Vision is a really big deal for me. I have been a low visioned individual my entire life, and one of my greatest fears is my vision worsening irreversibly. Visual health and the ability to maintain independence later in life often go hand in hand. So when my mother called me one day in late June of 2023 to tell me my dad (a former well-respected optometrist in the Boston area) had just been diagnosed with wet macular degeneration in his left eye and dry macular degeneration in his right eye, my heart sank. (Honestly, the irony in this situation is palpable.) My dad started receiving monthly injections to slow the leakage and as of his most recent ophthalmology appointment, his vision has started to stabilize. The damage will never be reversed, and his central vision in the left eye is lacking, but for the moment, it is not getting worse. Phew. Now he takes his Preservation vitamins and has pledged to read as many books as he can for right now.
The important takeaway though is nothing that I have mentioned above. You see, my Dad carries an Amsler Grid with him pretty much everywhere. When his symptoms of distorted vision first began, he used the Amsler Grid to test his vision and tentatively confirm the diagnosis which led him to seek evaluation and treatment as fast as possible. That’s the takeaway. A simple eye chart that can hang on the wall in someone’s house can shorten the time between symptom onset and diagnosis. My dad may be a retired optometrist, but anyone can be taught to use an Amsler grid at the onset of any visual distortion/disturbance.
So two months later, mid August, my mother developed symptoms. Again, the Amsler Grid. She now also receives injections and takes AREDS2. And now I know that I am totally screwed in the future. So let’s dive into the topic of AMD (age related macular degeneration) and get more acquainted with that all important Amsler Grid.
Macular degeneration, also known as age-related macular degeneration (AMD), is a common eye condition that affects the macula, the central part of the retina responsible for sharp, central vision. This condition typically occurs as individuals age and is a leading cause of vision loss among older adults.
There are two main types of age related macular degeneration: dry AMD and wet AMD.
Dry AMD: This is the more common form, accounting for about 80-90% of all cases and is relatively silent in nature. It is characterized by the gradual breakdown of cells in the macula, leading to a slow and progressive loss of central vision. Dry AMD may advance to the more severe form where there is a significant loss of macular tissue.
Wet AMD: Although less common, wet AMD is more severe and can lead to rapid vision loss. It occurs when abnormal blood vessels grow beneath the macula, leaking blood and fluid, which damages the macula. This form of AMD can result in distorted or blurred vision.
Preventive Measures:
While certain risk factors for AMD, such as age and genetics, are beyond one’s control, there are several preventive measures that individuals can adopt to reduce their risk of developing macular degeneration:
Healthy Diet: A diet rich in antioxidants, vitamins, and minerals, including lutein and zeaxanthin found in leafy green vegetables, can support eye health. Make sure you are getting a healthy dose of B vitamins! Vitamin B12 and Folate deficiencies have been linked to the development of macular degeneration.
Regular Exercise: Physical activity can contribute to overall health, including eye health. It promotes good blood circulation, which is essential for the eyes.
Protective Eyewear: Wearing sunglasses that block ultraviolet (UV) rays helps shield the eyes from harmful sun exposure, reducing the risk of AMD.
Quit Smoking: For crying out loud, QUIT SMOKING! Smoking has been linked to an increased risk of AMD. Quitting smoking can significantly improve overall eye health. There’s not much else to say about that.
Manage Cardiovascular Health: Conditions like hypertension and high cholesterol can contribute to AMD. Managing these conditions through a healthy lifestyle and medication, if necessary, is crucial.
Regular Eye Exams: yearly eye exams are very important. This is a pretty obvious one.
The Amsler Grid and Early Detection:
The Amsler Grid is a simple yet powerful tool for detecting early signs of macular degeneration. This grid is a pattern of intersecting lines with a central fixation point, resembling a checkerboard. To use the Amsler Grid effectively, individuals with AMD or those at risk should follow these steps:
- Wear Reading Glasses: If necessary, wear reading glasses as prescribed.
- Test One Eye at a Time: Cover one eye and focus on the central point. Repeat the process for the other eye.
- Note Distortions: While staring at the central point, pay attention to any distortions, wavy lines, blank spots, or missing areas in the grid.
- Regular Monitoring: Perform the Amsler Grid test regularly, preferably daily. Any sudden changes or distortions should be reported to an eye care professional promptly.
Below is the link for a free printable PDF of the Amsler Grid and instructions for its use as I have mapped out above.
https://www.amslergrid.org/AmslerGrid.pdf
So now, in the event that one day you use that Amsler Grid and you find a particularly troubling distortion, what are you going to do? As noted above, you will call your friendly eye care specialist! Remember, a blog (no matter how fascinating and well written) can never (and should never) take the place of a trusted healthcare professional!
So on to potential steps forward and treatments…..
Vitamin Supplements: Certain vitamin supplements, specifically formulated for eye health, have shown promise in slowing the progression of macular degeneration. The Age-Related Eye Disease Study (AREDS) recommended a combination of antioxidants and zinc for specific categories of patients. These formulations (PreserVision/AREDS/AREDS2) have recently been re-formulated (based on followup studies) to replace Beta carotene with lutein and zeaxanthin and removed the omega 3 fatty acids.
Intraocular Injections: For some individuals with wet macular degeneration, where abnormal blood vessels develop under the retina, intraocular injections are a game-changer. Anti-VEGF drugs are administered directly into the eye (by an ophthalmologist/retinal specialist), helping to inhibit the growth and leakage of these vessels and prevent further damage. This is the most common treatment for individuals with wet AMD.
Photodynamic Therapy: This treatment involves injecting a light-sensitive drug into the bloodstream, which is then activated by laser light focused on the abnormal blood vessels. Photodynamic therapy can be effective in slowing vision loss in certain cases, but this is not the most common method of treatment.
Laser Therapy: Laser treatments aim to seal leaking blood vessels or destroy abnormal tissue. While this method is less common today, it may still be considered in specific situations.
Low Vision Aids: Low vision aids, including magnifying glasses, telescopic lenses, and electronic magnifiers, can help individuals with macular degeneration make the most of their remaining vision.
While macular degeneration presents its challenges, the landscape of treatment options continues to evolve. From lifestyle adjustments to innovative technologies, there are avenues to explore in managing this condition. It’s crucial for individuals diagnosed with macular degeneration to work closely with their healthcare providers to determine the most suitable treatment plan tailored to their specific needs. With ongoing research and advancements, the spotlight on solutions for macular degeneration promises a brighter future for those navigating this visual journey. In the meantime, print out that Amsler grid and hang it on the wall!
