Age-related macular degeneration (AMD) is one of the most talked-about eye health issues in the United States. It’s grown in clout with eye doctors over the last decade, and in recent years, patients have started to know more and more about it. But what exactly do they know? It’s easy to think that patients know more than they do, but it’s important that they understand their risks and what they can do to protect their sight.
Family History of AMD
After hearing that family history is the main risk factor for developing AMD, many patients can tune out to the rest of the conversation. It’s important to stress that while this is one of the most direct risk factors, there is more to consider.
If patients are 50 years old or older, their risk for AMD increases significantly. Many don’t consider AMD a “mid-life” concern, but from 50 to 65, the prevalence of incident doubles. Patients need to know that there are steps they can take to protect their vision.
Light Skin & Eyes
Having lighter skin and eyes means that the patient has a higher risk of developing AMD than someone with a darker complexion and brown eyes. Precautions like sunglasses outdoors, blue light protection, and improved nutrition can help mitigate risk.
Like light skin and eyes, females have a higher risk of developing AMD than males. Precautionary actions can help these patients, too.
Smoking (Past or Present)
If a patient smokes or has ever smoked, their risk of developing AMD increases. The fact that should be stressed here is that even if they quit smoking, their risk is still increased. Proactive action should be taken to protect these patients’ eyes.
Low Macular Pigment Optical Density
Macular pigment is the protective pigment found in the back of the eye that absorbs harmful blue light and protects the photoreceptors from oxidation. The denser this pigment is, the greater the protection, but 78% of the U.S. has suboptimal macular pigment optical density (MPOD). A correlation has been found in patients with low MPOD and development of AMD, suggesting that denser macular pigment can aid in reducing the risk of AMD. Increasing intake of zeaxanthin and lutein, the carotenoids that make up the macular pigment, can improve MPOD and patients’ long-term protection.
Low MPOD can result from repeated exposure to blue light, as well as a diet low in vegetables. Zeaxanthin and lutein can be found in foods like kale, peppers, broccoli, corn, and spinach, but most Americans don’t get enough of these nutrients in their diet. Supplementation can help support and maintain MPOD and protect patients’ long-term health.
High Body Mass Index
Poor diet can also lead to a higher body mass index (BMI). BMI is calculated by taking one’s weight in kilograms and dividing it by the square of one’s height in meters. A higher BMI can increase the risk of AMD progression into the more advanced stages.
Stages of AMD
As important as knowing the risk factors, patients need to know how to care for themselves if they have AMD.
Early AMD – presence of medium-sized drusen and usually doesn’t include vision loss.
At this point, it’s important for patients to know that there’s still something they can do to protect and maintain their vision. Reassure them that you will work together to achieve this.
Recommend taking steps to reduce the modifiable risks. First and foremost, they should stop smoking if they still do. Then, they should begin eating a diet rich in colorful vegetables and leafy greens and exercising at least 3 times a week, which has been shown to reduce risk by up to 25%. Next, prescribe them an eye health nutraceutical designed to proactively reduce AMD risk. EyePromise® has just added 4 new ingredients to its at-risk formula, Restore, making it the best macular health formula for patients who are concerned with, at risk for, or with early signs of AMD.
Intermediate AMD – presence of large drusen and/or pigment changes in the retina.
Most patients won’t experience any symptoms, and any changes to their vision can only be detected during an eye exam. There are cases, though, where some patients could have vision loss to some degree. Again, reassure them that they’re not alone in this fight, but remind them that this is a fight.
Like early AMD, reducing the patient’s modifiable risk factors is a great place to start. Stop smoking; eat a healthier diet; exercise regularly. But this stage requires an AREDS 2 study formula. A formula like EyePromise AREDS 2 Plus Multi-Vitamin gives patients the important nutrients they need, plus extra ingredients proven to support aging eye health.
Advanced AMD – presence of drusen and vision loss from damage to the macula.
This is a fairly grim conversation to have, but patients need to know how severe the situation is. Make sure they know that you’ll help in any way you can, and that there are still options to help them.
Types of late AMD
- Geographic atrophy (Dry AMD): accounts for 90% of diagnosed cases.
- Neovascular AMD (Wet AMD): accounts for 10% of diagnosed cases and 90% of legal blindness.
Note: It’s possible for dry AMD to advance and cause loss of vision without turning into wet AMD; however, it is also possible for early-stage dry AMD to suddenly progress into the wet form.
Again, patients should work on their modifiable risk factors. Cease smoking; eat healthier; exercise more. And again, these patients should receive an AREDS 2 formula nutraceutical. If you have patients that are concerned about zinc intake, EyePromise AREDS 2 Plus Zinc-Free gives these patients the AREDS 2 ingredients, plus additional supporting nutrients, without the zinc. Along with an AREDS 2 nutraceutical, patients with wet AMD may need to get anti-vascular endothelial growth factor (anti-VEGF) injections until they appear dry on OCT images.
While the number of patients with age-related macular degeneration is expected to more than double by the year 2050, there are measures eye care professionals can take to be proactive with their patients’ eye health. Stepping in when patients are at risk of developing AMD and having them focus on their modifiable risks will ultimately mitigate their overall risk. For an even simpler explanation, download this infographic for your patients.
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- “Facts About Age-Related Macular Degeneration.” National Institutes of Health. U.S. Department of Health and Human Services, Sept. 2015. Web. 14 Feb. 2017.
- Haddrill, Marilyn. “A Guide to Age-Related Macular Degeneration.” All About Vision. Ed. Charles Slonim. AAV Media, LLC., 23 Dec. 2016. Web. 15 Feb. 2017.
- Herman, John P., OD, Sara J. Kleiner-Goudy, and Robert L. Davis. “Abstract.” Case Report of Dietary Supplements Improving Macular Pigment and Visual Function. Ophthalmology & Visual System, 19 Jan. 2017. Web. 15 Feb. 2017.
- Seddon JM, Cote J, Davis N, Rosner B. Progression of Age-Related Macular DegenerationAssociation With Body Mass Index, Waist Circumference, and Waist-Hip Ratio. Arch Ophthalmol. 2003;121(6):785–792. doi:10.1001/archopht.121.6.785