Macular Degeneration: Wavy Lines

The number of people with age-related macular degeneration (MD) is increasing due to the aging population. At 50 you only have a 2 percent chance of MD, after 75 that chance is 30 percent. Women are twice as likely to have MD as men. In 2003, an estimated 13,900 men and 27,000 women in the Netherlands had the condition.

What’s going wrong?

It is a disease in which the central part of the retina (the yellow spot, or macula lutea) in the eye malfunctions. The macula allows you to distinguish details and see clearly. Experts still don’t know exactly what causes MD. It is established that MD is the main cause of visual impairment and blindness over the age of 50.

And then?

As the disease As you progress, your vision becomes less and less clear. At a certain point, the central part of the visual field falls out: a blind spot has developed. There are two forms of macular degeneration. In the most common form of ‘dry’ MD, the yellow spot gradually deteriorates. In ‘wet’ MD, new blood vessels develop behind the macula. However, these break easily, resulting in bleeding and damage to the macula. Within weeks or months, this can lead to loss of central vision. In a few cases, the loss can be so rapid that a person becomes severely visually impaired within a few days. Dry MD can progress to wet MD.

What are the risk factors?

• Heredity. If one of your parents or siblings has MD, you yourself are four times more likely to have the disease than people who don’t have MD in the family.
• To smoke. This causes more than a quarter of all cases of MD. In addition, smokers are three to four times more likely to become blind from MD than non-smokers.

To a lesser extent:

• Excessive exposure to UV radiation (sunlight).
• High blood pressure, high cholesterol, cardiovascular disease.
• Eating unhealthy.

Does an eye test make sense?

Of course. Have your eyes checked regularly by the optometrist or ophthalmologist, especially if there is a family history of MD. Dry MD can only be tested by the optometrist or ophthalmologist.

When should you go to the doctor?

If you recognize one or more of these symptoms, you should immediately see your doctor or ophthalmologist: blurred vision; seeing straight lines as waves (lines in a text, a lamppost that looks crooked); seeing colors more dimly; find it more difficult to read; having difficulty distinguishing faces; seeing a blind spot in the center of the visual field. Good to know: in the beginning there are few warning signs, especially if the MD only affects one eye (the other eye unnoticed compensates for the deterioration).

How is it treated?

Miraculous results are achieved with the very latest treatment: injecting the eye with the vascular growth inhibitor Lucentis, named the greatest medical breakthrough of 2006 by the scientific journal Science. Research shows that in at least 94 percent of patients with this the disease progresses. can be stopped. The damage can no longer be reversed, but visibility will improve somewhat in about one third. Similar results are achieved with the vessel growth inhibitor Avastin. Furthermore, there is some evidence that patients with MD can prevent and slow the progression of the disease by taking supplements with high doses of antioxidants.

Ophthalmologist Reinier Schlingemann, who specializes in age-related macular degeneration at the AMC in Amsterdam:

“You should see wet MD as a raging fire. The sooner we can extinguish that fire, the more we can limit the damage. Unfortunately, patients often don’t see the ophthalmologist until late. People think of cataracts when they see worse. GPs too sometimes do not recognize the symptoms, while action must be taken as soon as possible. Once the damage has occurred, nothing can be done. In most cases we can now stop the disease with Avastin or Lucentis. But also hang on to this
The results depend on how quickly we can intervene.”

Good for the eyes

You can easily reduce the risk of visual impairment and blindness due to age-related macular degeneration (MD).

• Have your eyes checked regularly. Especially if there are risk factors for MD, it is a must to have your eyes checked regularly. Are you suddenly less sharp? Always have your eyes checked immediately.
• Do not smoke. Smoking is one of the biggest risk factors for MD.
• Protect your eyes from UV radiation. Excessive sunlight is a risk factor for MD.
• Eat healthy. The scientific evidence is mounting that a healthy diet protects against MD. Healthy: lots of green vegetables, lots of fruit and lots of unsaturated fatty acids (such as nuts, olive oil, fatty fish). Foods with a so-called low glycemic index contain carbohydrates that are absorbed slowly by the body, and are better for the eyes than foods with a high glycemic index (fast carbohydrates). Therefore, eat a lot of whole grain products, brown rice and legumes. The more fiber and the less processed the product is, the better. Examples of foods with a high glycemic index (and therefore a lot of unhealthy ‘fast sugars’) are cakes, cookies, white bread, white rice and sugary foods. There is also some evidence that high (but safe) dose vitamin C supplements protect against cataracts. This involves at least 360 mg of vitamin C per day.

To the optician, optometrist or ophthalmologist?

You can go to the optician for a normal eye test: measuring nearsightedness or farsightedness, the cylinder strength and the eye pressure. Optician is not a protected title. The designation ‘Recognised Opticians’ offers the guarantee that there is at least one MBO-certified optician in the shop. To have your eyes checked for macular degeneration, you can go to an optometrist and request an optometric examination.
Optometrists work at opticians’ shops and hospitals. Search via www.optometry.nl an optometrist near you (choose ‘Practice Finder’). An optometrist will always refer you to an ophthalmologist if you suspect an eye disease. For treatment you can only go to the ophthalmologist. You can of course also have your eyes checked by an ophthalmologist with a referral card from your GP. Only the ophthalmologist is reimbursed by the health insurer.