DRY AGE RELATED MACULAR DEGENERATION

1. Early Dry Macular Degeneration:
   • In the early stages of dry macular degeneration, individuals may not experience noticeable vision loss. This stage is often detected during a routine eye exam.
   • The hallmark characteristic in early dry AMD is the presence of small yellow deposits called drusen beneath the retina. Drusen are accumulations of waste materials, lipids, and proteins. Their presence can be an indicator of changes occurring in the macula.
2. Intermediate Dry Macular Degeneration:
   • In the intermediate stage, there may be an increase in the number and size of drusen, and some pigment changes may occur in the retina.
   • While individuals with intermediate dry AMD may not have significant vision loss, they are at a higher risk of progressing to advanced AMD.

Drusen: Drusen are yellow or white deposits that form under the retina. They can vary in size and are often categorized as small, medium, or large. The presence of drusen is a key diagnostic feature in AMD and is associated with changes in the retinal pigment epithelium (RPE) and the normal function of the macula. The accumulation of drusen can interfere with the transport of nutrients to the retinal cells, contributing to the degenerative process.

Treatment for Early and Intermediate Dry Macular Degeneration: As of my last knowledge update in January 2022, there is no specific medical treatment that can reverse or cure dry macular degeneration. However, certain measures may help manage the condition and reduce the risk of progression:

1. Nutritional Supplements: The Age-Related Eye Disease Study (AREDS) and AREDS2 have identified specific vitamin and mineral supplements that may slow the progression of AMD in certain individuals. These typically include a combination of antioxidants and zinc. However, it’s crucial to consult with an eye care professional before starting any supplements.
2. Lifestyle Modifications: Adopting a healthy lifestyle can contribute to overall eye health. This includes maintaining a balanced diet rich in nutrients, not smoking, managing conditions like hypertension, and protecting the eyes from excessive ultraviolet (UV) light exposure.
3. Regular Monitoring: People with early and intermediate dry AMD should have regular eye check-ups to monitor any changes in their condition. Detecting progression early allows for timely intervention and management.

It’s important to note that the field of ophthalmology is dynamic, and new developments may occur after my last update. Individuals with dry macular degeneration should consult with their eye care professional for the latest information and personalized recommendations based on their specific situation.

Late dry macular degeneration is the advanced stage of the disease, and one of its key manifestations is geographic atrophy.

1. Late Dry Macular Degeneration:
   • Late dry macular degeneration is characterized by the progression of the disease to an advanced stage.
   • In this stage, there may be a significant loss of retinal pigment epithelium (RPE) cells and photoreceptor cells in the macula, leading to a more pronounced and irreversible loss of central vision.
   • The term “late dry macular degeneration” is often used interchangeably with the term “advanced dry macular degeneration.”
2. Geographic Atrophy:
   • Geographic atrophy is a specific form of advanced dry macular degeneration.
   • It involves the gradual loss of RPE cells and photoreceptor cells in discrete patches or areas in the macula.
   • These atrophic areas can lead to the formation of irregularly shaped lesions, resembling a map, which is why it’s termed “geographic atrophy.”
   • The progression of geographic atrophy can result in a significant and permanent decline in central vision.

Emerging Treatments for Geographic Atrophy: There are ongoing research efforts to find effective treatments for geographic atrophy. Some medications have recently been FDA approved.  Some of the emerging approaches include:

1. Anti-Complement Therapies: Research has focused on targeting the complement system, a part of the immune system involved in inflammation. In geographic atrophy, abnormal activation of the complement system may contribute to the degeneration of retinal cells. Anti-complement therapies aim to modulate the activity of the complement system to slow the progression of geographic atrophy.
2. Stem Cell Therapy: There have been investigations into the use of stem cells to replace damaged or degenerated retinal cells. The goal is to transplant healthy cells into the affected area to restore function and prevent further vision loss. However, stem cell therapy for geographic atrophy is still in the early stages of research.
3. Gene Therapies: Some studies are exploring gene therapies to address the underlying genetic factors associated with AMD. The aim is to develop treatments that can target specific genetic mutations linked to the development of geographic atrophy.

It’s important to note that while these approaches show promise, further research and clinical trials are needed to establish their safety and effectiveness. Individuals with geographic atrophy should consult with their eye care professionals for the most up-to-date information on emerging treatments and potential participation in clinical trials.

Geographic atrophy can progress and lead to vision loss. When people with dry AMD lose vision, it is almost always from geographic atrophy. The animated image with this text shows growing geographic atrophy over 3 years in an 86 year old patient. This person is fortunate to have good vision because the dark areas of geographic atrophy are not yet affecting the central vision. Given the progression, the central vision will likely be affected within about 3 years. The images are fundus autofluorescent images that are useful for following geographic atrophy because the atrophy shows up as well delineated dark spots.

In 2023, the first treatment for Geographic Atrophy, Syfovre, was approved by the FDA. It is available in all of our offices. Syfovre is an intravitreal injection that reduces the rate of progression of geographic atrophy. It is given every month or two as ongoing treatment. Recently, Izervay was also approved for the treatment of geographic atrophy. Both of these treatments reduce the risk of progression of geographic atrophy. They do not improve vision nor do they stop progression of geographic atrophy.

Patients who consume fruits and vegetables have the lowest rates of macular degeneration development. Lutein, a carotenoid pigment found exclusively in fruit and vegetables, serves as the primary protector of the eye. Lutein accumulates in the macula and likely blocks the damage caused by sunlight, one proposed cause of AMD. Fruits and vegetables are also high in antioxidant vitamins such as Beta- carotene, Vitamin E, and Vitamin C. Green leafy vegetables and other colorful foods like kiwi, squash, red grapes, and corn are good sources of Lutein. Other dietary habits have been shown to increase the risk of AMD. Individuals with a higher percentage of vegetable, monounsaturated, and polyunsaturated fats in their diet have higher rates of Wet AMD development. Diets rich in Omega 3 fatty acids reduce the risk of vision loss. These are found naturally in cold-water fish such as salmon and tuna, and in flaxseeds and flaxseed oil. Two servings of fish per week are adequate.

The Age-Related Eye Disease Study 2 showed that among people at high risk for developing late-stage, or wet, macular degeneration (such as those who have large amounts of drusen or who have significant vision loss in at least one eye), taking a dietary supplement of vitamin C, vitamin E, lutein and zeaxanthin, along with zinc, lowered the risk of macular degeneration progressing to advanced stages by at least 25 percent. The supplements did not appear to provide a benefit for people with minimal macular degeneration or people without evidence of the disease during the course of the study. These vitamins contain a mixture of Vitamins C and E, Lutein, Zeaxanthin, Zing and Copper. Another large study in women showed a benefit from taking folic acid and vitamins B6 and B12. It is very important to remember that vitamin supplements are not a cure for macular degeneration, nor will they give you back vision that you may have already lost from the disease. However, these supplements do play a key role in helping some people at high risk for developing advanced (wet) AMD to maintain their vision, or slow down the progression of the disease.