DR. HOOK- See here! Heed macular degeneration signs

"Out of sight, out of mind." I have some patients who subscribe to that philosophy. If they don't know what unhealthy condition is brewing under the surface, they think things are great.

Unfortunately, that makes me the target not to be seen. "Dr. Hong, I really like you, but you also represent the Grim Reaper. I'm just waiting for you to diagnose me with some God-awful disease." 

My response is, "Does the Grim Reaper wear Johnston & Murphy shoes? I don't think so!" 

I'm just there to counsel patients, and the rest is truly up to them. However, not everyone likes to hear, "According to the medical literature, you have a 400 percent increased risk of heart disease."

I, too, am guilty of not wanting to know things– not with my health, but with things like how much I owe the IRS on April 15, and whether there's really a drought, and Oprah's current weight. However, being short-sighted can rob you blind.

Age-Related Macular Degeneration (ARMD) affects 1.7 million Americans, and all you Baby Boomers out there are going to make it rise to three million pretty soon. The macula (which sounds like Dracula) is the center of vision in the retina. When the doctor asks you to look straight into the light (and some see a tunnel), the doc is looking at your macula. 

Impaired central vision affects things like reading, driving (in particular at night), watching shows, and seeing fine things. The vision can become distorted so that something straight like the Eiffel Tower looks more like the arch of the Leaning Tower of Pisa.

There are two categories of ARMD: dry and wet (sounds like an antiperspirant). Dry (atrophic) ARMD causes slow visual loss because it's a gradual process. Drusenoid deposits are junk material that fill up in the macula and can cause the macula to degenerate. The choroid region supplies blood to the retina. This starts to thin out in time with ARMD. If things progress too much, the result can be wet ARMD.

Wet (exudative; neovascular) ARMD is bad news, like Iraq. It progresses very fast, unlike dry ARMD. Over weeks to months, central vision loss and distortion occur. Literally, it can be a bloody mess. Abnormal blood vessels grow in the choroid, and if they leak, it can lead to retinal detachment. Also, if one eye has wet ARMD, there's a high risk the other eye will develop it too. (This is a case where 2-for-1 is not a bargain.)

So who's at risk? Older people. The condition is almost never seen in people under the age of 55. Smokers have two-to-four times the risk of non-smokers. A family history of ARMD, non-Hispanic whites, and people who have high fatty diets are more at risk. 

Eating fruits appears to lower the risk of ARMD. Possible things that might help include ginko biloba, lutein, zinc, vitamin C. Beta carotene and vitamin E might help, but high doses are associated with heart disease. (But at least you'll be able to see yourself in the ambulance mirrors on the way to the ER with a heart attack.)  

Mohit Nanda is a retinal specialist ophthalmologist here in Charlottesville. He treats macular degeneration and was a principle investigator with the drug Macugen, an intraocular injection. Yes, that's a needle in the eye– and I'm not telling a lie.  

Lucentis– another eye injection– should be coming out the fall. It blocks VEGF (vascular endothelial growth factor), a substance that stimulates the choroid vessels to grow abnormally and leads to vision loss. It should be interesting to see if these newer products will be able to shed some light for those who don't want to remain in the dark.

For more information, call Dr. Nanda at 434-978-2040.

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