Human eye cross-sectional view. Courtesy NIH National Eye InstituteNormal vision. Courtesy NIH National Eye InstituteThe same view with age-related macular deneneration.
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Macular degeneration

Macular degeneration is a medical condition where the light sensing cells in the macula malfunction and over time cease to work. According to the American Academy of Ophthalmology, it is the leading cause of central vision loss (blindness) in the United States today for those over the age of fifty. There are two basic types of the disease: Standard Macular Degeneration (MD) and Age Related Macular Degeneration (ARMD), with ARMD being the most common form of the condition. Macular degeneration that is not age related is most commonly caused by an inherited condition. These forms are sometimes called Juvenile macular degeneration (JMD). more...

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In macular degeneration the final form results in missing or blurred vision in the central, reading part of vision. The outer, peripheral part of the vision remains intact.

Age related macular degeneration

ARMD is further divided into a "dry," or nonexudative, form and a "wet," or exudative, form. Eighty five to ninety percent of cases are categorized as "dry" macular degeneration where fatty tissue, known as drusen, will slowly build up behind the retina. Ten to fifteen percent of cases involve the growth of abnormal blood vessels under the retina. These cases are called "wet" macular degeneration due to the leakage of blood and other fluid from behind the retina into the eye. Wet macular degeneration usually begins as the dry form. If allowed to continue without treatment it will completely destroy the macula. Medical, photodynamic, laser photocoagulation and laser treatment of wet macular degeneration are available.

Risk factors

  • Aging: Approximately 10% of patients 66 to 74 years of age will have findings of macular degeneration. The prevalence increases to 30% in patients 75 to 85 years of age.
  • Smoking: The only environmental exposure clearly associated with macular degeneration is tobacco smoking .
  • Family history: The lifetime risk of developing late-stage macular degeneration is 50% for people who have a relative with macular degeneration vs. 12% for people who do not have relatives with macular degeneration, i.e. a four fold higher risk.
  • Macular Degeneration Gene: Complement factor H (CFH) gene has been determined to be strongly associated with a person's risk for developing macular degeneration.
  • Exposure to sunlight especially blue light.
  • Hypertension.
  • Cardiovascular Risk Factors - high cholesterol, obesity.
  • High fat intake is associated with an increased risk of macular degeneration in both women and men. Fat provides about 42 % of the calories in the average American diet. A diet that derives closer to 20-25 % of total calories from fat is probably healthier. Reducing fat intake to this level means cutting down greatly on consumption of red meats and dairy products such as milk, cheese, and butter. Eating more cold-water fish (at least twice weekly), rather than red meats and eating any type of nuts may help macular degeneration patients.(Reference: Macular degeneration Types and Risk Factors.
  • Oxidative stress: It has been proposed that age related accumulation of low molecular weight, phototoxic, pro-oxidant melanin oligomers within lysosomes in the retinal pigment epithelium (RPE) may be partly responsible for decreasing the digestive rate of photoreceptor outer rod segments (POS) by the RPE. A decrease in the digestive rate of POS has been shown to be associated with lipofuscin formation - a classic symptom of macular degeneration. (Reference: Ophthalmic Research, 2005; volume 37: pages 136-141. "Melanin aggregation and polymerization: possible implications in age related macular degeneration")
  • Race Macular degeneration is more likely to be found in whites than in blacks.

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Improvement of visual functions and fundus alterations in early age-related macular degeneration treated with a combination of acetyl-L-carnitine, n-3
From Alternative Medicine Review, 9/1/05 by J. Feher

Improvement of visual functions and fundus alterations in early age-related macular degeneration treated with a combination of acetyl-L-carnitine, n-3 fatty acids, and coenzyme Q10. Feher J, Kovacs B, Kovacs I, et al. Ophthalmologica 2005;219:154-166.

The aim of this randomized, double-blind, placebo-controlled clinical trial was to determine the efficacy of a combination of acetyl-L-carnitine, n-3 fatty acids, and coenzyme Q 10 (Phototrop) on the visual functions and fundus alterations in early age-related macular degeneration (AMD). One hundred and six patients with a clinical diagnosis of early AMD were randomized to the treated or control groups. The primary efficacy variable was the change in the visual field mean defect (VFMD) from baseline to 12 months of treatment, with secondary efficacy parameters: visual acuity (Snellen chart and ETDRS chart), foveal sensitivity as measured by perimetry, and fundus alterations as evaluated according to the criteria of the International Classification and Grading System for AMD. The mean change in all four parameters of visual functions showed significant improvement in the treated group by the end of the study period. In addition, in the treated group only 1 out of 48 cases (2%) while in the placebo group 9 out of 53 (17%) showed clinically significant (>2.0 dB) worsening in VFMD (p = 0.006, odds ratio: 10.93). Decrease in drusen-covered area of treated eyes was also statistically significant as compared to placebo when either the most affected eyes (p = 0.045) or the less affected eyes (p = 0.017) were considered. These findings strongly suggested that an appropriate combination of compounds which affect mitochondrial lipid metabolism, may improve and subsequently stabilize visual functions, and it may also improve fundus alterations in patients affected by early AMD.

COPYRIGHT 2005 Thorne Research Inc.
COPYRIGHT 2005 Gale Group

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