Jacques was a very active retiree. That ended one November morning as his life was suddenly turned upside down. When he woke that day, he couldn’t see out of one eye. Panicked, he came to see me right away.
Jacques had been diagnosed with age-related macular degeneration (AMD) a few years earlier. His condition had been stable, but now, it suddenly progressed to the most severe form of the disease: “wet degeneration.” This stage is characterized by the sudden development of a network of new blood vessels that ooze into the deep layers of the retina, causing a rapid loss of functional vision in the affected eye.
An urgent referral to ophthalmology is made in cases like these because the window of opportunity for treatment is narrow. Immediate treatment usually results in the best prognosis. Jacques managed to get treatment within a few days.
The ophthalmologist gave him intraocular injections of medication, but this only improved his vision slightly. Jacques was depressed and his anxiety was increasing. He felt useless and had lost considerable autonomy.
The loss of an eye is a traumatic event, regardless of the patient’s age. While the significant negative psychological effects are well documented for older patients, recent publications also report the same adverse consequences in younger populations.
For example, the rate of depression is six times greater in those with significant vision loss than in the general population (25 percent versus 4 percent).
Hope for Patients
So what can we do to help Jacques? We can’t promise that his vision will be fully restored. Although injection treatments can be effective, the basic degeneration won’t go away. The best option for Jacques is to refer him to a visual impairment rehabilitation center, where he’ll receive help from a variety of professionals.
At this center, he’ll be seen by specialists trained to treat visual impairment and its repercussions on the lives of people who suffer from it, and on the people around them. Understanding this reality is the first step toward helping patients address their needs.
The next step, after providing psychological support to Jacques, is to optimize his visual condition. Optometrists who specialize in low vision can prescribe optical aids to help Jacques regain some of his visual function, including magnifiers, vision aids, and specialized glasses that can be provided through a government program designed for this purpose.
Jacques is in Canada, so this part of his experience may be different from that of people in other places. Specialists in visual impairment rehabilitation (VIR) trained at the school of optometry of the University of Montréal (the only institution in Canada that offers a master’s program in VIR), will help Jacques learn new strategies to carry out his daily activities. Specialized educators can help him use a computer and specific software. When needed, orientation and mobility specialists teach people methods to safely orient themselves and get around, whether on the street or in an unfamiliar environment.
A social worker, aware that the impacts of a visual handicap go far beyond the person experiencing it, may accompany Jacques during his rehabilitation process and communicate with his family. In short, Jacques will hopefully have a good support system and will be able to regain a certain level of autonomy in his life, which, in turn, will have a positive impact on his morale. Support groups can also help him in his efforts, and if, thanks to effective injections, his visual acuity improves, he will be in a win-win situation.
However, Jacques still has other concerns about his disease. He’s worried that his children will develop similar conditions, especially one of his sons.
Several Risk Factors
Age-related macular degeneration is aptly named: its prevalence increases with the age of the patients. In the United States, as many as 11 million people have some form of age-related macular degeneration. In Canada, which has approximately one-tenth the population, nearly one million Canadians—300,000 in the province Québec alone—suffer from AMD. Of these, 10 to 15 percent have the wet form, like Jacques. AMD is the leading cause of blindness in people over the age of 65.
In addition to aging, other risk factors associated with the development of the disease include family history, ethnic origin (white people are more affected), gender (women are more affected), atherosclerotic and vascular diseases, obesity, and sun exposure (phototoxicity of the retinal cells).
Smoking also plays an important role. Consuming 25 cigarettes per day doubles the risk of severe damage. Exposure to secondhand smoke is also harmful. The chemicals absorbed during exposure to smoke increase the absorption of harmful sunlight by the retina by 1,000 times.
For Jacques’s son, the risk of developing AMD is clear, but so are his options. He won’t be able to change his genes, prevent himself from aging, or change his ethnicity or chromosomes. However, he can control the modifiable factors: he can quit smoking, control his weight, and stay physically active.
Diet can play a preventive role. Reducing fat intake in the diet and ensuring adequate omega-3 consumption (forms of triglyceride, 800 mg DHA/EPA per day) are important. However, adding vitamins formulated for eye health to the mix is not recommended in Jacques’s case. Vitamins are only effective in treating dry AMD in its middle stages, not for preventing it. However, they are one of the few ways Jacques can reduce the risk of having his other eye affected and losing all his functional vision.
It’s imperative for both Jacques and his son to follow the doctor’s recommendations on managing vascular problems (hypertension, cholesterol, diabetes). When poorly controlled, these conditions significantly increase the risk of developing wet AMD.
Remember, macular degeneration is first and foremost a vascular disease: The blood vessels are no longer able to nourish the retinal cells and no longer get rid of their metabolic waste efficiently. As a result, the cells die. New blood vessels develop, but they’re fragile, and when they break, they flood the retina with fluid.
Finally, both father and son will need to protect themselves from the sun’s harmful rays, either with a transparent filter (UV400) in their regular prescription glasses or by wearing good quality sunglasses when they’re outdoors. Their eye care professionals will be able to advise them about this.
Jacques’s spirits are not high, but I have given him some hope that better days lie ahead. He knows he can count on a team of professionals to support him and that he won’t be dealing with his condition alone. There’s hope. And hope is the first thing that makes it possible to overcome the impacts of any disease.
is a professor at the school of ophthalmology with expertise in eye health and the use of specialized contact lenses at the University of Montréal in Canada. This article was first published on The Conversation.
