National Family Caregivers Association

Saturday Oct 11, 2008

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Age-Related Macular Degeneration (AMD) Understanding and Helping Your Loved One

Made Possible by: Genentech, Inc Content by Macular Degeneration Partnership

Age-related macular degeneration (AMD) is the leading cause of severe vision loss for people over the age of 60. Thirty-five to 40 percent of seniors can expect to be affected. AMD destroys the central vision, - the sharp, refined vision that we use to read, drive, watch television and recognize faces. Over time, only a ring of peripheral vision remains around the edges.

If you have a family member with macular degeneration, it’s important that you learn all you can. In addition to helping your loved one, you will help yourself, because this is a genetic disorder. You have a higher risk of developing it because your parent has AMD.

Understanding Macular Degeneration
Protect Yourself and Your Loved One
Treatments
Important Things for Caregivers to Know

Understanding Macular Degeneration
If you think of the eye as a camera, then the retina is the film. It lines the entire back of the eye and is made up of cells that react to light and pass the image to the brain. The macula is the very center of the retina and is responsible for your fine, detailed vision. Light enters the eye through the cornea (the clear curved front) goes past your iris (the colored part), through the pupil (the black hole in the center of the iris) and passes through the lens that focuses the image on the retina. If all these parts of your eye is healthy, but the macula is damaged, it’s like a perfectly good camera that has bad film. If everything in your camera works, but the film is bad, you’re not going to get any pictures. If the macula is damaged, the messages it sends to the brain are not clear and you don’t see well.

There are two types of macular degeneration: dry and wet. Dry or atrophic is the most common kind and tends to develop very slowly. The later stage of the disease is wet or exudative and can destroy the vision very quickly. It affects about 10% of the people with AMD.

There are no treatments for dry AMD, but lifestyle changes can slow down the progression. There are several treatments for wet AMD and they can be effective if given early.

Protect Yourself and Your Loved One
If you are 60 years or older it is very important to have an eye exam every year. The recommendations for dealing with both types of AMD include:

Stop smoking

Eat lots of vegetables and fruits, especially dark, green leafy vegetables and brightly colored foods

Eat fish several times a week

Reduce cholesterol and blood pressure

Wear sunglasses

Ask your eye doctor about vitamin supplements

People who smoke are twice as likely to develop AMD. The first step is to stop smoking. Research shows that people who consume a diet that is high in antioxidants lower their risk and may slow the progression. Eating fish three times a week also reduces risk. High cholesterol and high blood pressure contribute to macular disease. Exposure to sunlight can damage the retina, so you should wear UV protective sunglasses and a hat or visor. The National Eye Institute proved that a daily supplement of antioxidants and zinc can slow the progression and the vision loss in people who already have AMD.

Treatments
Because there are no medical treatments for dry AMD, the healthy lifestyle above is even more important.

There are several treatments for wet AMD that may be used singly or in combination. These therapies are aimed at stopping the blood vessels from spreading and leaking.

It is critical to start treatment as soon as possible. For this reason, the person with AMD should be using the Amsler Grid or some other method to identify any changes in vision. Increased distortion or worsened central vision can mean that there is a new episode of bleeding that needs to be treated.

Important Things for Caregivers to Know
In the early stages of macular degeneration, assistive devices can help with reading mail, paying bills, managing practical matters and enjoying hobbies. With training, AMD patients can continue to get around the house and take care of daily tasks. But as vision deteriorates, a family member or paid caregiver can become a vital bridge not only to the outside world, but to the simple maintenance of a home life. Before caregivers can provide help to someone suffering vision loss, they need to understand macular degeneration and how it affects the patient. Caregivers have many questions: What does the patient see? Why can’t she recognize a face, but can pick up a coin dropped on the carpet? Why does he turn his head whenever he talks to someone? Caregivers also need to know what is helpful and what is not helpful in communicating with an AMD patient.

A caregiver may take the patient to doctors’ visits and act as a resource during examinations. When decisions on treatment need to be made, the caregiver needs to know what questions to ask. The caregiver may be able to research information and treatments for the patient. This includes things like dealing with depression (a very common situation in vision loss), finding resources for assistive devices and vision rehabilitation, and staying up to date on the latest in research and therapy. The Macular Degeneration Partnership provides them with a Vision Simulation Card and resources to help them understand the experience of macular degeneration.

For more information about AMD, visit www.AMD.org and for AMD Information from Genentech visit www.eyeonamd.com.