Question: What is Macular Degeneration?
Dr. Young: Macular Degeneration is a condition which affects individuals later in life, although it can occur as early as in someone's 40s. We have learned that it is a 100% genetic condition, that is also affected by lifestyle choices, such as smoking, and sun exposure.
Question: Wait. You just said it's 100% genetic, but is affected by lifestyle?
Dr. Young: A person can have the genes for Macular Degeneration but may not experience vision loss or a severe form of the disease if they are not a smoker and protect their eyes from sun exposure. For example, smokers with this gene have a greater chance of having vision loss from Macular Degeneration.
Question: So, this is a senior people's disease?
Dr. Young: It generally affects people in the 60s and beyond, but it can occur as early as in someone's 40s.
Question: What part of the eye is affected by Macular Degeneration?
Dr. Young: Macular Degeneration affects the most sensitive part of the retina, which is called the macula. It is a condition where the outer layers of the retina become disrupted, which in turn affects the person's ability to read, drive, and recognize faces.
There are two forms of Macular Degeneration. A dry form which is most common. This affects about 90% of people diagnosed with Macular Degeneration. The other is a wet form, or hemorrhagic type of Macular Degeneration.
This wet form if more visually disabling and more aggressive of the two. There are a percentage of people who transition from dry Macular Degeneration to wet Macular Degeneration and that's why Macular Degeneration needs to be monitored very carefully.
We check the retina, and if we determine the patient has formations suggestive of Macular Degeneration, we will then do further imaging studies and genetic testing, called the Macula Risk Test, which allows us to determine a person's specific phenotype for the disease, meaning the person's particular genetic makeup of the disease. We like to do this test because it helps us determine which nutritional supplements are going to optimize their vision and decrease the chances for vision loss.
Question: If I don't show symptoms of Macular Degeneration, or anything you might suspect, then you wouldn't run the genetic test?
Dr. Young: Correct.
Question: What is the treatment for Macular Degeneration?
Dr. Young: There is no treatment for dry Macular Degeneration. We manage it with nutritional supplements. There is treatment for wet Macular Degeneration, to try and save the vision. This involves injections into the eye of Anti-VEGF. This decreases the blood vessel growth into the eye - shutting down the leaky blood vessels.
Question: Do people come to you complaining of symptoms or is Macular Degeneration more typically found during your testing?
Dr. Young: It's more typical for me to find it, and the patient to not know they have it. That's the dry form of the disease- the more common form. 90% of people suffering from Macular Degeneration have the dry form of the disease. They are older, their vision is declining, but they don't yet know that they have Macular Degeneration. During the course of our exam, when we perform the retinal evaluation, we will see these formations in the retina, in the macula, and they are called "drusin". These drusin spots are what make us begin our investigation for Macular Degeneration. If the patient has these drusin spots, we will explain everything about Macular Degeneration to the patient. We will ask if they have any family members that have it that they know of, and get more information from them about their lifestyle choices including smoking history.
We want to find out what stage they are at, the severity of the disease, do they have any blood vessel ingrowth, and whether it is the dry or wet form of Macular Degeneration.
We will then do a cheek swab for the Macula Risk Test. Once we get the results back, in two to six weeks, we can determine what nutritional supplements best fit their genetic profile, as well as determine what are their chances of progression to vision loss. Once we have all this information, we know how to monitor them to try to prevent vision loss.
Question: Does insurance cover the supplements?
Dr. Young: Yes. some insurance companies will reimburse for them. These antioxidant supplements are called nutraceuticals. They have been proven scientifically (during the AREDS studies, which provided information about the disease and how to prevent vision loss) to prevent further damage and to actually heal the eyes in some cases.
Question: Does insurance cover treatment for Wet Macular Degeneration?
Dr. Young: All treatment for Wet Macular Degeneration, including the injections, is covered by insurance.
Question: Is there anything else you would like to say about Macular Degeneration, which we haven't addressed?
Dr. Young: I would like to say that knowledge is power. Nobody likes getting bad news, but it's far better to know what could be ahead, and how to plan and prevent the most adverse of effects. It's very important. That's why everyone is urged to have their eyes examined annually.