Ask an Expert about Macular Degeneration

There are reports linking warfarin use with development of wet age-related macular degeneration/macular bleeding. According to a 2003 research report in Heart, Volume 89, issue 9, p.985, it is recommended that the international normalized ratio (INR) be kept on the lower end of the recommended range in patients with a history of or recent diagnosis of wet macular degeneration/macular bleeding. Your eye doctor can provide you with more detailed information about your specific situation.

Genetics contribute to age-related macular degeneration (ARMD), so if your daughters have dry ARMD, your sons are also at higher risk for developing the disease. ARMD is also age related, and this disease more commonly manifests itself with increasing age. No clear link has been established between ARMD being more common in either men or women. Though most scientific studies have not found that ARMD is more common in either men or women, a handful of other studies have demonstrated a slight increase in prevalence of ARMD in women.

The exactly link between aspirin and worsening of age-related macular degeneration (ARMD) is not known. Three well designed studies have reported a possible association between aspirin usage and worsening of ARMD. Likewise, three other independent well designed studies did not find this relationship. Thus no clear relationship has been defined between aspirin and ARMD. You should discuss your concerns with the physician prescribing the medications and continue taking the aspirin until you talk with him/her. Importantly, do not stop the aspirin unless it is recommended by the physician who regularly prescribes your blood thinners.

Many types of hereditary macular degeneration can affect young children, and the prognosis varies considerably depending on the exact type of macular degeneration. Your niece may benefit from evaluation by an academic retina center, and also evaluation by a low vision specialist. An academic center may be able to help establish a firm diagnosis for your niece. Strong academic centers in India include L. V. Prasad Eye Institute in Hyderabad and Aravaind Eye Institute in Madurai. Your retina specialist may be able to send your nieces’ retina photos for an opinion from specialists at either of these or other centers. Moorfields Eye Hospital in London has a particularly strong inherited retinal disease department as well. A low vision specialist can help your niece maximize her existing vision. With training and assistive devices from a low vision specialist, your niece may have an easier time reading, taking notes, and completing other tasks of daily living. Your current retina specialist can likely give you a referral to a local low vision specialist. Most large eye centers have therapists with this expertise on staff.

Some studies have reported an increased association between aspirin consumption and a slight increase in rates of various types of late-stage age-related macular degeneration (AMD. This theory is still undergoing study, as the association shown does not prove cause and effect. In other words, these studies do not explain how aspirin might be causing increased progression of AMD, only that it people at higher risk for AMD are often taking aspirin. Aspirin is often prescribed against pain and heart disease, and is used regularly by about nearly 1 in 5 people in the US.

It is always prudent to consult your physician(s) before taking supplements and either over-the-counter or prescription medications. Your physician will be able to help balance potential risks against the other potential health benefits of any activity, including taking aspirin.

If your husband has wet age-related macular degeneration (ARMD), Lucentis is a very common treatment. In clinical trials, Lucentis preserved vision in 90% of patients, but improved vision in only 40% of patients with wet ARMD. Your husband many not belong to the 40% of patients that notices significant visual improvement after Lucentis treatment. Other commonly used treatments for ARMD include Eylea and Avastin, which have comparable treatment success rates to Lucentis. Some patients may react better to one eye injection compared to another. Ask your husband's retina specialist if a trial of one of these other wet ARMD injections would be appropriate.

Your right eye could be blurry for a variety of reasons including things related to your cataract surgery and/or your age-related macular degeneration (ARMD). You may be light sensitive for a variety of reasons related to one or both processes as well. Without a complete eye exam and possible testing, it would be difficult to differentiate between the multiple things that could be causing your symptoms based on your description alone. You might also consider getting a second opinion from a retina specialist regarding the prognosis of your symptoms and what could be causing those symptoms.

A minority of patients (about 10%) with dry-age related macular degeneration (ARMD) convert to wet ARMD and the most effective treatment for wet ARMD is an injection of a certain type of medication into the eye. In multiple clinical trials, these medications preserved vision in 90% of patients, but improved vision in only 40% of patients. People require different frequencies of treatment, and the most common dosing plan is monthly.

If the left eye has wet ARMD, the right eye is at higher risk of developing wet ARMD. The risk can be as high as 75% in the next five years depending on whether certain features were observed in the right eye during the examinations.