintain a healthy diet (rich in green leafy vegetables and fruits) and lifestyle, in addition to taking the AREDS formulation (only after seeking approval from a physician) is the current standard for managing the disease.

Juvenile macular degeneration is a term that can be used to describe a spectrum of diseases in which the macula is affected in childhood or adolescence. Another term for these diseases is macular dystrophies. Macular dystrophies are caused by different genetic mutations and can be inherited in several different patterns (autosomal recessive or autosomal dominant, for example). Since each disease is caused by a different gene and mechanism, it has been difficult to develop effective therapies for each condition. Hopefully in the future, gene therapy could be used to target the individual gene responsible for each of these conditions; however, research in this field is still ongoing.

There are no studies that directly address the effects of low dose oral steroids on macular degeneration. Steroids can have a variety of effects on the eye, including the development of cataracts and increased eye pressure. Recently, a clinical trial designed to assess the effect of anecortave, a steroid administered as a periocular injection, was ended, as preliminary results did not show efficacy in the treatment of neovascular (wet) age-related macular degeneration.

Usually, injections are given for the wet type of age-related macular degeneration (AMD). Wet AMD occurs when abnormal blood vessels grow in the macula, the area of the retina that is responsible for central vision. The purpose of these injections is to cause these blood vessels to regress. You should be able to continue normal daily activities after an injection; however, it would be prudent to talk with your eye doctor about this as he/she is intimately aware of your medical history. If you develop decreased vision, eye redness, or eye pain after an injection, you should see your eye doctor immediately as these could be signs of a serious eye infection.

The primary contraindication to beta carotene is that it increases the risk of lung cancer in smokers. If you smoke, you should take Preservision with lutein (the formulation that does not contain beta carotene). If you are not a smoker, regular Preservision (which contains beta carotene) should be fine. All medications and supplements should only be taken under medical supervision, so it is advised that you follow-up with your doctor for specific treatment guidelines.

Computer monitors do not emit enough radiation to cause eye damage, and it is not necessary to wear eye protection. To prevent eye strain, take breaks when working on your computer, and make sure your eyeglass prescription is up to date.

Lucentis is an anti-VEGF antibody fragment that is FDA-approved for the treatment of wet age-related macular degeneration (AMD). In wet AMD, the development of choroidal neovascularization (abnormal blood vessels underneath the macula) is the main cause of vision loss. These abnormal blood vessels can bleed or leak and result in decreased vision. Lucentis has been shown to cause regression of choroidal neovascularization and improve vision in some patients with wet AMD. Avastin is a full-length anti-VEGF antibody that is used off-label for the same purpose. However, their relative safety profiles have not been directly compared. Avastin, when used in larger doses for medical conditions outside of the eye, has been shown to increase the risk of both heart attack and stroke. Recently, there is clinical evidence suggesting that Lucentis can also increase the risk of stroke. Currently, there is an ongoing clinical trial* designed to evaluate the efficacy and safety profile of Avastin and Lucentis. As your mother has a history of both heart attack and stroke, it would be prudent for her to discuss these potential risks with her ophthalmologist if he/she is considering a trail of either Avastin or Lucentis.

*The Comparison of Age-Related Macular Degeneration Treatments Trials (CATT).