1. ADVANCES IN RETINA AND
NUTRITION IN AMD
The Retina Centers Of Washington
www.retinaone.com
Georgetown University
Rockville- Arlington offices
T.S. Melki, MD
December 15, 2012
3. Age-Related Macular Degeneration
(AMD) Defined
AMD= disease associated with aging
that gradually destroy sharp, central
vision.
AMD can advance so slowly that people
notice little change in their vision. In
others, it can progresses much faster
and may lead to a loss of vision in both
eyes.
Two types: Dry and Wet AMD
4. Dry AMD
Occurs when the light-sensitive cells in the
macular slowly breakdown, cause gradually
blurring central vision.
Three stages of dry AMD:
1- Early AMD: several small or medium-sized drusen.
Patients have no symptoms.
2- Intermediate AMD: many medium-sized or one or
more large drusen. They can see a blurred spot in the
center of their vision.
3- Advanced Dry AMD: in addition to drusen, patients
have a breakdown of light sensitive cells, causing
blurred spot in the center and getting bigger over time.
5. Wet AMD
WetMD occurs when abnormal blood
vessels behind the retina start to grow under
the macular.
These new blood vessels tend to be very
fragile and often leak blood and fluid.
The blood and fluid raise the macular from
its normal place, causing macular edema.
Lossof central vision occur quickly without
treatment.
7. Epidemiology
The Beaver Dam Eye Study:
30% individuals aged >75 have some
form of AMD
7% of those have an advanced form
Recent studies:
8 million Americans to be at risk of
developing advanced AMD in the next 5
years
8. Epidemiology
The cause of AMD remains unknown
Mild
association between hypertension and
AMD
Smokinghas been demonstrated to be the
most consistence modifiable risk factors
Greater levels of plasma vascular endothelial
growth factor (VEGF), von Willebrand factor,
and fibrinogen, as well as increased plasma
viscosity, in patients with AMD
9. Treatment for Dry AMD
Once dry AMD reaches the advanced
stage, no treatment can prevent the vision
loss.
However, treatment can delay and
possibly prevent intermediate AMD from
progressing to the advanced stage.
The National Eye Institute’s Age-Related
Eye Disease Study (AREDS) : taking a
specific high-dose formulation of
antioxidants and zinc reduces the risk of
advanced AMD.
10. INDICATION FOR AREDS
Extensive intermediate drusen ( 64- 124
µm in diameter)
At least one large drusen (≥ 125 µm in
diameter)
Noncentral geographic atrophy
Advanced AMD in 1 eye
11. AREDS 2
Examine the effects of high
supplemental doses of dietary
xanthophylls ( 10 mg lutein and 2 mg
zeaxanthin) and ω−3 LCPUFAs (DHA
and EPA) on the development of
advanced AMD.
Results are likely to be announced in the
second quarter of 2013
12. We Are What We Eat
- Ho et al. analyzed the risk of early AMD
in a cohort of 2167 individuals whose CFH
and HTRA1 genotyping was known.
( CFH Y402H variant : ↑ AMD risk 11x
HTRA1 A69S allele: ↑ AMD risk 15x )
- Increase intake of zinc, ᵦ-carotene, ω−3
fatty acids and lutein/zeaxanthin each
significantly reduced the hazard ratio of
AMD development .
13. We Are What We Eat
Overall, the data suggest that we
are not entirely at the mercy of our
genes. A well-balanced diet
including foods rich in zinc, ω−3
fatty acids and antioxidants might
avert the genetic decree.