Common eye disease affecting older adults can now be diagnosed before vision has been damaged

New research published in the Journal of the American Optometric Association reports that age-related macular degeneration (ARMD) can now be diagnosed in the early stages, long before symptoms are manifest and before vision has been damaged. In a related development, data from a pilot study indicates ARMD can be treated in its early stages and possibly reversed. The treatment includes ingesting lutein, a nutrient found in spinach, kale and other dark green, leafy vegetables.
While ARMD has long been thought to be an inevitable part of the aging process in some people, this research suggests that ARMD is more likely caused by a lack of lutein and other nutrients in the body.
One of the most common and most-feared eye diseases in older adults, ARMD progressively destroys central vision. In ARMD, the macula, located in the center of the eye’s retina, gradually deteriorates. The retina is a fragile lining at the back of the eye that contains layers of light-sensitive nerve cells, including rods and cones. These cells are vitally necessary for seeing. The macula is essential for seeing clearly at far and near distances and for seeing colors. In addition, the macula helps the eye see in lowlighting conditions and at night.
ARMD has no early noticeable symptoms; by the time they do appear, some vision has already been lost. The most common early symptoms include a decreasing ability to see objects in focus and distorted vision, in which objects appear to be the wrong size or shape and where straight lines appear wavy or crooked. A progressive loss of clear color vision is a more advanced symptom of this debilitating eye disease.

Although side vision remains in people with advanced ARMD, they are plagued with a dark or empty area in the center of their vision. The American painter Georgia O’Keefe documented the ravages of ARMD in her later paintings, some of which feature black disc-like masses in the center of the canvas. These vividly express the blindness and the blackness that lies in the middle of an advanced ARMD patient’s field of view. People with advanced ARMD cannot drive a car, read, watch television or play cards. The disease can make everyday personal care such as shaving or applying make-up very difficult or even impossible.

The ability to diagnose ARMD is a breakthrough considering that so many people have become legally blinded by it. ARMD currently affects approximately 10 million elders in the United States. The National Eye Institute estimates that this figure may reach 18 million by 2030. In addition, there currently is no medical or surgical treatment for the vast majority of patients who have the dry variety of ARMD.

According to Stuart Richer, O.D., Ph.D., author of the groundbreaking ARMD study, “A series of four diagnostic tests which are currently available in optometrists’ offices and are now being used for other purposes can be used to detect ARMD. After optometrists have read my articles in the Journal of the American Optometric Association,” he says, “they will understand how to diagnose the condition.” Noting that optometrists do not need to purchase any further examination equipment, Dr. Richer says that one of the tests, the contrast sensitivity test, will add additional time to an eye exam, which may result in a slight increase in the cost of the exam. The contrast sensitivity test is not currently covered by Medicare.

Regarding treatment of ARMD, “Nutrition is the way to go,” Dr. Richer says. According to research published in the January 1999 Journal of the American Optometric Association, consuming at least five fruits and vegetables a day is recommended, including spinach and other dark green leafy vegetables that contain the nutrient lutein, since these may help prevent age-related macular degeneration.
While some ocular vitamin formulas containing lutein and other nutrients in spinach are available, plain lutein gel cap supplements are also available from nationally distributed manufacturers, such as Twin Lab. Before taking these supplements, however, individuals should discuss them with a physician, says a spokesperson for the American Optometric Association. This is because spinach in vegetable or supplement form may be harmful to some people, including those who are using blood thinners or aspirin, and those who have high iron levels or kidney stones.

Dr. Richer, chief of the Optometry Section at the VA Medical Center in North Chicago, holds a Ph.D. in physiology and biophysics and has been researching the relationship between nutrition and ARMD for more than 10 years. His 1996 research study of antioxidants and ARMD found that supplements containing certain antioxidants, vitamins and minerals actually slowed or stopped the progression of ARMD in advanced cases. This 18-month study, also published in the Journal of the American Optometric Association, was conducted at eight VA medical centers in seven states, and at the Pacific University College of Optometry in Oregon.
Dr. Richer has received new funding to continue his research into nutritional links to ARMD. He has recently begun a controlled clinical trial study at the North Chicago VA Medical Center to further explore the early diagnosis and treatment of ARMD.

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