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Spring 2014 • Kentucky
15
Working to Beat Macular
Degeneration
By Fiona Young-Brown
When Dr. Mark Kleinman was offered
the chance to come to the University of
Kentucky Department of Ophthalmology
and Visual Science for a fellowship in vitreoretinal surgery, he didn’t hesitate. “The
university has one of the top eye research
centers in the world led by Dr. Jayakrishna
Ambati,” he says, “and I wanted the opportunity to work with such a strong team.” That
team also includes Drs. Andrew Pearson,
Sheila Sanders, and Woodford Van Meter,
all of whom were recently named among
the best doctors in the United States. High
on the research team’s list of priorities —
finding a way to beat Age-Related Macular
Degeneration (AMD).
The macula is a layer of light sensitive tissue
in the center of the retina. It is what enables
us to distinguish certain colors, discern
fine details, and notice contrasts. Macular
Degeneration is the breaking down of that
layer of tissue. There are two distinct types
of the disorder. Wet Macular Degeneration
occurs when blood vessels leak fluid or
blood underneath the retina. Dry Macular
Degeneration occurs when the cells that
comprise the macular tissue break down and
disintegrate.
As of 2010, according to the National Eye
Institute, an estimated 2,000,000 Americans
suffered some form of AMD, which is the
leading cause of vision loss in the nation.
While many suspected cases are referred by
optometrists, there are a number of warning
signs that family physicians should be aware
of, especially since early detection is key.
These warning signs include:
• Age. Most cases occur in people over 50.
• Family history. There is growing evidence that more than 50 percent of
those with AMD have a genetic predisposition to the disease.
• Tobacco use. Smoking increases the risk
of developing the advanced forms of the
disease nearly four-fold.
• Auto-immune diseases such as
Rheumatoid Arthritis or Lupus. Some
medications used to treat these diseases,
such as Plaquenil, may increase the risk
of toxicity in the retina resulting in earlyonset macular degeneration.
AMD is usually painless but a range of
symptoms may develop, including blurred
vision, distorted images, difficulty noticing colors or contrasts, or the presence of
blood in the eye. Since AMD looks different
in every patient, Kleinman emphasizes the
importance of an ophthalmologist referral
sooner rather than later.
To make a diagnosis, the ophthalmologist
will collect a detailed medical history of
both the patient and family members. This
is followed by a set of vision tests, dilation, and other exams to inspect the retina.
For example, a Spectral-Domain Optical
Coherence Tomography (SD-OCT) is a
non-invasive imaging procedure that provides a series of detailed cross-sections of
the retina, thereby allowing the specialist
to look for disruptions in the retinal tissue
layers and other abnormalities. An Amsler
grid test can check for distorted vision and
be used at home by the patient to remotely
monitor for the development of sub-retinal
fluid. Also, an
angiogram may be
performed, injecting
dye into the arm so
that its path into the
eye may be followed,
checking for the
abnormal blood vessels that are linked to
Wet AMD.
may also suggest a course of vitamins and
supplements to help slow the condition’s
progression depending on clinical staging
of the disease. Similar regular checks will
be required with a diagnosis of Wet AMD.
In addition, recombinant antibody technology can help slow the disease’s progression
or perhaps even reverse some vision loss.
Kleinman estimates that, after beginning
treatment, one third of patients with Wet
AMD respond very well and regain significant vision (3-lines or 15 letters) while one
third will eventually go blind (20/200 or
worse) in the affected eye.
While those odds may not be ideal, they
offer hope to millions. Meanwhile, patients
can rest assured that Kleinman and his colleagues are working hard to improve those
odds for everyone.
Your lifevest in an ocean of uncertainty
But what of treatment? Any prescribed plan will
depend largely upon
two key factors:
the type of AMD
(wet or dry) and
the level of advancement. As always, the
earlier AMD can be
detected, the earlier
a plan of action can
be put into place.
Sadly, there is no
treatment to reverse
the effects of Dry
AMD, although that
is the focus of an
intense translation
research program at
UK. However, the
ophthalmologist will
recommend ongoing
checkups to track
any vision deterioration. He or she
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