Science & Research

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.

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.

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.

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.

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.