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All Posts Tagged Tag: ‘AMD’
Every year there is a national (AMD) week of attempting to raise awareness of the eye condition AMD (Age related Macular Degeneration).
There are two types of AMD. Neither form is curable at this time, but the vision in Dry AMD will slowly deteriorate over a number of years, and there is much evidence that eye health multivitamin supplements are very effective at slowing this condition down.
The more dramatic form of AMD is the exudative (Wet) form. This type of macular degeneration is caused by new blood vessels which grow underneath the retina. These vessels are leaky and prone to bursting. The leaking causes retinal swelling and visual distortion. The rupture of one of these blood vessels – a haemorrhage, causes the retina to be damaged into a scar which does not function. This means that the central straight ahead vision is irreparably damaged. This is the vision you require to read, drive, see the television and recognise a face, so it is a great loss to those who do not have it.
If Wet AMD is detected early enough it can be treated with intra-ocular injections of a drug which causes these abnormal vessels to “wither away”, and reduce their “leakiness”. This is likely to be an ongoing management, probably indefinitely, but it does significantly help control this condition. There are other possible treatments also, but this type is the most commonly used at the moment, as it is the most effective.
But here is the thing – A National Week of AMD awareness is not sufficient to deal with this devastating eye condition.
Neither is a regular sight test!!
Most eye conditions will be detected during a routine test, but Wet AMD can come on so rapidly that we would really need to be checking everyone every 3 weeks to exclude this possibility – obviously not possible. So you really do need to do this for yourself!
I am aware of many people who come in for a test, as they “need better glasses”, but it only becomes apparent to them (and me) that there has been a significant deterioration in their sight in one eye only. As they see as a pair, they were completely unaware of this significant drop in one – though we do not see twice as good with two eyes – 2 eyes are about 1.44 times better than one. But why really does it need the Optometrist to compare your eyes individually?
A particular gent I recall was very aware of Wet AMD as it is common in his family. He booked in not long (a couple of months) after he had had an eye test, as he had noticed that one of his eyes had changed – he noticed that a horizontal line had a very small kink in it in one eye. He was referred to see a specialist in Dublin, where the condition was unfortunately diagnosed in that eye. He had a round of three injections, and at his next scan, the specialist advised that the eye which was treated had responded well, but the condition was now also in the other eye. – It comes on that quickly!
So what to do?
Just compare your eyes! Ideally put an Amsler grid on the fridge door, but failing that, just compare the vision in the two eyes. If you can’t wink / close one at a time, use your hand to alternately cover the right and left eyes to compare them. If there is a difference between them, but there always was, (maybe you have a weaker eye), get to know what is normal for you? This way you should be able to detect the very earliest possible signs of this problematic disease, and the sooner it is detected, the sooner it can be treated, which is of the essence.
Once a week, be it the Sky guide, the Saorview guide, the newspaper or an Amsler grid, compare your eyes. I would also advise clients that they should come in if they are unsure if they have an issue – please do not wait until you are sure – this problem could be more advanced if you wait until you are sure!!
If you want to you can download an Amsler Grid Here.
A new study has found that there may be a potential benefit in the treatment of the most common dry form of Age Related Macular Degeneration (AMD), using a commonly prescribed Statin drug (used to lower cholesterol). This drug, known by the brand name Lipitor is already commonly prescribed to treat raised cholesterol, but has been found (in a small trial) to reduce the build up of debris underneath the retina which is associated with the dry type of AMD.
The study found that the drug could reduce, or eliminate these deposits, called drusen, particularly “soft” drusen, and lead to a moderate increase in Visual Acuity in affected subjects. The study was trialling a higher dose of the drug than commonly prescribed to treat the cholesterol issue alone, but seemed to be effective – further investigations, with a larger study will be required to ensure that the treatment is safe and effective.
Until now, the only effective help for Dry AMD has been anti-oxidant Vitamins, minerals and other supplements, which do seem to slow the progression of the disease, but perhaps in future there may be other possibilities?
As this problem affects millions of people worldwide, this is potentially exciting news!
One of the most successful treatments for Exudative (Wet) Age Related Macular Degeneration is with an antiVEGF treatment. This does require the drug to be injected into the the vitreous jelly inside the eye, but is highly effective in stopping the growth of the new abnormal blood vessels. The requirement for regular injections is both inconvenient to patients, and does carry a small risk of infection inside the eye.
Researchers from University College London, found that Imatinib, a drug currently used to treat leukaemia had also been found to be effective at inhibiting the growth of new blood vessels. Imatinib also uses a different method to inhibit new vessel growth- it does not depend on blocking VEGF (Vascular Endothelial Growth Factor, which causes the new vessels to grow).
This new drug is taken orally, and there is hope that this may be another line of treatment for this problematic condition in the near future- perhaps as well as injections, but possibly without the requirement for regular injections- or for people where the injections do not work or are beginning to lose effect.
This article can be read here.
Another trial has found that there may be a benefit in AMD from the use of drugs which are used to treat HIV. These drugs are used the world over, so their side effects and safety are well documented. It was initially thought that the anti HIV drugs were showing a benefit in the treatment of the Dry type of AMD, but the researchers have found that there may be a benefit in both the Wet and Dry forms of AMD. Trials have been very effective, but it is only at the mouse/rat stage at this time.
The link to read the full text of the HIV trial can be read here.
Red, scaly itchy eyelids are something that many people have had for many years, and think that it is normal. I recently had a conversation with a man who had a very bad case of this common eyelid condition, called Blepharitis:
Me “You have inflamed eyelids, which is very likely contributing to your dry eye symptoms, and there is a simple, inexpensive remedy you could use.” (I was thinking about an MGDRx Eyebag.)
Him “They have always been like that.”
Me “But it is not normal.”
Him “It’s normal for me!”
Me “But there is a way to fix it.”
Him “Is it going to kill me?”
Him “Well I’m not interested [In my fix] then.”
I am sure that he had the distinct impression that I was trying to sell him something to cure a condition that he had never heard of, and had no complaint about. I did feel like the “Snake Oil” salesman coming into the the wild west town with a cure for every ailment.
Blepharitis is often caused by blocked glands in the eyelids- these glands naturally have bacteria living in them, but when the glands get blocked, the bacterial waste is trapped, which causes inflammation – swelling and redness of the eyelids. The skin gets dry and flaky, the eyelashes show crystals sticking to them, and the individual has the appearance of red rimmed eyes. I think that people notice this, perhaps subconsciously, and assume that they are tired, or have had a hard night.
We actually stopped selling the MGDRx Eyebags, because I felt so bad trying to sell something to cure a condition the “sufferer” was unaware they had, and had never heard of. At the time, with the exchange rate to the pound, they could get it cheaper direct from the manufacturer than we could manage- we were paying a middle man in Ireland, and had to add VAT. We were making nothing on them, and I still felt bad trying to “sell” them. Sometimes an Eyebag alone will not fix this condition, but along with meticulous lid hygiene we can usually get this to clear up without resorting to medicines such as antibiotics.
The reason for the post…..
I had a man in last week who had a family history of Wet Macular Degeneration, with complaints of visual distortion in his Right Eye. I referred him to The Mater Private Retinal Clinic, hoping that he did not have this problem, but he does. He was seen on Tuesday, and was given his first injection into the eye that day. If this man had had active Blepharitis he would not have been able to get this injection- Blepahritis is an absolute contraindication to IntraVitreal Injections, because of the risk of infection inside the eye.
Blepharitis can take a good while to clear up, either Medically with antibiotics, or with the Eyebag – It may not kill you, but it may mean that you cannot have the injections your eye requires to save your sight.
You can order an MGDRx Eyebag here.
The RTE One programme Nationwide this evening was visiting the Waterford Institute of Technology, highlighting the research into, and importance of Macular Degeneration, particularly its early detection and treatment. It was an interesting programme, and obviously the team in Waterford are leading specialists, for sure in Ireland, but perhaps worldwide.
The programme can be viewed on the RTE.ie website – there seems to be a limit of the last ten episodes.
One thing I do think is worth a mention- virtually everyone interviewed decided to have their eyes checked because they had noticed that they were having problems – they felt their glasses were not sufficient, or noticed distortion. Recently the Royal National Institute for the Blind in the UK was campaigning to highlight the problem with symptom led eye examinations- they were imploring Optometrists to stress the importance of regular eye tests – ones where there were no symptoms!
Many problems can be detected before symptoms are noticed by the individual, though this may not necessarily be the case in Wet AMD. Anyone concerned about Wet AMD should put an Amsler grid on their fridge or noticeboard and check their vision weekly. An Amsler grid can be downloaded here.