Ask an Expert about Macular Degeneration

The term “polar disk macular degeneration” is not a commonly used term in the United States. She may have degeneration of her macula from being nearsighted, commonly called myopic degeneration. In a variant of this condition, called “posterior polar degeneration” the eye slowly increases in length over time leading to a gradual degeneration of vision. This pathologic lengthening of the eye currently has no treatments. Myopic degeneration can also lead to other problems (such as new blood vessel growth) that can be treated, and these disorders can be treated by therapies available in India. Your sister is fortunate to have someone generous enough to offer her an eye transplant; however, the parts of the eye that are damaged in myopic degeneration cannot currently be transplanted.

Age related macular degeneration (ARMD) has two forms: wet and dry. A pigment epithelial detachment typically signifies that you have the wet subtype. Pigment epithelial detachments can occur for other much less common reasons, such as central serous retinopathy, inflammatory disorders, or lack of blood flow to the back part of the eye. Please clarify with your retinal specialist if your pigment epithelial detachment is from ARMD, and if you have the wet subtype of ARMD. Many clinical trials are ongoing for wet ARMD.

I find no research reports concerning gluten and retinal health. There are, however, a few case reports regarding patients with celiac disease, a disease characterized by gluten intolerance in the diet, which mentions that a number of patients with the disease also experience ocular problems. This may be due to the fact that patients with celiac disease often suffer from deficiencies in various vitamins, some of which are important for maintaining retinal health. Therefore, it may be plausible to assume that if a person suffers from gluten intolerance (a condition managed by following a gluten-free diet) and also has one or more known risk factors for age-related macular degeneration, then that individual may be more susceptible to the development of retinal problems such as macular degeneration. Again, this is only speculation, I've found no recent scientific reports demonstrating or suggesting a direct link between gluten and retinal health.

The macula is the center of the retina, and responsible for clarity of central vision. If your child has a genetic disease of the retina, he or she may have reduced clarity of central vision now or later in life. Whether this vision reduction is minor or major, stationary or progressive, will depend on the exact disease. Many people with genetic diseases of the macula live very full and productive lives. Your pediatric ophthalmologist can help determine the exact disease, and provide a referral to a physician specializing in ocular genetic diseases.

A retinal hole is an absence of retinal tissue surrounded by an adjacent region of normal retina. In contrast, a retinal detachment is caused by fluid between the retina and the retinal pigmented epithelium, which can result from a variety of causes. In some cases, retinal holes may cause retinal detachments by allowing fluid to reach the space underneath the retina. Not all retinal detachments are caused by retinal holes, however.

You are correct in thinking that the AREDS trial used higher than normal levels of some vitamins. The most common side effects during the trial were slightly increased rates of urinary tract diseases, anemia, and tooth discoloration in patients using the AREDS vitamins. Increased bleeding or bruising rates were not reported in patients taking the AREDS compared to control group patients, however. The AREDS vitamins can also interact with other medicines you may be taking to cause the increased bruising and bleeding. Please discuss this matter of increased bleeding with both your primary care physician and ophthalmologist; it is possible that you may have a hereditary bleeding disorder than requires medical evaluation.

Typically age-related macular degeneration (ARMD) is not seen in people younger than 45 years, so your age and exam findings could suggest a more aggressive disease process.  Approximately 27 percent of patients with intermediate macular degeneration will progress to advanced ARMD during a period of five years (based on the AREDS trial), so not all patients progress rapidly. People with slowly progressive disease will often die prior to severe vision loss from either advanced dry ARMD or wet ARMD. Please discuss the long-term prognosis with your retina specialist.

Melanin may be involved in the pathological process of ARMD, but the effects of potential melanin binding agents like Lamictal (lamotragine) on ARMD have not been well studied to date.

Injection therapy should not induce double vision. Double vision can be caused by a variety of reasons, some very benign and others very dangerous. While prisms placed in glasses can correct many types of double vision, it is more important to be evaluated by an ophthalmologist to see if you truly have double vision. If so, he or she can then determine its cause. Once your physician is sure that you do not have serious disorder causing the eye misalignment, corrective prisms added to glasses can be considered.