Macular Degeneration

Macular Degeneration

About one in four Americans over age 65 and one in three over age 75 will get macular degeneration, the most common cause of vision loss in people over the age of 65, according to the Association for Macular Disease in New York City.

The disease is caused by a breakdown of the macula, a dot-sized part of the retina that allows a person to read, thread a needle, and see other fine details clearly, says Anne Sumers, M.D., ophthalmologist in Ridgewood, New Jersey, and a spokesperson for the American Academy of Ophthalmology. When the macula doesn’t work properly, it causes blurriness or darkness in the center of vision.

Macular degeneration may be linked to aging, since it most often strikes in later life. But what really triggers this malfunction is still a mystery, Dr. Sumers says. Some of the suspects include diabetes, family history, atherosclerosis (hardening of the arteries), and ultraviolet light.

There is no cure for macular degeneration. In a few instances, laser surgery can prevent progression of the disease, but it can’t restore vision that has already been lost, Dr. Sumers says. Because side vision is usually not affected, people often can continue many of their favorite activities by using low-vision aids such magnifying glasses.

“Many people with macular degeneration have functional vision for many years, which enables them to see well enough to complete household tasks such as cooking and laundry but may not allow them to read regular print in a newspaper. They might even continue to drive with their doctor’s approval,” Dr. Sumers says. “It is not necessarily a sentence of blindness. People should not get depressed when they get the diagnosis. There are lots of things you can do to continue living a full and active life despite this disease.”

Try This First

Gaze in the shade. Avoid direct sunlight exposure, which places an additional strain on the retina and damages the light receptors in the eye, says James G. Ravin, M.D., author of The Eye of the Artist and a clinical associate professor of ophthalmology at the Medical College of Ohio in Toledo. When you’re outside, wear a pair of sunglasses that filters out ultraviolet (UV) rays. “Try to avoid exposure between 10:00 a.m. and 2:00 p.m., when the UV rays are most intense. The closer you live to the equator, the more you need to protect your eyes.”

Other Wise Ways

Reach for Popeye’s favorite dish. Eat five to nine servings of fruits and vegetables daily, including at least one serving of dark green leafy vegetables, says Dr. Sumers. Dark green vegetables, particularly spinach, are the ideal food for the eyes, she says, because they contain an array of nutrients, including zinc, beta-carotene, and magnesium, that may improve blood flow to the eye and protect the retina from the worst effects of macular degeneration.

Normal chemical reactions caused by the effect of light on the macula may activate oxygen and cause macular damage over time. Some vitamins and minerals like beta-carotene function as antioxidants, chemicals that work against this activated oxygen, and perhaps protect the macula from damage. In addition, zinc, one of the most common trace minerals in your body, is highly concentrated in the eye, particularly in the retina and tissues surrounding the macula.

“There’s a reason why Popeye always says, ‘I’m strong to the finich ’cause I eats me spinach,’” says Stuart P. Richer, O.D., Ph.D., chief optometrist at the Department of Veteran Affairs Medical Center in North Chicago. “Dark green leafy vegetables are very important to the overall health of your eyes. I tell my patients to eat the equivalent of 2 1/2 to 5 ounces (one-half to one cup) of frozen spinach a day.” That’s the same as one-quarter to one-half of a 10-ounce box. For variety, he suggests trying collard greens, kale, or romaine lettuce.

Bigger is better. Large-print books and playing cards, television remote controls with large readable buttons, and other oversized products can help you continue doing activities you enjoy, Dr. Sumers says. Some companies even sell telephones with large numbers and extra-large wall clocks and calculators. Ask your ophthalmologist if these products are available in your area, or for a catalog of items designed to make life a little easier for people of low vision, write to Lighthouse International, a nonprofit agency for people who have partial sight or are blind, at 111 East 59th Street, New York, NY 10022. The catalog is available in large-print, braille, and audiotape versions.

Zoom in. A high-quality magnifying glass is a must if you want to read, says Charles R. Fox, O.D., director of vision rehabilitation at the University of Maryland School of Medicine in Baltimore. You don’t have to purchase it from a vision rehabilitation center or mail-order service; buy it at Brookstone, the Nature Store, or another gizmo and gadget store. It can be just as good as one you would get from a low-vision center and often will be cheaper, he notes. To make sure that you get a high-quality magnifier, put the magnifier flat on a piece of lined paper and raise it up until the lines look bigger. It helps to use just one eye for this. The lines should look bigger, but just as sharp. Make sure that there are no distortions, no waves, and no breaks.

Cozy up to your TV. If you have trouble watching television because of macular degeneration, try sitting as close as you can to the set, Dr. Fox suggests. “If the television is far away from you, the black hole in the center of your vision may cover the whole screen. Bring the television closer and closer, and the black hole covers less and less of the screen. So if it helps to sit three feet away from the television, do it.”

Light up your life. Switch to 100-watt soft lightbulbs. They will brighten your living space and cut down on glare, Dr. Fox says. Make sure that your lamps or light fixtures can handle the additional wattage. Many have a maximum safe rating of 60 watts, which is usually labeled on the lamp, near the socket that holds the bulb. Get a goosenecked or swing-arm adjustable lamp from a home center or office supply store so you can shine the light directly onto the material you are reading.

Listen to passenger protests. You may feel offended if friends and relatives are reluctant to ride along when you drive. But don’t ignore their protests, particularly if their warnings are repeated on a regular basis. Macular degeneration erodes sight slowly, so you may not be aware that your driving skills are impaired because your vision betrays you at times. Consider their concerns about your safety to be a warning sign that it may be time to relinquish the car keys and let someone else slip behind the wheel, Dr. Ravin says.

Weed out cigs before they blindside you. Snuff the smokes, urges Dr. Sumers. People with macular degeneration who continue to smoke are three times more likely to go blind than those who quit, she says. Over-the-counter nicotine patches and gums can help you kick the habit and retain your usable sight.