GETTYSBURG MEDICAL NEWS
The Clinical View
By P.E. Hoffsten, M.D.
8 November 2006

BLINDNESS FROM MACULAR DEGENERATION

          There are several things regarding health and disease that people just hate.  One of these is cancer.  Another is stroke, in which the person winds up with one side of their body that doesn’t work and the inability to speak.  A third one is blindness.  One of the lessons in medical school was illustrated to me in a most impactful way.  During the course on eye disease, one morning the professor mandated that every person in an even-numbered seat would be blindfolded for the day and led around by a person in an odd-numbered seat.  We had to hope that we were sitting next to friends.  The instructors passed out the blindfolds and admonished us “no cheating.”  So for the rest of the lecture, we couldn’t see the slides; all we could do was listen.  For the rest of the day, from the time we went to the cafeteria or to the bathroom or to anything else that we did, we were blindfolded.  Since we had never learned to read braille, we couldn’t study other than to listen.  At four o’clock in the afternoon when the class reconvened we got to stop the exercise, but it was terrible during that day and we all learned great respect for how precious our vision is.

          Blindness comes in many forms.  One of the leading causes of blindness in our country is diabetes in which the light-sensing cells on the back of the eye are lost because their blood supply is destroyed.  Another cause is glaucoma, when the ability to see to either side is impaired before all vision is eventually lost in some people.  Glaucoma causes so-called tunnel vision.  Another cause of impaired vision is cataracts, which in today’s world can be surgically corrected in most people.

          The topic for today’s column is another cause of blindness called macular degeneration.  It is the most common cause for blindness in elderly individuals.  The macula of the eye is right in the center of the back of the eye.  On the macula there is an intense concentration of light-detecting cells in this small area on the eye.  It is this area that allows you to read.  It is the part of the eye that allows for fine detail vision.  One of the causes of blindness is the degeneration of this area of the eye, which robs the person of the ability to read or do fine detail work.  A person with macular degeneration can make out a face to determine who the person is.  They can get a vision of the room and where the furniture is.  They can even watch television in some situations and get an idea of what is going on.  But anything that has to do with detail where the person has to look right at what they are trying to understand is lost. 

          The major risk factor for development of macular degeneration is age.  The impaired vision may begin when people are in their fifties, but becomes manifest generally in the sixties and later.  Population estimates indicate that thirty percent of individuals over age seventy-five have some degree of macular degeneration.

          The second major risk factor for development of macular degeneration is smoking cigarettes.  This effect was recently emphasized by two articles in the Archives of Ophthalmology. 

          The third major risk factor is a low intake of omega-3 fatty acids.  Omega-3 fatty acids are those that are found in saltwater fish and products such as flaxseed.  Individuals who had a high intake of these types of fats were fifty percent less likely to develop macular degeneration, as documented in the article in the Archives of Ophthalmology above. 

          So how do you avoid age-related macular degeneration?  Many optometrists and ophthalmologists today recommend the use of a product called Lutein.  It is an over-the-counter nutrient available through most pharmacies.  It is made up of a yellow pigment found in vegetables.  These yellow pigments are called carotenoids and are very rich in corn, squash, egg yolks, broccoli, peas, and leafy green vegetables.  A study done at the University of Wisconsin and published in the Archives of Ophthalmology in August 2006, indicated that individuals who ate more of these types of vegetables and had a higher intake of lutein had a less likelihood of developing macular degeneration.  Ever since George Bush, Sr., said “yuck” to broccoli in the early 1990s, a lot of people won’t even eat it.  Apparently you don’t have to.  There is now a lutein pill that is available at the pharmacy.

          The second recommendation is a high intake of omega-3 fatty acids, as mentioned above.  This can be done through the intake of saltwater fish.  Some people don’t like fish and some people find it too expensive for regular consumption.  You can solve this problem by taking over-the-counter fish oil.  The right dose is four of those gel capsules per day.  People ask if they should take one with each meal or spread them out or take them all at one time.  It doesn’t seem to make any difference.  I take my four gel caps at one time when I get up in the morning.  You don’t smell like a fish; it is just a form of food.

          The last and most emphatic recommendation is discontinuation of cigarette habit.  I know I sound like I am back on my soapbox again, but there just isn’t anything that American people do that is more destructive and detrimental than smoking cigarettes.  It used to be people worried about lung cancer, but the biggest worry is heart disease.  Now you can add macular degeneration and blindness to the list of horrors that cigarettes cause.

          The most important steps in avoiding blindness from macular degeneration are regular visits to your eye healthcare professional.  Macular degeneration is best dealt with early, rather than when everybody’s face looks like a blur.  Once vision is lost it doesn’t come back.

          As a closing remark, there are minor associations to macular degeneration.  One of these has to do with blood pressure, which just makes sense.  The second has to do with excess weight.  Both of these factors are associated with an increased incidence of macular degeneration.  It all boils down to the basics that we preach day in, day out.  Healthcare maintenance works.  Abusing and neglecting your body really doesn’t.