By Maryann Gogniat Eidemiller.
FOR THE TRIBUNE-REVIEW.
Monday, April 17, 2006.
Gene Andolsek, of Crabtree, started losing his vision about six years ago, and having cataracts removed didn't help. He still couldn't see his lifetime stamp collection, and he was no longer able to create the precisely drawn artwork that has brought him national attention.
Andolsek, 84, has age-related macular degeneration, or AMD, the leading cause of untreatable vision loss among people over age 55. The eye disease affects more people than cataracts and glaucoma combined.
According to the National Eye Institute, one in 10 older Americans, or a total of 15 million, are affected by macular degeneration. Of those, 2 million will become legally blind. The institute projects that by 2025, more than 50 million Americans will have AMD.
"Just a few years ago, diabetic retinopathy was the leading cause (of vision loss), but now because people are living longer, it's macular degeneration," said Dr. Robert Johnson, an optometrist with Johnson Family Eye Care, in Latrobe.
"Diagnostic testing has gotten better, too," he said, explaining the increasing number of diagnoses. And the disease is making a bigger difference in seniors' lives.
"There are more visual demands than there were 50 years ago," Johnson said. "Maybe then, Grandfather was happy sitting on the porch, and now Grandfather wants to drive, play softball with the grandkids and read the stock market reports to check on his 401(k)."
Macular degeneration damages the macula, the central area of the retina at the back of the eye. There, blood vessels nourish millions of light-sensing cells that sharpen and transmit the visual image to the optic nerve, which carries the image to the brain.
The disease has two forms: The more common "dry" type develops gradually as cells disappear and the macula grows thin. In "wet" AMD, abnormal blood vessels leak fluid and blood under the retina, causing scarring and other damage.
Typically, AMD does not destroy sight totally. Instead it causes hazy or distorted vision, color distortion or blackened areas, usually in the center of the visual field.
It's equally common in men and women. Some people may have a genetic predisposition to developing the disease.
Like 95 percent of AMD patients, Andolsek has the dry type -- and it has slowly stolen the quality of his vision. Last year he could barely see his own artwork when it was exhibited at the American Folk Art Museum in New York City. This year, he said, the picture on his television is hazy, he can't read at all, and he even has trouble with the controls on the player for his audio books.
"Listening is not the way I like to enjoy books," Andolsek said. "And I really miss reading the sports page."
There is no cure for dry AMD, but certain vitamin and mineral supplements may slow its progression. Ocuvite, an over-the counter supplement by Bausch & Lomb, is often recommended by doctors. Johnson advises his patients to use that, and to supplement their diet with 6 milligrams of lutein and 2,000 milligrams of omega fish oil or flax seed oil each day.
"But you should always seek the advice of your own health care provider," he cautioned. "Is there any way to prevent macular degeneration? Quit smoking, and keep your cholesterol, triglycerides and blood chemistry within normal limits. And wear protective eyewear or brimmed caps to decrease exposure to ultraviolet rays."
That's advice that should be followed even in childhood, Johnson added. According to an educational program by Transitions Optical, 80 percent of a person's lifetime exposure to UV rays occurs before age 18 -- and some research suggests that early exposure to blue and ultraviolet light may increase the chances of having AMD later in life.
Because of his interest in low vision, Johnson was instrumental in helping to establish a low-vision occupational therapy center at Excela Health Latrobe Hospital.
That's where Mary Jo McDonald, 82, of Latrobe, found help adapting her environment to accommodate her decreasing vision after the "wet" form of AMD began to take a toll.
"We can address any activity of daily living skills, and we look at the whole person," said Ann Amatucci, inpatient therapy manager at both Latrobe and Frick Hospital in Mt. Pleasant. "The very first thing we look at is what's the best form of magnifier, or a pair of glasses or other optical device. Then we look at tasks like distance TV (viewing), or reading, or putting on makeup and shaving."
Therapists may visit patients' homes to help them to learn to use the new devices, and to suggest helpful changes, such as repositioning furniture.
"Ann fixed my computer so that I have large letters that I can see, and that was very helpful," McDonald said. "Then she marked positions on my washer and drier (so I could) see where the dials belong, and on the controls on my oven and range. She also made some marks on my telephone."
McDonald's right eye was affected by AMD eight years ago, and the disease spread to her left eye two years ago.
"I had four laser treatments in the left eye, but they can't do anything with the right eye," she said. "That one's completely gone except for side vision."
Laser therapy is an option for certain patients with wet macular degeneration. Others may be treated with medication injected into the eye.
"The best that these treatments can do is stabilize the eye, and we can try to preserve (vision), not make it any better," said Dr. Miguel Busquetes, an ophthalmologist who is specially trained in retinal diseases and retinal surgery.
Busquetes has several offices, including one in Greensburg. Seventy percent of his patients have macular degeneration, he said.
Those with the wet type may be treated with Macugen, a medication injected into the eye every six weeks for two years. It slows the growth of abnormal blood vessels and may stabilize the disease, he said.
Two other investigational drugs, Lucentis and Avastin, a cancer drug, show promise for actually improving vision.
Some of the world's leading research into AMD is being done at the Eye & Ear Institute of the University of Pittsburgh School of Medicine.
Because of its aging population, the Pittsburgh area has been hit especially hard by AMD. The region's large number of seniors, plus the abundance of multi-generational families, makes this a prime area for genetic research.
Dr. Joel S. Schuman, an Eye & Ear Foundation professor and director of UPMC Eye Center, said research physicians are looking into "the fundamentals of what causes macular degeneration." Several have identified genes that may prove helpful in understanding, diagnosing and treating AMD, he said.
Another research scientist is studying the genetics of the disease by investigating retinal development and abnormalities in zebra fish. The small, striped, aquarium fish are well-suited to this type of molecular and cellular research: In a period of just 72 hours, their retinas develop from a single sheet of cells to a layered structure with several distinctive functions.
Diagnosing AMD in its earliest stages is yet another goal. For patients, the first signs of AMD may be changes in vision -- fine lines that appear wavy instead of straight, or difficulty reading or watching TV.
Schuman was among the developers of optical coherence tomography, which produces high-tech images of the eye with a resolution of 3.5 microns -- about half the size of a red blood cell.
"This is a cutting-edge experimental unit that helps us in detecting and managing macular degeneration," he said.
As is the case with many diseases, doctors say early detection is the key to the best outcome.
For AMD, it's best to start with a dilated retinal exam by a vision specialist.
"Over 60 is probably a good time to start having those exams," Johnson said.
Maryann Gogniat Eidemiller can be reached at .
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