Macular Degeneration Show Segment

Q. Dr. Margherio, older people are always worried, properly so, about their eyesight, but we keep hearing about something called, Macular Degeneration. What is that?

A. Well Macular Degeneration is really, especially for the elderly, is the single most common form of permanent loss of vision. It affects the back part of the eye called the retina and a very small portion of the retina generally speaking. Something about the size of a head of a pin. That's the macular. That's where all clear vision is centered.

Q. But then when there's something damaging in that area, what happens? We go blind?

A. Well you don't go, you go legally blind. In other words the definition of blindness in the state of Michigan is 2200 or the person can see something at 20 feet. What the average person or normal person can see at 200 feet. So that the individual can see, for instance, if they were looking at you they could see that you were there. But they wouldn't be able to recognize your features because they'd be looking straight at you and it's this area straight ahead, the little spot in the center that is sort of blurry or blanked out and depending on the degree of macular degeneration, the size of that blank can be larger or smaller.

Q. Well now, what happens when it degenerates?

A. Well the tissues under the retina, the blood vessel layer under the retina becomes porous and blood vessels grow under the retina forming a scar and it's really the scar that affects the center of vision.

Q. Well that, it's such a tiny area and you say scar tissue. That really is scary.

A. Well it really is a very tiny spot, you know, and as far as the total area of the retina or of the eye is concerned it's a very very tiny spot. But, if that's spot's affected by an injury or, in this case, by macular degeneration, you're at a situation where you can't read, you can't see clearly things on television, you can't write your checks, and you can't drive.

Q. Is this, peculiar, then to old, you said, in case of injury or something. So I suppose that would imply that could happen to somebody younger but, is it mostly for older people have this problem?

A. It's rare that a person in their 20's or 30's. Generally speaking we think of, in fact it's called age-related macular degeneration so that it primarily affects folks over 60 years old.

Q. Well now I'm sure that like most of the population most of us do wear glasses some of the time or all of the time. So, obviously, we have been to a physician to find out what we need. Does this degeneration, this macular business, does that, is it caught in a standard eye exam?

A. Yes. Of course if you're having problems, I mean serious problems, it's very easy to detect. You know yourself you can't see well. But early on you can be suspicious of something. For instance, if you have a relative, a grandmother or grandfather, mother, father especially or other siblings, brothers or sisters who are having problems with vision the glasses won't take care of. You are at risk to develop macular degeneration. And, especially if you're blue-eyed. So it's familiar.

Q. Especially if you're blue-eyed.

A. Especially if you're blue-eyed. So, you know, folks like you and I are certainly at that risk.

Q. Well, I didn't know I had blue eyes but yeah, being at risk. Well now, if it's something that you say you notice this yourself, but not until it gets pretty bad, is there any way we can tell before it gets that bad?

A. Sure. You know everybody starts let's say at a normal situation. But as you'll see from our booklet there on macular degeneration, there are some changes that occur in the retina before you develop symptoms. Before you have visual problems. These are discoloration's in the back portion. In the macular region. They are called drusin. Which is the scientific name but really all they are are little yellowish-white spots and your ophthalmologist can look in there and say, "Well you've got drusin. You are at risk for the development of macular degeneration. If you see these things happening to you, then we want you to contact us immediately."

Q. Well now there's even another thing that I keep hearing about or heard about from you and from the people here at Beaumont and this is this amsler grid. What's that, what's that all about?

A. Well the amsler grid is like a graph paper. It's a series of squares and what we suggest to our patients who are at risk either from a hereditary point of view or if we visualize these drusin on the examination, is you take this grid home with you and put it up on the refrigerator for instance and every day, take, with your glasses on, close one eye, look at the grid, and see if the lines are straight. Then close the other eye and look at the grid and see if the lines are straight. Many times people look at things with both eyes and you really can't tell if one eye is having a problem. You really have to close the one eye, check the other eye. Close the other eye, check the original eye. That's the only really, the way you're going to be able to tell. And if you start to see these areas of distortion, then you have to contact your ophthalmologist immediately. And I mean, you know, like within hours.

Q. That quick.

A. Well, what we have found is that if we catch this problem in the first two weeks, about 75-80% are treatable. treatable meaning we can use a laser and try and arrest the problem. After about a month or two, less than 5% are treatable. So it's really critical those first few days.

Q. And by having this amsler grid, this, just these neat little squares, we can almost, we can test ourselves.

A. You can test yourselves. That's right. And the, you know another way, if you happen to be away from your little grid or whatever, or if you just happen to be going down the street, I suggest to folks if you're in a car, and you're not driving, look at the lines on the road. Look at telephone poles and again, close one eye, close the other eye and see if you see a wave. If you see a wave, again, you could have a problem. Or if you're reading and you start noticing that you're dropping letters. That you can see a six letter word you can see five out of the six letters but something near the middle or toward one of the ends is dropping off consistently, again, it's a sign that something's wrong. Everybody thinks that, "Well it's just my glasses." Well it probably isn't just your glasses. There's something happening. If there's a change that's there and it doesn't go away.

Q. Well, you've I think not scared everybody but certainly taught us some caution and also indicated that there are treatment. You said laser. What other, is there any other kind of treatment?

A. Well generally speaking laser is the accepted form of treatment. Here at Beaumont, we, for the past 12 years now been involved in something called immaculate photo coagulation study which was trying to demonstrate whether or not laser treatment was effective in this for of, in this form of disease and it is. It is a destructive type of treatment but it will arrest the condition in certain cases. So it is very useful. Other things that have been proposed in the papers recently and on TV, there is an anti-cancer drug called Interferon and you've heard about Interferon and there's a very small report that's come out of the west. West being California, that maybe there's some use for this drug in the treatment of macular degeneration. People who have established macular degeneration. Who have already got the blood vessel growing, the bleeding and all that. We're really not sure about that. It's, I would put it in the experimental category at this point. The other thing that, two other things that people have talked about, number one is sunlight. Ultraviolet specifically. And so, in the elderly we suggest, well actually for everybody, we suggest the use of ultraviolet filtration on your glasses. It's relatively inexpensive, it's safe, there are no side effects, it's not going to hurt. And also, there's been a movement recently about nutrition. Especially zinc and some of the other trace elements. We have a concern about that. It, that has not been proven to be of value but the government, in fact, has chosen 11 sights around the country, Beaumont being one, to study the efficacy of zinc and other vitamins as to whether or not they are of any value in the treatment or prevention of cataracts and macular degeneration. The problem there is, unlike the UV protection, they could have serious side effects. Zinc for instance in taken in certain dosages which are not considered excessive. Now when you're not thinking about treatment of this sort, can cause an anemia. It can cause elevated cholesterol, and those things have their own serious problems.

Q. Well now you said vitamins as well as zinc you mentioned vitamins there. Does that indicate that maybe we shouldn't take vitamins or I realize I'm pinning you down here a little bit but I don't want people to be frightened.

A. Well I think it's like everything else. Moderation is really the key word isn't it. I mean it's the key word regarding fats, nutrition and I think most nutritionists will feel if you eat a balanced diet you don't really need vitamins. Now most vitamins are just excreted in the urine and so it's just a matter of an expense. But there are some vitamins, zinc being one of them, which is the one particular thing that's touted in the treatment of macular degeneration which can be dangerous taken in doses which are available over the counter readily.

Q. Yes. You, as a physician, obviously you're not going to give any patients anything of which there is even the slightest doubt, but some of these things you can get right over the counter. Vitamins, you can buy them any place. Buy them in a grocery store.

A. That's true and unfortunately to my way of thinking at least and I think other folks in the field feel the same way, some of these vitamins have now been packaged with names on them that would give one the connotation that they are good for a specific portion of the body like the eye. In other words, the term eye, or some portion of the eye being portion, a portion of the name of the vitamin. And I think that's a little bit misleading and I would be, I think if someone want to take vitamins that's one thing but to have companies promote substances which have not been proven to be of value, is in my perspective a little misleading.

Q. You are being very tactful about that and yet I think getting the point across that we shouldn't really self-medicate ourselves under any circumstance and certainly not, well, eyes are pretty important too to a customer and as I'm sure you know I know you're involved here at Beaumont in a National Institutes of Health study on these things. Is that right?

A. That's right. It's a ten year program and it's going to take a long time to come to any conclusions but this is an effort by the National Institute of Health to, in some degree to this fact that so many of our seniors are now spending hundreds of millions of dollars on these supplements. Food supplements. Trying to see, you know, are they any good and or how much danger is there to them. So they'll be individuals who we will be working with here who will be on different doses of these vitamins and minerals to see, just to see what happens. Nothing dangerous but, to a point of, that we think might have some therapeutic efficacy.

Q. And I'm sure that when you have a definite answer of something that's really good for us or going to help, we'll hear about it because that's your field and what we need to know. I think what I'm getting out of this is yes there's something simple we can do. The amsler test at least gives a little early warning sign, but see your physician, your specialist. Am I right so far?

A. You're right on target.

Q. Yeah. Because this is nothing we want to fool around with. Now we've had to go over a great deal of information here and you've been very clear with it. On the other hand a lot of people are going to want to know a little bit more. Where can we get information on this?

A. Well we'd be happy here at the institute to send prints of amsler grids and whatever other information individuals might like if they'd just call 551-2020. Area 313 for those folks outside of the area, we'd be happy to send free of charge, the amsler grid and other information.

Q. And the one thing that I have seen on this and I give you, or whoever put this together, high marks. It's nice, big print. Thank you.

A. You're welcome.

NOTE: William Beaumont Hospital Eye Institute is located in Royal Oak, MI. The Phone number has been changed and is (248) 551-2020 as of 5/1/98