Age Related Macular Degeneration

The Causes
Genes

We inherit these from our parents. Genes are the genetic information that tells our body what chemicals to make. Overall, our genes may contribute to more than 50% of ARMD. This paper suggests that we will soon be able to work out who is at risk...the main genes have been found.

See Gene page   The genes that may cause macular degeneration probably control the way used-up chemicals are removed from the eye.

Being long-sighted (hyperopic) is also a risk factor

Lifestyle
A healthy lifestyle helps to prevent age related macular degeneration. This is important for the younger relations of age related macular degeneration sufferers:
Smoking

• Overall smoking accounts for 32% of ARMD. Even stopping at the age of 80 will reduce the risk of developing the disease. So if you have a relation with macular degeneration, try and stop as smoking may make it develop earlier. Smoking increases the risk of macular degeneration about 3 times. Macular degeneration occurs 10 years earlier in smokers. If you have macular degeneration, do try and stop. Even if you are 90 years old stopping smoking will help your eyes considerably. Passive smoking is also harmful: for instance, if your partner smokes cigarettes a day, you body receives 25% of the smoke, so that is equivalent to you smoking 5 cigarettes a day. 28000 cases a year in the UK. See 2002 report and 2003 study . Lithuania     Japanese  A new report here describes the risk of passive smoking (doubles the risk) and personal smoking (triples the risk) of both types of ARMD, that is geographic atrophy and neovascular. Each cigarette probably increases the progression rate or ARMD ~15%

• Regular Exercise 
• 30 minutes a day at least, walking, or more active exercise for younger people,  reduces risk by 70%  : a 2006 study. Exercise may help by preventing hardening of the arteries.
  30 minutes walking a day for example...regular walking, for example, three times a week will result in less than a third of the amount of neovascular ARMD compared to people who don't walk or exercise and who drive everywhere.
  
• A low blood pressure helps. A level of 140/85 or below is likely to be best. Blood pressure is written as '140/85', with the systolic/diastolic. Above 115 (systolic) the risk of heart disease increases. See the evidence and more.Macular haemorrhages are more likely with high blood pressure. More evidence Eye.
  
• Obesity is also a risk factor see.
  
• A low salt diet is important Salt and more than 2 units of alcohol a day may cause blood pressure to rise.
• Alcohol
• Too much may contribute indirectly by increasing blood pressure, and is related to ARMD, see     May be red wine (in small amounts) is healthier.Blood pressure rises after drinking (opposite...drinking 4 pints/bottle of wine).
  Each gram of alcohol puts systolic blood pressure up 0.24mmmHg, diastolic 0.16 mmHg. This means 1 pint of beer (2 units, each unit 8g alcohol) with 16gm of alcohol, if drunk every day, will put the systolic blood pressure up (16 x 0.25=) 4mmHg.
•  A healthy diet

• Experts recommend a healthy diet. This should include a variety of vegetables and fruit (at least 5-9 x 100gm portions/day) ( 2008) low fat only dairy food the minimum of trans and saturated fat the minimum of red meat, as part of a balanced diet oily fish ...2 small portions a week, Blue Mountain 2009, Australia 09 reduces aging 1-2 hours exercise a day A low salt diet is important Vitamin D reduces risk, (Vitamin D increases with sunilght)  Archives 2011 a Mediterranean or Japanese diet (as was 20years ago) will almost certainly protect.  Losing weight (if overweight) reduces risk Solid fats are harmful Eye 2011 Fruit/vegetables prevent 36-50% of ARMD see, see and see (fruit & vegetables lower homocysteine levels, and this improves blood flow). Pulses like beans are fine. Bread, pasta, rice and potatoes provide ‘energy’. Vegetarians have lower blood pressures and healthier lipid levels,  see . A healthy diet reduces homocysteine levels, which are associated with ARMD . Certainly saturated fats increase the risk of ARMD; and fish and polyunsaturated fats halve the risk. Avoiding certain fats helps, with strong evidence here (explained more clearly here for heart disease). Nuts may help prevent ARMD (small amounts...they are fattening).

  5-9 portions of fruit/vegetables a day, with portions of different colours 5 is a minimum..best 9 for men, 7 women, 5 children, see. The Guardian (2005) reviewed healthy diets etc, here, here , here , here and so on. See some epidemiology

• Vitamins
• If you are unable to eat this many vegetables, low dose multivitamin tablets may help, but too many vitamins may be harmful.   Lack of vitamins has been linked to macular degeneration
  Some research suggests that the pigments in vegetables, lutein, and two types ofzeoxanthin might be helpful, as these are the pigments found in the healthy macula.
  Against. See AREDS. BMJ
  Lutein is in most fruits and vegetables, one type of zeoxanthine is in corn, nectarines and oranges (and other yellow/orange fruits/vegetable), but one type is not normally present in the diet. However, some supplements include doses that are too high, so once again, these are probably best as part of a healthy diet.
  'Ocuvite-Lutein' is one preparation that may help. One paper suggested zinc may be helpful, but only in low dose, and is probably best as part of a healthy diet.
  ICap (Alcon), is available in pharmacies and optometrists. This has lutein and other vitamins in, and had been recommended by some ophthalmologists. Beta-carotene supplements are not recommended for smokers, as they may contribute to lung cancer. I Cap is similar to the AREDS vitamins that reduced ARMD risk by 28%.
  These supplements may not help (see), as some experts advise that people with a healthy diet may be harmed by taking vitamin supplements. A review (2006, Drug and Therapeutics Bulletin, not free online) recommmeded a healthy diet including green vegetables diet was preferable to supplements.
  If you have a healthy diet, ophthalmologists disagree.
  Oily Fish
  Oily fish twice a week reduces ARMD by 40%, especially oily fish such as tuna, mackerel, sardines, herring, and salmon. A Japanese diet may be helpful as above. Other omega 3 fats are helpful
  Cholesterol
  
  
  ARMD is commoner in people with higher cholesterol levels. Atherosclerosis, caused by a high cholesterol, does contribute to ARMD, see  
  Statin treatment reduces macular degeneration. See    see,   Although statin tablets are not yet formally recommended by all agencies, this author would recommend them for people with ARMD.  
  This paper & another found no benefit, so it is difficult to be certain.
  Naturally all relatives of ARMD patients should address this issue of fat levels in the blood, sticking to a low fat diet with plenty of exercise, avoiding obesity, just as described on this page for ARMD patients.
  Pathology
  
  Age-related macular degeneration is explained in more detail on other web-sites, such as the RNIB and NIH. This is an excellent animation: www.eyesight.org. Below is a brief description.
  Age-related macular degeneration (ARMD) is usually a progressive condition.
  Dry ARMD progresses over many years. See dry ARMD page. Sight does deteriorate, but most people manage to cope well, although reading is difficult and life may be different. In some types of dry ARMD progression may be very slow, but it may be quicker in other types.
  Dry ARMD may progress to the 'wet type', but this is not always the case.
  Wet ARMD  begins as new vessels growth in the macular area, causing retinal leakage and swelling. See wet ARMD page. It progresses to cause a scar in the macular area. If the scar is small, sight is reasonable; if large, the sight can be very poor.
  Imagine your retina has five layers. Normally this retinal appearance stays constant even in old age, but changes may develop as you get older.
  
  
  
  
  Glasses online