Age-related macular degeneration: David Kent Discusses
Q: Can you tell us a little about AMD?
A: Macular degeneration is a chronic neurodegenerative disease that affects the macula, the centre of the retina in the back of the eye. The biggest risk factor for its development is increasing age, hence its more correct designation, age-related macular degeneration or AMD. Now neurodegeneration is quite an imposing word, so I prefer to just think of AMD as a condition where the macula just gradually wears out after a lifetime of working normally.
Q: Are there different types of AMD?
Yes, you can have either wet or dry AMD. Everybody with AMD starts out as having the dry type and about 10% of these go on and develop the wet type. In reality wet AMD is a very advanced form of the disease and indeed AMD will have been present for many years if not decades before this wet advanced form occurs. All ‘wet’ means is that the back of the eye appears boggy or wet to the examining doctor because of leakage of fluid into the retina from abnormal blood vessels that have grown beneath the retina as a result of the AMD. With the ‘dry’ type then there are no abnormal blood vessels but after many years it can lead to loss of central vision.
Q: Does AMD lead to loss of sight?
A: No, it is important to say that not everyone with AMD will go blind. In fact, most people may not have significant sight loss at all and even though the disease is present, it will not in the vast majority of people cause major vision loss. Also, when I use the term ‘blind’ I must stress that someone with AMD will never go completely blind. Yes, it affects their central vision but it will never take away so much vision that a sufferer will not be able to walk around independently. Of course tasks like reading, texting and sewing will provide considerable challenges but even then, magnifiers called low vision aids (www.ncbi.ie) can come to the rescue.
Q: So, what about the treatment for AMD?
A: Many people may know someone with AMD and know that they attend the hospital regularly for injections into the eye. Sounds terrible, but in fact it is really quite straight forward. Anyone having injections means that they have wet AMD. There is no drug treatment for the dry type but I have found the results I have had with micropulse laser very encouraging.
Q: So, for people with early AMD there is still a huge amount you can do to prevent its progression?
A: Yes, gone are the days where we said it’s your genes and there is nothing to do but wait for your sight to go (google epigenetics). Imagine how this made you feel if you had a family history of AMD. Like all the age-related diseases there is so much we can do in terms of our lifestyle choices. The key to a long and healthy (with emphasis on the word ‘healthy’) life, with good vision, are healthy lifestyle choices.
Front and centre to a healthy lifestyle is your nutrition. So, avoid processed food, especially those containing sugar and manmade vegetable oils. The two together can be devastating for your cellular health, just like smoking. Try not to snack at night and try and get a 12 hour fast in most nights so that breakfast means what it is meant to be mean: break-fast. Of course, if you can fast longer that is even better.
Move! Especially outdoors. Exercise is free and it is so beneficial to your health, including your macula. Exercise produces something called brain-derived neurotrophic factor or BDNF. Don’t remember that name but do remember it’s like Miracle Gro for your brain and retina. Outdoors means sunlight (even in cloudy Ireland) so you will also boost your vitamin D levels and reset your circadian clock which is the single most important component for restorative sleep. One last thing. If you want to bio-hack the benefit of exercise even more, then incorporate some resistance training into your routine, no matter what age you are.
Q: Sleep is something we hear about quite often. Many people find it difficult to get the recommended amount of sleep. What advice can yo give them?
A: Well, restorative sleep is when the body gets most of its repairing of tissues done so good sleep hygiene is important. THis means we should avoid bright lights and especially LEDs, including those on our phones, tablets and computers in the evening (have them on night time settings all the time). You see, these lights trick our brains into thinking it is morning and this prevents the release of the hormone that brings on sleep, melatonin.
Q: Finally, what about dietary supplements? Can they help your eye health?
A: Many people are probably already familiar with the fact that certain supplements may slow down the progression of AMD. Basically, these are tablets that contain vitamins and minerals that come under the category of antioxidants. Antioxidants are small molecules that hoover up other small molecules (often called free radicals) that build up and cause devastating damage to our cells and tissues, including the retina. I therefore recommend supplements that contain vitamin C and D and E, along with luteins, zinc and copper and the omega 3 fatty acids. These will not only benefit the cells of the macula but also all cells throughout the body.
Mr David Kent is a Consultant Ophthalmic Surgeon at Aut Even Hospital Kilkenny. You can read more about Mr Kent’s background and specialist interests here: David Kent