Overview of early warning signs of macular degeneration

Among adults over 50, dry macular degeneration is a prevalent eye condition. It causes the macula to thin, which results in impaired or diminished central vision (MAK-u-luh). The portion of the retina called the macula is what gives you sharp vision when you look directly in front of you. 

Dry macular degeneration may start in one or both eyes before spreading to the other. Your ability to read, drive, and identify people may be impacted when your eyesight deteriorates over time. You won’t necessarily lose all of your vision, however. People often just lose their center vision, keeping their peripheral vision. Some individuals simply have a little loss of central vision, however, in others, it may be more severe. 

The loss of vision caused by dry macular degeneration may be postponed with early identification and self-care methods. 

Here are a few warning signs of macular degeneration to look out for: 

Vision Blurred

ARMD symptoms often appear gradually. Over time, your eyesight becomes hazy, especially when attempting to concentrate on close-up objects. You could discover that you require more light to read or that the wording on a prescription bottle is a little difficult to read. Additionally, straight lines might look warped or deformed. These symptoms keep getting worse. 

Dark Spots in the Center of Your Vision

Age-related macular degeneration may be the cause if you detect a blurry or dark patch in the center of your vision. A clear sign of ARMD is the presence of shadowy areas in the center of your focus region. The illness might sometimes cause a white spot in your eyesight. 

You just celebrated your 50th birthday

To assist in discovering vision issues, such as ARMD, it is a good idea to get a thorough eye exam every 2-4 years starting at age 50 and increasing in frequency as you become older. Before you have symptoms, your eye doctor can often see early indications of macular degeneration. 

While ARMD cannot be treated, early detection and adopting wise lifestyle choices may allow you to limit the progression of the illness. It is thus crucial to be aware of the warning symptoms and see your eye doctor if you have any concerns.

Other Symptoms

Symptoms of dry macular degeneration often appear gradually and painlessly. They may consist of: 

• Visual anomalies, including straight lines, seem curved 
• A  central visual impairment in one or both eyes 
• An increased need for stronger lighting while reading or doing close-up work
• Difficulty adjusting to low light conditions, such as when entering a restaurant with dark lighting 
• Words written in print become hazier; colors lose their strength or brightness. 
• Face recognition issues 
• A distinct blind patch or hazy region in your range of vision

Before eyesight deteriorates, early warning signs of sight loss might be able to be found. 

According to recent research, people may experience age-related macular degeneration signs even before they start to lose their vision. The results pave the way for investigation into early therapies that can help delay the start of the illness, which is the most prevalent cause of sight loss in the western world. 

Researchers from King’s College London, Moorfields Eye Hospital, and the University of Southampton examined the records of more than 30,000 individuals whose genetic information and retinal scans were housed in the UK Biobank. The researchers compared the retinal measurements of persons with and without the 34 genetic risk factors for age-related macular degeneration (AMD). 

The results, which were reported in the journal Scientific Reports, demonstrated that individuals with healthy eyes and no prior history of Macular Degeneration had thinner retinas if they possessed the risk-posing genes. 

Along with Prof. Pirro Hysi of King’s College London and Mr. Praveen Patel of Moorfields Eye Hospital, Andrew Lotery, professor of ophthalmology at the University of Southampton, led the study. He said, “At the moment, most treatments for AMD only begin when patients have already experienced severe vision problems, so it is essential that we understand more about what causes it. These findings aid in our comprehension of the disease’s very early phases before it manifests clinically. It is more probable that we will be able to save sight if we can act sooner. 

Which cells are initially impacted by AMD has not been completely understood by prior studies. Additional analysis of the retinal scans in the biobank revealed that individuals with the genetic risk factors also had thinner photoreceptors, which perceive light in the eyes. According to the study team, this helps them better understand the early phases and will assist them in deciding which cells to focus on in future studies. 

While more research is still required to determine a solution, early detection of AMD warning signs would enable people to adopt lifestyle choices that might increase their chance of saving their vision sooner. 

Professor Lotery said, “Changing to a Mediterranean-style diet, exercising more, and quitting smoking may help delay the advancement of the illness.” In order to include individuals who are most at risk, he said, “These results may also help us narrow down the participants in future clinical studies.”

Diagnosis of Age-Related Macular Degeneration 

Your Optometrist or Ophthalmologist may do the following tests to identify age-related macular degeneration in addition to a thorough medical history and eye examination: 

Test of visual acuity. This widely used eye chart exam evaluates a person’s distant vision. 

Dilation of the pupils. Eyedrops are used to enlarge the pupil so that the retina of the eye may be seen up close. 

Angiography using fluorescein. A particular dye is injected into an arm vein during this diagnostic procedure to identify wet age-related macular degeneration. Pictures are then taken while the dye travels through the retina’s blood vessels, assisting the physician in determining whether or not the leakage is treatable. 

Amsler Grid. This test employs a grid that resembles a checkerboard to see whether the patient’s straight lines in the pattern seem wavy or absent. It is used to identify wet age-related macular degeneration. Both symptoms might be signs of macular degeneration.

Pre-Diagnosis testing

Genetic testing that serves as early warning signs of macular degeneration

Approximately 70% of the risk for AMD is derived from genetic variations (Gorin, 2012). After extensive genome-wide association studies and family-based linkage studies, over 25 genes have been shown to impact the risk of getting AMD. Early, middle, and advanced phases of AMD have been linked to the initiation, development, and participation of genes impacting a number of biological processes, including genetic loci linked to the control of complement, lipid, angiogenic, and extracellular matrix pathways. 

The highest risk of AMD is seen in loci based on frequent single nucleotide polymorphisms (SNPs). Complement factor H (CFH) and  (ARMS2)/HtrA age-related maculopathy susceptibility 2 serine peptidase 1 are two important AMD loci that have been found in several ethnicities (HTRA1). Although ARMS2 and HTRA1 alterations have both been investigated as possible AMD risk factors, the two genes’ close proximity makes it challenging to tell whether a gene is linked to an elevated risk for AMD or whether both genes are to blame. Complement 2, Complement 3, Complement Factor B, and Complement Factor 1 are additional genes in the complement system that have been linked to AMD (CF1). 

Hepatic lipase (LIPC), lipoprotein lipase (LPL), and ATP-binding cassette (ABCA1) may also be involved in the high-density lipoprotein (HDL) cholesterol pathway, according to large genome-wide association studies (Lim, 2012). AMD has been linked to the extracellular matrix pathway genes tissue inhibitor of metalloproteinase 3 (TIMP3), vascular endothelial growth factor A (VEGFA), and the collagen matrix pathway genes COL10A1 and COL8A1.

An Early Warning about Zinc

For years now it has been thought that zinc was highly beneficial for AMD. For many that are still the case.

Recent scientific research from 2018 and 2019 provides convincing proof of the connection between a certain genetic group and long-term zinc usage (such as the AREDS formulations), which accelerates the disease’s development to wet AMD (nvAMD) in individuals with dry AMD. This most recent study builds on years of earlier genetic findings in AMD. 

An international team of researchers under the direction of Dr. Demetrios Vavvas (Harvard University and the Massachusetts Eye and Ear Infirmary) conducted the largest and most thorough validation of the clinical utility of the Vita Risk test, which revealed that 15% of patients carried a genetic profile that increased progression to wet AMD after prolonged exposure to zinc. Two complement factor H risk variants paired with no risk markers at the ARMS2 locus are referred to as this genetic profile. These are the two main genes linked to an increased risk of AMD. Compared to patients not getting supplements, these patients had a risk of nvAMD development that was approximately three times higher.

Is it better to know early?

A developing subset of medical tests that varies from diagnostic medical tests is predictive genetic testing in asymptomatic persons. The clinical value of predictive genetic testing varies significantly, despite the fact that the goal of such tests is early identification of risk for a certain ailment to improve monitoring and prevention. Genetic testing may put patients through undue mental or financial hardship with measures that may not have a significant impact on the result given the degree of ambiguity involved in predicting when a disease may begin or how severe it will be. 

Angiogenesis inhibitors or retinal surgery are now the sole options for treating exudative (wet) AMD, a less prevalent type of the disease. However, the former only manage the illness with repeated medication, while the latter cannot stop the disease from returning. However, the far more prevalent atrophic (dry) type of AMD is incurable and does not respond to therapy meaning medication. However, studies do show that it responds to certain nutrients and lifestyle changes. Epigenetic studies and treatment protocols are starting to play a role in functional medicine and many patients that are adopting these lifestyle and dietary changes are finding that their disease slows dramatically if not actually improves. 

Leo Semes, O.D., a former professor at the University of Alabama-Birmingham School of Optometry and a founding member of the Optometric Retina Society, comments that this is why there is a dispute. 

However, we must also understand that even if you have a predisposition, there are actions you can take to influence modifiable risk factors, according to Dr. Semes. “There are certain studies that appear to indicate specific gene types being more sensitive,” he adds. 

You may give up smoking, decrease your cholesterol, be mindful of how much light you are exposed to outside, and possibly think about taking antioxidant supplements like lutein and zeaxanthin, which studies are still trying to prove.

Conclusion

Knowing the early warning signs of macular degeneration and getting treatment earlier in the process is always better than waiting until permanent damage is done. The fact that we have the technology to determine if we have the genes to potentially cause macular degeneration and we have in-office tools to measure retinal thickness which is also a risk factor is great news for those that may be at risk. 

Be proactive with your overall health, practice healthy eating habits, educate yourself about supplements and have regular eye exams. 

FAQ’

Is macular degeneration genetically detectable? 

A combination prognostic and pharmacogenetic DNA test called Macula Risk® PGx is intended to assess a patient’s risk of developing severe Age-related Macular Degeneration (AMD) and to assist in choosing the best eye vitamin formulae for AMD based on his or her unique genetic risk profile.

What percentage of macular degeneration is inherited? 

At least one first-degree family, such as a brother or parent, has age-related macular degeneration in 15 to 20 percent of those who have it. 

Which foods should people who have macular degeneration avoid? 

Foods to stay away from if you have AMD: 

• Trans-fat-containing processed foods. 
• Tropics, such as palm oil (use vitamin E–rich safflower and corn oil instead) 
• Margarine, shortening made from vegetables, and lard. 
• Fatty dairy products (eggs in moderation are a good source of eye-healthy nutrients) 
• Fatty pork, lamb, and beef.