Ask an Expert about Macular Degeneration

For age related macular degeneration (ARMD), medicines injected into the eye like Lucentis are typically considered first-line therapies. Photodynamic therapy still is used for a certain subset of patients with ARMD who do not respond to Lucentis or other intravitreal* injection agents.

*Intravitreal refers to the eye's vitreous humor between the lens and the retina.

Anyone considering cataract surgery should be aware of the risk of bleeding, infection, loss of vision, prolonged recovery of vision, and loss of the eye. These risks are very low, but not zero percent. The results of the cataract surgery can be limited by the macular degeneration and glaucoma. For example, the age-related macular degeneration can limit the final gain in central vision and the glaucoma can limit the final gain in peripheral vision, depending on the severity of each disease. Cataract surgery can also cause brief but intense elevations in eye pressure that can be vision threatening to patients with severe glaucoma. The optimal eye for initial surgery should be decided by your mother and an eye surgeon, who is aware of the severity of all disease processes in your mother's eyes.

Acular is the brand name for ketorolac, and they are the same drug. These eye drops are typically used to treat retinal swelling from a variety of causes, and are not commonly used to treat age-related macular degeneration (ARMD), but your husband's eye doctor can more fully explain why he/she is prescribing this treatment.

Tremendous strides have been made in researching and bringing them cell therapies for macular degeneration to clinics in the United States. While I can't speculate for certain when such therapies would be made readily available, you can contact clinicaltrials.gov and/or the National Eye Institute to receive more detailed information regarding trials, etc. Though you may feel that the United States is lagging behind other nations in this regard, it is important to note that before medical procedures, drugs, etc. are made available for public use, there are safeguards in place that require stringent testing to minimize any unwanted or undesired side effects that could potentially harm individuals. As such, the time devoted to fully researching and understanding these issues is much needed and will likely benefit us all in the long run. For more information about stem cell therapies, please visit the International Society for Stem Cell Research website.

The major reasoning behind many countries starting to phase out the use of incandescent light bulbs is to encourage the use of more energy-efficient alternatives such as compact fluorescent or LED lighting. However, if you feel very strongly against this, you may want to write or call your local or state government representative(s). While I'm not an expert on various types of lighting, you are correct that compact fluorescent bulbs do contain mercury. However, after researching the topic, it appears that the potential danger from mercury released from one broken bulb is not substantial. Instructions for properly cleaning up a broken compact fluorescent light bulb can be downloaded from the EPA website. As far as comparison of the brightness of compact fluorescent bulbs versus incandescent bulbs, the packaging on all compact fluorescent bulbs should list "equivalent wattage values," which will help in selecting a bulb with comparable brightness or lighting effectiveness as an incandescent bulb.

It is currently believed that the presence of large drusen and/or the loss of retinal pigment epithelial (RPE) cells (the cells that nourish the photoreceptors), lead to a decrease in the blood supply to these regions of the eye. This decrease in blood supply is associated a decrease in the supply of oxygen to these areas, which causes a condition known as hypoxia. In an attempt to provide emergency or alternate supplies of oxygen to these areas, the affected cells release growth factors, which include vascular endothelial growth factor (VEGF), a major stimulant of new vessel growth. These new vessels theoretically should bring oxygen back to depleted areas; however, because the integrity of these vessels is most often not very good (they are generally thin and leaky) they often do more harm than good. The growth of these new blood vessels appears to be a failed rescue attempt.

There are several types of macular degeneration that affect young people (i.e., children, teens, and younger adults). Generally, these "early onset" or "juvenile" forms of macular degeneration appear to be hereditary (genetically linked) and are commonly referred to as "dystrophies" rather than "degenerative" diseases of the macula. Types of early-onset or juvenile macular degeneration include: Stargardt's disease (the most common form of early-onset or juvenile macular degeneration), Best disease, and Sorsby's macular dystrophy. According to one estimate found in a 2007 research report, approximately 10,000 people in the United States are affected by juvenile macular degeneration.

Pigment changes and one or more large drusen inside the macula would be consistent with age-related macular degeneration (ARMD). Thinning on the OCT may also be consistent with atrophic changes observed in ARMD as well. Specific eye vitamins have been proven to decrease the progression of ARMD for a certain subset of patients, and other eye vitamins are still under investigation. Your eye doctor can provide you with your exact diagnosis and discuss appropriate treatment options.