ask the expert

Age-related macular degeneration

November 29, 2007|By Derek Nnuro

With baby boomers approaching retirement, age-related macular degeneration (AMD) is a coming epidemic that will affect millions of Americans, according to the National Institutes of Health. Based on published data, an estimated 8 million Americans ages 55 and older are at high risk to develop the disease, which causes blindness.

Until recently, AMD was a poorly understood disease with little progress in research. Major breakthroughs have been made in understanding the disease, but there is more that needs to be done, says Dr. Morton F. Goldberg, chairman of the National Neurovision Research Institute of the Foundation Fighting Blindness in Owings Mills and former director of the Wilmer Eye Institute at Johns Hopkins Hospital.

What is AMD?

AMD is a deterioration of the sharp central portion of the retina [in the back of the eye] that enables people to see fine objects. That little tiny portion of the retina is only about the size of the head of a straight pin, but with aging it degenerates and the sharp central vision deteriorates.

Why is AMD considered an emerging epidemic?

It's the single leading cause of new cases of legal blindness in the North American population. Primarily because the population ... is aging, and as people get older, the higher their chances [are] of getting AMD.

There are two types of AMD, wet and dry. What are the differences between them?

Dry AMD is more common than wet AMD. Dry AMD is classified by a [gradual] loss of tissue in the macular [an oval yellow spot near the center of the retina] where the tissues dry up and go away. Wet AMD is characterized by more rapidly occurring, devastating loss of sharp vision. This loss of vision is brought on by the bleeding and leaking of microscopic arteries and veins in the macular.

Who is most likely to be affected by AMD?

When you are specifically talking about AMD, then the population affected is the older population. But there are several types of inherited macular degeneration that aren't common. They run in families and can affect any age groups within a family. Again, they are not very common.

What causes AMD, and what are the symptoms?

AMD is caused by smoking and aging and its [main] symptom [is] blurred central vision. For people with AMD, it's like there's a big smudge in the center of their eye. When they look at a face, they can see the hair, the chin and the ears pretty well, but they cannot see clearly the eyes, nose and mouth. Therefore they cannot recognize the face easily.

How is the disease diagnosed?

A trained eye physician can look inside the eye and see characteristics at the back of the eye that will enable him or her to detect the disease before a person develops the symptoms.

Is there anything that can be done to prevent it?

There are some meaningful preventive measures one can take if AMD is diagnosed before its onset. The only thing proven is a combination of antioxidants and vitamins A, C, E and zinc and copper in the proper combination and at the proper dose level that significantly reduce the risk of progression of AMD, specifically, before it causes loss of vision.

What kind of treatment options are available?

At the present time, nothing has been approved by the [Food and Drug Administration] to treat dry AMD, but there are experimental treatments that are being tried around the country and around the world. None of them have yet been unequivocally demonstrated to be beneficial. But they are being studied.

As far as wet AMD is concerned, over the last 24 months there has been a beneficial revolution because it has been proven in large clinical studies [and now also approved by the FDA] that a ... drug called Lucentis will not only stabilize vision ... but in addition will actually improve vision.

Lucentis is injected into the eye in some cases monthly for a year and in other cases monthly for two years. It acts as an important stabilizer by suppressing the bleeding and leaking of abnormal microscopic veins.

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