ADVANCES IN RETINA AND NUTRITION IN AMD

The Retina Centers Of Washington www.retinaone.com

Georgetown University Rockville- Arlington offices

T.S. Melki, MD December 15, 2012

Anatomy of the Retina

Age-Related Macular Degeneration (AMD) Defined

 AMD= disease associated with aging that gradually destroy sharp, central vision.

 AMD can advance so slowly that people notice little change in their vision. In others, it can progresses much faster and may lead to a loss of vision in both eyes.

 Two types: Dry and Wet AMD

Dry AMD   Occurs when the light-sensitive cells in the

macular slowly breakdown, cause gradually blurring central vision.

  Three stages of dry AMD:

  1- Early AMD: several small or medium-sized drusen. Patients have no symptoms.

  2- Intermediate AMD: many medium-sized or one or more large drusen. They can see a blurred spot in the center of their vision.

  3- Advanced Dry AMD: in addition to drusen, patients have a breakdown of light sensitive cells, causing blurred spot in the center and getting bigger over time.

Wet AMD  Wet MD occurs when abnormal blood

vessels behind the retina start to grow under the macular.

 These new blood vessels tend to be very fragile and often leak blood and fluid.

 The blood and fluid raise the macular from its normal place, causing macular edema.

  Loss of central vision occur quickly without treatment.

Wet AMD

Epidemiology

The Beaver Dam Eye Study:

  30% individuals aged >75 have some form of AMD

  7% of those have an advanced form

Recent studies:

8 million Americans to be at risk of developing advanced AMD in the next 5 years

Epidemiology

 The cause of AMD remains unknown

 Mild association between hypertension and AMD

 Smoking has been demonstrated to be the most consistence modifiable risk factors

 Greater levels of plasma vascular endothelial growth factor (VEGF), von Willebrand factor, and fibrinogen, as well as increased plasma viscosity, in patients with AMD

Treatment for Dry AMD  Once dry AMD reaches the advanced

stage, no treatment can prevent the vision loss.

 However, treatment can delay and possibly prevent intermediate AMD from progressing to the advanced stage.

 The National Eye Institute’s Age-Related Eye Disease Study (AREDS) : taking a specific high-dose formulation of antioxidants and zinc reduces the risk of advanced AMD.

INDICATION FOR AREDS

  Extensive intermediate drusen ( 64- 124 µm in diameter)

  At least one large drusen (≥ 125 µm in diameter)

  Noncentral geographic atrophy

  Advanced AMD in 1 eye

AREDS 2

  Examine the effects of high supplemental doses of dietary xanthophylls ( 10 mg lutein and 2 mg zeaxanthin) and ω−3 LCPUFAs (DHA and EPA) on the development of advanced AMD.

 Results are likely to be announced in the second quarter of 2013

We Are What We Eat - Ho et al. analyzed the risk of early AMD in a cohort of 2167 individuals whose CFH and HTRA1 genotyping was known.

( CFH Y402H variant : ↑ AMD risk 11x

HTRA1 A69S allele: ↑ AMD risk 15x )

- Increase intake of zinc, ᵦ-carotene, ω−3 fatty acids and lutein/zeaxanthin each significantly reduced the hazard ratio of AMD development .

We Are What We Eat

Overall, the data suggest that we are not entirely at the mercy of our genes. A well-balanced diet including foods rich in zinc, ω−3 fatty acids and antioxidants might avert the genetic decree.

Wet AMD case 1

Wet AMD case 1- s/p 1st IVA

Wet AMD case 1-recurrent

Wet AMD case 1-s/p 2nd IVA

AMD case 2

AMD case 2 (cont.)

AMD case 2 – s/p IVA

Case 3-Before IVL

Case 3: After IVL – 5 weeks

Case 3: 2 mos- slightly increasing fluid

Case 3: after reinjected IVA

Case 4: Before IVA

Case 4: After IVA – 6 weeks

Case 5

Case 5- Fluoresceine

Case 6- Before and after IVA

Case 7: Wet AMD, 2-mo s/p IVA

Thank you for your attention

Questions are welcome