How to See More Clearly in Your Future.

Ten million Americans have a degenerative eye disease. But some simple lifestyle changes can lower your risk.

Age-related macular degeneration (AMD) is a devastating eye disease that painlessly robs your vision. Although people rarely become totally blind and the disease isn't fatal, its victims become steadily unable to distinguish faces, read a newspaper or book, drive a car, watch television, or even walk safely. This is because the disease affects only the central area of your vision.

AMD affects about 10 million Americans, and, according to the Macular Degeneration Foundation, a new case is diagnosed every three minutes. Statistics predict that people in their 50s have about a 2 percent chance of developing AMD, with the risk factor rising to almost 30 percent for people over age 75. Unfortunately, medical research can offer neither a cause nor a cure for AMD, which affects the eye area known as the macula.

What Is the Macula?

The innermost of the three layers of eye tissue is the light-sensitive layer known as the retina, which is responsible for changing light energy into nerve signals. This is how your brain knows what you are seeing. And located in the middle of the retina is the exquisitely sensitive area known as the macula. The macula allows you to enjoy the small-scale features of your world. As the macula deteriorates, your ability to distinguish shapes and colors fades away, and your world dissolves into an indistinct blur.

The Two Forms of AMD

The disease occurs as the dry form, which accounts for approximately 90 percent of its occurrences, and the wet form. However, it's wet AMD that accounts for 90 percent of blindness. During an eye exam, doctors recognize wet AMD by the abnormal, fragile, and leaky new blood vessels growing toward the macula; it's the leaking blood vessels that rapidly destroy the macula. About 50-75 percent of people with wet AMD are treated with laser surgery. However, the benefits are short-lived, and this is merely a temporary solution. And because the leaky blood vessels continue to grow, the laser surgery needs to be repeated. Unfortunately, the success rate is low, and blindness follows.

The Risk Factors

The known risk factors for developing AMD are:

1. Age

2. Gender (According to some studies women may be at greater risk.)

3. Family history

4. Smoking

5. High blood pressure

6. Elevated blood cholesterol

7. Not wearing sunglasses while outdoors--also a risk factor for cataracts

As you can see, making some health lifestyle changes can reduce your risk factors for developing AMD.

Symptoms of AMD

There is no pain associated with either form of AMD. A common symptom of the dry form is slightly blurred vision, which may cause the person to require more light for reading or other tasks. Some people notice an increasing difficulty recognizing familiar faces until the person is very close. As the dry form slowly progresses, you may notice a distinct blurred spot in the center of your vision. Because initially only one eye may be affected, at first you may not notice the vision changes. On the other hand, people developing the wet form may notice a rapid loss of central vision. Another early symptom of wet AMD can be the wavy and distorted appearance of straight lines.

Diagnosing AMD

Eye-care professionals advise that people age 40-64 have a comprehensive eye exam every two to four years. And people 65 or older need one every one to two years. If you have any symptoms or risk factors, more frequent eye exams are recommended.

During the exam your doctor uses an Amsler Grid as a screening test for wet AMD. But keep in mind that some people don't see blurred, distorted, or wavy lines on the Amsler Grid. Another early sign that your doctor can detect is small yellow deposits in the retina called "drusen." However, the drusen aren't necessarily a hallmark for the disease but may forecast future vision problems.

Treatments for AMD

Unfortunately, the only treatments currently available are more powerful eyeglasses and machines that enlarge print. The laser surgery, mentioned earlier, only slows the relentless progression of wet AMD.

A new treatment for wet AMD, called photodynamic therapy, is undergoing testing by the Johns Hopkins University. It's a combination treatment using a light-sensitive medication called Visudyne, which is injected into an arm vein while a laser light is beamed into the eye. The therapy, described as a "smart missile," damages abnormal new blood vessels while leaving normal vessels and tissue alone. However, the therapy also requires additional treatments, and it only postpones the inevitable. And a drawback is that the photodynamic therapy is recommended only for people newly diagnosed. Presently the therapy has been approved by the U.S. Food and Drug Administration.

Prevention of AMD

Because the treatment choices are bleak, prevention appears to be the only option. And the exciting news is that prevention may be as straightforward as eating your fruits and veggies. Researchers are demonstrating that food substances known as carotenoids, especially lutein and zeaxanthin, may help reduce your risk of AMD. These two carotenoids are selectively accumulated by the body in the retina and macula of the eye. And because of their color they can filter out visible blue light, which theoretically causes the damage.

In fact, Joanne Curran-Celentano, of the University of New Hampshire, found an abnormally thin layer of these two carotenoids in the eyes of people with AMD. And then she discovered that a diet high in these substances can thicken the macula. Where can you find these two compounds? They're in dark, leafy green vegetables such as spinach, kale, collards, and mustard greens.

Another study presented in the November 9, 1994, issue of the Journal of the American Medical Association concluded that these carotenoids may decrease your risk of developing AMD by 43 percent. The article also stated that vitamins A, C, and E, because of their antioxidant properties, can protect the macula from deteriorating.

D. Max Snodderly reported, in a 1995 issue of the American Journal of Clinical Nutrition, that laboratory data indicates the carotenoids, especially lutein and zeaxanthin, and antioxidant vitamins may help to retard the destructive processes in the retina and macula that lead to AMD. As you can see, following the dietary guidelines of the "rule of five" and eating five servings of fruits and vegetables daily can protect your eyesight

Remember: the gift of sight is priceless. Start protecting your eyes now, and maybe you'll never need to utter the words spoken by a woman with AMD: 'I walk slowly so that when the disease steals my precious sight the memories will be etched in my brain forever." And you can continue seeing in your future.

Information and Support

If you have AMD, know someone who does, or simply want more information, contact the following organizations:

* Macular Degeneration Foundation, [phone]; www.eyesight.org

* Macular Degeneration Partnership and Help Center; www.MacD.net

* Macular Degeneration International, [phone]

* Prevent Blindness America; information on eye health and safety; copy of the Amsler Grid, [phone]; www.preventblindness.org

* American Academy of Ophthalmology, [phone]

* American Foundation for the Blind, [phone]; www.afb.org

* The Lighthouse National Center, [phone] or [phone]; www.lighthouse.org

* National Eye Institute, [phone]

Lorraine T. Parker is a writer living in Albuquerque, New Mexico