Reducing the Risk of Wet AMD

Having a clear central visual field allows you to safely and easily accomplish tasks ranging from reading and driving to chopping an onion and playing fetch with your dog.

Screening for AMD

To detect AMD before symptoms appear, the following groups of people should be screened:

  • People over 60 years of age
  • People with hypertension or cardiovascular disease
  • People who smoke
  • People with a close family history (brother/sister or mother) of vision loss from AMD regardless of age
  • People with aphakia or pre-1984 pseudophakia
  • People with significant cumulative light exposure.

Signs of High Risk

During screening, your vision care provider will look for the following signs that you are at high risk of developing AMD-related low vision:

  • Number and size of drusen. Drusen are yellow, fat-like deposits on the eye associated with macular degeneration (see Overview of AMD). The presence of many drusen and at least one large drusen indicates an increased risk of developing advanced AMD.
  • Geographic atrophy in one or both eyes. Geographic atrophy is a large central area of retinal atrophy that destroys the center of vision.

Risk Factors

Age
Wet AMD is the leading cause of low vision in Americans age 60 and older. Age is the single most important non-modifiable risk factor.

Gender
Women are more likely than men to develop AMD. Because women have longer life expectancy, they are also more likely to develop AMD-related low vision.

Ethnicity
People of caucasion descent, especially those age 75 and older, are much more likely than African-Americans to develop low vision related to AMD. Of those with low vision, it it attributable to AMD in less than 5% of African-Americans and less than 15% of Hispanics. By comparison, low vision is attributable to AMD in more than half of people who are caucaision.

Hereditary factors

Family history. Ten to twenty percent of people with AMD have one or more immediate family members (siblings, parents, or children) with AMD. Scientists have identified some of the specific genes believed to be responsible for causing macular degeneration. Researchers are working to develop genetic testing that might allow people to find out whether they are at high risk and should be closely monitored.

Eye color. People with light-colored eyes tend to have a higher risk of AMD than those with darker eyes.

Systemic factors

Obesity. A body mass index of 30 or greater increases the likelihood that early- or intermediate-stage dry AMD will progress to advanced dry or wet AMD. Body mass index is a measure of body weight adjusted for height.

Nutrition. Low antioxidant levels may increase the risk of age-related conditions, including macular degeneration. One study conducted over a five-year interval showed that people with early or intermediate AMD who took a nutritional supplement of antioxidant vitamins and zinc had a 25% reduced risk that the disease would progress to an advanced stage. However, you should consult your primary care provider before taking a vitamin supplement, since high concentrations of zinc, vitamin K, and other vitamins and minerals can be harmful for some patients or can cause medication interactions.

It is also helpful, of course, to eat a diet high in antioxidants. People who eat five or more servings per week of dark leafy green vegetables, such as kale and spinach, have a reduced risk of developing AMD. In addition, researchers are investigating a possible link between AMD and diets high in saturated fats.

Ocular factors

Severe hyperopia (farsightedness). People who are extremely hyperopic (farsighted) have up to two and a half times the risk of developing AMD.

Environmental factors

Smoking. Smoking has a deleterious effect on virutally every body system, and your vision is no exception. The chemicals in tobacco are believed to keep your body from properly absorbing lutein, an antioxidant that helps shield the retina from age-related deterioration. In fact, smoking is the most important preventable risk factor for AMD, increasing the risk to two to three times that of a person who has never smoked.

Evidence shows, however, that quitting reduces your risk of developing AMD, a benefit that continues to build each year that you do not smoke, especially in the first several years after quitting. Speak with your doctor about your options for smoking cessation.

Modifying Your Risk Factors

You're stuck with your age and genetics, but you can reduce your other risk factors. Here's how:

  • Stop smoking
  • Eat a diet high in antioxidant vitamins, especially fish, nuts, and dark leafy green vegetables such as spinach and kale.
  • Get moving! Aerobic physical activity doesn't have to involve leg warmers and Spandex. It just means you need to get your heart rate up to your target range at least three times a week. You can do this with brisk walking, swimming, bicycling, roller blading, or any other activity that's powered by you.
  • Stay out of the sun. You already knew that getting a tan causes wrinkles and age spots, not to mention skin cancer. Now you know that sunlight can contribute to the development of cataracts, AMD, and other eye diseases. If you can't avoid the sun, use a high-SPF sunscreen, a wid-brimmed hat, and UV-filtering sunglasses.
  • Control high blood pressure and reduce your blood cholesterol.

When to Seek Care

If you have wet AMD, don't put off having the treatment recommended by your vision care provider. Vision loss occurs rapidly with wet AMD but can improve with prompt treatment unless the macula has been permanently damaged by delay in treatment.

If you have dry AMD, you need to monitor your vision so that you can seek treatment if it progresses to wet AMD. If you have no blank spots in your central vision, ask your provider for an Amsler grid or print one out here. Look at the grid every day, covering each eye separately, and see your provider right away if the grid lines begin to look wavy, blurry, or gray. If your ability to read declines or if your vision deteriorates in any other way, an immediate visit to your vision care provider is in order.

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