Science & Research

One component of the original AREDS formulation is beta carotene, which increases the risk of lung cancer in patients who smoke or have a history of smoking in the past. There is a smoker's formulation of AREDS, in which beta carotene is replaced with lutein. From your question, it seems that you are taking the appropriate formulation for ex-smokers.

The purpose of anti-VEGF injections for macular degeneration is to decrease levels of vascular endothelial growth factor (VEGF), which stimulates the formation of new, abnormal blood vessels that leak and bleed. These abnormal blood vessels (choroidal neovascularization) are present only in the wet form of macular degeneration. Giving anti-VEGF injections to a person with dry AMD would not benefit the patient. There are risk factors with any intraocular injections, including risk of endophthalmitis (intraocular infection), elevated eye pressure, etc. In addition, there is a theoretical risk that a small amount of the anti-VEGF medication, although injected into the eye, can distribute into the bloodstream and cause systemic effects. Anti-VEGF medications, when used in higher doses for chemotherapy, have been shown to increase the risk of stroke and heart attacks.

The choroid is the layer of the eye between the sclera (the white wall of the eye) and the retina. Polypoidal vasculopathy is a condition in which the choroidal vessels are abnormal and have small outpouchings and dilatations, similar to small aneurysms. These abnormal vessels can leak and bleed, resulting in decreased vision, in a process similar to that of wet age-related macular degeneration. Polypoidal vasculopathy tends to occur in younger patients (compared to age-related macular degeneration patients) and people with darker pigmentation, but can also affect Caucasians.

Stem cell therapy for macular degeneration has not been studied in any large scale randomized clinical trials, and is certainly not the standard of care at any of the leading ophthalmology institutions in the United States. We do not have adequate data on either the safety or efficacy of this proposed therapy. There are, however, a number of laboratories in the United States and other countries around the world that are conducting pre-clinical research on stem cell treatments for macular degeneration and other eye diseases. Many promising new pharmaceutical compounds are in the pipeline for the treatment of age-related macular degeneration that will be emerging in the next few years, which may prove beneficial to you and other patients suffering from this degenerative eye disease.

You may be experiencing what is known as "night myopia," which is due to a combination of factors. In darkness, your pupils dilate to allow more light to enter the eye. Due to the optics of the lens in your eye, light that passes through the periphery of the lens is refracted (bent) more than light that passes through the center of the lens, which increases your near sightedness. In addition, spectral sensitivity shifts to shorter wavelengths, which are refracted more than light of longer wavelengths, further enhancing your shortsightedness. Finally, when your brain perceives objects as being "blurry," it triggers the accommodation response, which occurs when you are trying to focus on near objects. This will decrease your ability to see well at a distance.

From your description, you have potentially three issues limiting your vision. The damage to your macula from the accident likely resulted in scarring, which would limit the clarity of your central vision. If you had elevated eye pressure requiring a glaucoma tube implant, you may also have some glaucomatous optic nerve damage that might reduce your peripheral vision. In addition, if your cornea has decompensated to the point of requiring a transplant, the corneal clouding could certainly limit your vision as well. You may recover some vision after the corneal transplant, but you should ask your ophthalmologist if your retinal issues are the limiting factor in your visual recovery. Unfortunately, there are no current therapies to help restore vision after retinal scarring. At this point, it is important for you to follow monocular precautions by wearing protective eyewear at all times, including prescription glasses with polycarbonate lenses. You can ask your ophthalmologist about how best to protect your remaining healthy eye.

The type of visual symptoms that you report (glares and haloes) is most consistent with cataracts. The lens helps to focus light on the retina, and any opacities in the lens (cataract) can cause scattering of light and result in the symptoms mentioned in your question. If you have not had cataract surgery already, consider asking your retinal physician for a cataract evaluation.

Nystagmus is usually associated with poor central vision. During childhood, the neural connections between the eye and the brain undergo strengthening and remodeling, and are reinforced by good visual input. This process requires the eye to be anatomically and physiologically normal. If those neural connections are not strengthened within a specified window of time, then repairing the eye or correcting any refractive errors will not necessarily improve vision later on. Without examining your daughter's eye, it is difficult to evaluate if her vision will worsen with time. Your pediatric ophthalmologist would be the best person to evaluate your daughter's visual prognosis.