Ask an Expert about Macular Degeneration

Obesity has long been included in the list of known risk factors for macular degeneration, and one might expect weight loss to indeed have a positive effect in terms of slowing the progression of the disease; however, given that so many variables likely play a role in the development and progression of macular degeneration, and the fact that there are differences between one patient and another, there are no guarantees.

According to a 2001 scientific report published in the American Journal of Ophthalmology (Volume 132, pgs. 271-273) by a University of Wisconsin Medical School research group (Tomany SC, Klein R, and Klein BE), there is no association or link between drinking coffee/caffeine consumption and incidence of macular disease. Preventive strategies are provided in our Macular Degeneration Risk Factors and Prevention section of the website.

There does not appear to be at present any clinical evidence linking or associating Crohn's disease and macular degeneration genetically or otherwise. However, it seems that you have a history of the disease on both sides of your family (paternal and maternal). Because your family has a known incidence of macular disease, and a history of Crohn's disease, which as you mentioned may affect one's ability to properly absorb nutrients, it is highly recommended that your younger cousins and other relatives pay close attention to changes in their eyes. It is important to mention however, that initial changes in vision due to problems with the macula, the portion of the retina affected by macular degeneration, may be very subtle, so complete/comprehensive annual eye exams by an ophthalmologist are very important.

A blurry central spot that is not present at certain times, can be one of many things from something simple such as a refractive error, cataract, or dry eyes, to issues that are more high risk, like age-related macular degeneration. A skilled eye exam can detect most of these conditions, so a normal eye exam is very reassuring. If your symptoms do not improve or continue to worsen, please request serial exams by your ophthalmologist. Symptoms of most diseases become more evident with time, even if not initially apparent.

From this description of symptoms only and not exam findings, it is challenging to come up with a definitive diagnosis. Your visual symptoms could be from a range of conditions, some harmless, and others visually threatening. For these symptoms, please have an examination and appropriate testing from an ophthalmologist.

Eye misalignment, called strabismus, is common in children. A very small degree of eye misalignment may not cause issues, but a larger degree of eye misalignment may cause permanent loss of vision in the deviating eye; this is called ambylopia. Your child should be examined by a pediatric ophthalmologist to test for strabismus and ambylopia. Both can be treated very successfully if caught early.

The eye injections such as Lucentis, Avastin, and Eylea are the currently best available treatments to control wet age-related macular degeneration (ARMD). These injections have been shown in multiple clinical trials to prevent vision loss in 90 percent of patients, and to improve vision in about 30 – 40 percent. Your brother may not be in the 30 – 40 percent of patients that observe significant visual improvement with the eye injections. The eye injections do not cure wet ARMD, they only control it. Stopping injections thus could lead to the worsening of ARMD and possibly permanent loss of vision. Your brother should discuss the benefits and risks of stopping the injections with his retina specialist so that he can make an educated decision based on his specific situation.

In several large clinical trials, Lucentis stopped vision loss in 90 percent of patients, and improved vision in about 30 – 40 percent. You mother may not be in the 30 – 40 percent of patients that demonstrates an improvement in vision after taking Lucentis, especially if she has had prior laser treatment for age related macular degeneration. Laser treatment for wet age-related macular degeneration (ARMD) was minimally effective in stopping vision loss from ARMD, and sometimes resulted in scarring of the retina and worse vision. This unfavorable risk to reward profile is why laser treatment is not commonly used today to treat wet ARMD.