Science & Research

Yes, studies aimed at evaluating the effects of these and other compounds on age-related macular degeneration (AMD) are being performed. These include studies conducted using experimental models (cell culture and/or animal models of AMD) to look at the effect of drugs on specific factors or processes known to be associated with AMD development.

To put it simply, each of these studies* examined the effects of the drug in question on specific cell types or processes that are known to be critically involved in development and/or progression of AMD.  And, based upon the findings of their respective studies, each group speculated some potential benefit of the drug in the treatment of AMD.  Studies of this type lay the foundation for others aimed at determining whether these compounds can eventually be extrapolated to treatment of human patients with AMD.  Additional studies based upon analysis of patient database information are also being performed (i.e., studies that attempt to correlate the number of patients who had or developed AMD while taking various medications may help determine whether there is an increased or decreased risk of development and/or progression of the disease, or if there no apparent relationship). This is particularly true regarding the potential use of statins like simvastin for AMD treatment.   So the short answer to your question is yes; the research is being done. Some preliminary studies have been inconclusive whereas others have been promising, but we still likely have a ways to go before seeing any of these compounds incorporated into the daily care of AMD patients.

* In a recent study by Yoshida et al., (FASEB Journal (2010) volume 24, no. 6, pgs.1759-1767), it was reported that digoxin inhibits retinal ischemia-induced Hif-1alpha and ocular neovascularization.  

Hoffman et al. (Graefe's Arch Clin Exp Ophthalmol. (2006) volume 244, pgs. 376-381) studied the effects of verapamil isomers on the proliferation of cultured choroidal endothelial cells.

A cross-sectional study conducted by Hall et al. (British Medical Journal (2001), volume 323, pgs. 375-376) evaluated the risk of macular degeneration in statin users and suggests a possible association between statin use and lower risk of AMD.

The prognosis for your daughter depends on her exact subtype of macular degeneration. Age-related macular degeneration (ARMD) is the most common type, and is not typically seen in people under the age of 55. It is unlikely she has ARMD because of her age. If she is very nearsighted (-15.5 in the left eye) she could have myopic degeneration. With this disease, she is more prone to the formation new blood vessels, called choroidal neovascularization (CNV). If diagnosed using fluorescein angiography and OCT imaging, these new blood vessels can be very effectively treated. Currently, CNV is not treated with gene therapy, but rather with injections of Avastin or Lucentis, and less commonly with a specific type of laser treatment, called photodynamic therapy (PDT).

You are exactly correct that Fuchs' dystrophy may limit your husband's vision. Even if he did not have age-related macular degeneration (ARMD), the Fuchs' dystrophy could cause slowly worsening vision. Please speak to your eye specialist about the severity of your husband's Fuchs' dystrophy so that you can estimate its impact on his vision compared to the ARMD. Imporantly, multiple treatments exist for Fuchs' dystrophy including drops and corneal transplant, from which your husband may benefit. Reduction or gain of one line of vision may be due to chance rather than the effect of Avastin or worsening of ARMD. Different eye charts, lighting conditions, etc. can result in a minimal fluctuation in vision, such as a difference of one line.

At this juncture, most drugs have not definitively been associated with age-related macular degeneration (ARMD) progression, which is why such warnings are not commonplace. Smoking has been definitively proven to worsen ARMD progression in multiple studies and this is a main risk factor that can be changed.

Smoking has been definitively proven to worsen age-related macular degeneration progression (ARMD) progression in multiple research studies. Smoking cessation would be very important for the ARMD as well as for general health. The relationship between alcohol and ARMD is not as clearly defined; however alcoholism can lead to a host of other health problems, so please speak to your brother about seeking treatment for his possible alcoholism.

The term foveal dystrophy describes a broad group of disorders. Without knowing the specific kind of foveal dystrophy it would be difficult to describe specific symptoms. Most foveal dsytrophies would result in some decrease in central vision or color vision.

Avastin injections are typically used to treat wet age-related macular degeneration. (ARMD). This disease is extremely unusual in patients younger than 55, so you likely have a different type of macular degeneration. Without knowing the specific eye disease you have I cannot comment on the likelihood that you will develop the same disorder in the other eye.

Avastin does leave the eye and can spread to the blood circulation. Since it prevents new blood vessel growth it can certainly interact with a pregnancy, though the exact impact is unknown. Prior to trying to get pregnant, it would be very important to have a discussion with your retina specialist about the possible systemic effects of Avastin upon pregnancy. They may cease treating you with Avastin when you begin trying to conceive.

Exercise on the hydraulic equipment will not increase the progression of age-related macular degeneration (ARMD). Weight bearing exercise does not commonly cause any side effects in the eyes or vision. Very rarely, heavy weight lifting, coughing, bearing down, or other straining activities can cause bleeding inside the eye independent of ARMD. This bleeding typically resolves spontaneously without long-term problems, however.