macular degeneration

My long - standing patient, Mrs. R, came in today for her annual eye exam. She has macular degeneration. Unfortunately she noticed that she could no longer see in 3 dimensions. To me this meant she had lost depth perception. Her right eye vision was worse than 20/200, the definition of legally blind. Her left eye saw 20/20. You need both eyes seeing well in order to have fine depth perception. While it is true that I cannot make her see better out of her right eye, she can take steps to protect her remaining vision.
Step 1: Don't smoke!! Fortunately she does not.
Step 2: Wear sunglasses outdoors to protect the macula from ultraviolet radiation.
Step 3: Monitor each eye at least once a week by covering one eye at a time and viewing a piece of graph paper (we give this a fancy name - an Amsler Grid). If the patient notices a distinct change in the vision in one eye, wavy vision, areas missing, that does not improve over the day, she should seek evaluation as soon as possible.
Step 4: Eat a diet rich in antioxidants or take a daily multivitamin. My patient is on Ocuvite Preservision. This very high antioxidant formula is used when significant abnormalities of the macula are noted. It can slow the disease progression. It is not yet been shown beneficial for milder forms of macular degeneration.
Step 5: Do your best to stay in good cardiovascular health.
Mrs. R told me she gave up driving after nearly hitting someone recently. Though the law states based on her vision she can still drive, she is acting prudently.
If her vision in her left eye worsens, I would have the sight center work with her to optimize her remaining vision. Patients with macular degeneration want to know if they are going blind. Sadly, some do over time. However, there are newer treatments available for some patients that can be vision saving. Lucentis and Avastin are injected into the eye and have been a wonderful part of the ophthalmologist's armamentarium. These drugs have been available for 2 years or so. Many patients ask if they can be treated with them. However, they are used only for wet macular degeneration, not dry. Wet is a complication of dry and means new blood vessels are growing into the macula, leaking blood and fluid and rapidly threatening the eye sight. It is not good to have this condition but the above medications can help. They do not aid in the treatment of dry macular degeneration which most patients have.