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Dr. Geeta Lalwani, M.D. - Commonly Asked Retina Questions

What are some of the eye conditions people are at higher risk for as they age?

Age-related macular degeneration (ARMD) about 15% in those 65-80, 35% in those over 80)

The biggest risk factors for age related macular degeneration are: age, light-colored skin, family history, and smoking. Of these, the only modifiable risk factor is smoking cigarettes! Approximately 85% of cases of macular degeneration are considered “dry,” meaning no leaking blood vessels within the macula (a small central area of the retina with the highest density of photoreceptor cells and responsible for central vision). The only treatments for dry macular degeneration are nutritional. A nationwide study completed in 2012 (Age Related Eye Disease Study 2, or AREDS2) showed that a specific formulation of vitamins and minerals slowed the progression of disease in those who have moderate macular degeneration. The AREDS2 Formula of vitamins is currently recommended for anyone with macular degeneration that meets certain criteria. If the patient has high risk characteristics (observed by your eye doctor) or has moderate to severe vision loss in one eye due to ARMD, then it is recommended that they take the AREDS2 formula vitamins. There is no evidence to suggest that patients with mild-moderate ARMD will benefit from the AREDS2 formula vitamins. Evidence does suggest that those patients will benefit from a healthy diet, similar to the Mediterranean diet. As mentioned above, there are not many modifiable risk factors, but an important one is nicotine use. We know that nicotine quadruples to quintuples the risk for macular degeneration. There are ongoing clinical studies looking at other treatments for dry macular degeneration. Regular monitoring, both by your eye doctor and by you at home is important to detect possible conversion to the “wet” form of macular degeneration which requires additional treatment. The treatment for wet AMD in an injection of an anti-vascular endothelial growth factor (anti-VEGF) agent into the eye to stop the blood vessels from leaking. This treatment, while incredibly successful compared to past interventions, is chronic and ongoing. Important to note is that it is not painful! Early diagnosis of wet AMD is crucial.

The risk for diabetic retinopathy (bleeding in the retina) increases with the duration of disease as well as with an increase in average blood sugars or hemoglobin A1C (HbA1C). Higher average blood sugars will lead to faster progression of the disease. The vast majority of type I diabetics will have diabetic retinopathy after 15 years with diabetes, with 50% of these progressing to a more serious stage of disease requiring surgical intervention. 60-80% of type II diabetics will have diabetic retinopathy after 15 years with the disease. However, good control of blood sugars starting at the time of diagnosis can lead to a life free of retinal complications of the

disease. If you have diabetes, even well controlled, it is crucial to see an optometrist or ophthalmologist annually because early to mid-stages of the disease often have no symptoms. If there is a significant amount of diabetic retinopathy, you will likely be referred to a retinal specialist for additional evaluation and treatment.

What are some steps people can take to reduce the risks of cataracts, glaucoma, macular degeneration and retina detachments?

In general, the healthier you keep yourself, the better for your vision and eyes. For example, diabetes and hypertension are risk factors for glaucoma and for certain retinal conditions. Eating

a healthy diet and exercising regularly can reduce your risk for these conditions and potentially decrease your risk for ocular complications associated with them.

Smoking, or using nicotine in any form, is a significant risk factor for macular degeneration. Eating a diet rich in green leafy veggies, antioxidants and Omega-3 fatty acids is recommended to maintain a healthy macula as is UV protection. Supplementing your diet with lutein and zeaxanthin may also be beneficial.

Regular dilated eye examinations are important.

What are some signs or symptoms that people may experience with these various eye conditions?

The most common symptom for any of these of conditions is blur. Many people come in thinking perhaps they need to update their glasses, but there is no change in lenses that can improve vision. However, the acuteness of the symptoms is very helpful in differentiating between the different conditions. Both wet macular degeneration and diabetes often cause a distortion of the central vision, with ARMD being much more acute. Over days to weeks, the visual distortion progresses. Both of these conditions are treated with anti VEGF agents which greatly improve the vision. Prompt evaluation and treatment is imperative for both conditions.

As mentioned above, a sudden onset of floaters is most likely related to a posterior vitreous detachment, a normal part of aging. However, it is a very good idea to be examined and rule out a retinal tear which can lead to a retinal detachment. A retinal tear by itself, typically has no symptoms.

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