A National Eye Institute study has reported an impressive success rate at early detection of wet (neovascular) age-related macular degeneration (AMD). The study compared two groups of dry AMD patients and compared the proportion within each group for patients presenting with 20/40 acuity or better when their wet AMD was detected. An experimental group used the FDA-cleared daily home monitoring device called ForeseeHome (Notal Vision Ltd.) to self-monitor their vision, while a control group used either personal observation and/or the Amsler grid.
Amazingly, 94% of patients in the ForeseeHome group detected neovascular changes at the level of good functional vision (20/40 or better), compared to only 62% of patients in the control group. The ForeseeHome system represents a singular advance in the detection of early wet AMD, often detecting wet AMD prior to any symptoms. To date, the system has logged over one million tests.
Prevention Before Intervention
On the heels of AMD Awareness Month in February, an intriguing question was recently raised: why don’t more people see their eye doctors for annual eye exams? (“Eye Exams: More Important Than You Might Think”). A “prevention before intervention” approach certainly exists for cancer screenings. Should it not also apply to eye health in general, especially when it comes to age-related macular degeneration (AMD)?
One can only speculate that this absence is due to lack of disease awareness of AMD, and dry AMD in particular. Many people have heard that AMD is the leading cause of blindness in people over the age of 60, and that over 11 million people have some form of it. What they don’t hear enough, however, is that the devastating symptoms of the wet form of AMD are often not discovered until significant vision has already been lost. Is there anything that can be done to detect wet AMD at a much earlier stage, before it has a chance to progress to visible symptoms?
There are steps that can be taken that empower people to take charge of their AMD disease progression. It starts with having regular eye exams and frequent monitoring of any symptoms using the familiar Amsler Grid and the ForeseeHome in between doctor office visits.
AMD is caused by a number of known factors, including age, genetics, obesity, smoking and high blood pressure to name a few. It can creep silently into one’s life as early dry AMD. Since, at this stage, one may not notice any obvious symptoms, some people opt to forego their recommended annual eye exam. Even as it progresses to intermediate dry AMD, some may notice only a blurred spot in the center of their vision and may compensate for this by using more light to read and to do other tasks. They may not realize that their vision could be converting to wet AMD, wherein abnormal blood vessels grow beneath and into the retina. If this goes untreated, quick vision loss is almost always certain.
Statistics show that 10-20% of dry AMD cases advance to wet AMD. The damage may be rapid and severe, unlike the gradual changes that occur with late stage dry AMD. It is impossible to predict when someone may convert from dry AMD to wet AMD, so vigilant monitoring for signs of progression is required. Studies have proven that the earlier the detection of AMD, the better the chances of preserving good functional vision. Dry AMD progression can be slowed by good dietary and behavioral practices. Anti-VEGF drug therapy has been available as an approved treatment for wet AMD since 2004. It does not, however, guarantee complete success. Factors such as the size, position, and age of the blood vessel affect the performance and outcome of the drugs. In cases where treatment has been delayed, multiple injections have failed to stop leaking blood vessels due to damage that is too great, visual acuity too poor, or retinal scarring has formed.
More effort must be made to diagnose AMD at a much earlier stage to ensure the greatest chance of preserving good functional vision. What proactive steps can one take to detect dry AMD early and/or subsequently prevent the disease from progressing unchecked?
- Have an annual eye exam. This is the single most important action that will help to diagnose dry AMD early, before it progresses to advanced dry or wet AMD.
- If diagnosed with intermediate or advanced dry AMD, schedule frequent check-ups with a retinal specialist or ophthalmologist. Ensure that the appointment following diagnosis is scheduled no later than 6 months afterward.
- Ask about available tools and technology to self-monitor your condition between exams. In addition to testing with a simple Amsler grid, monitoring daily with the more technologically advanced ForeseeHome AMD monitor (www.foreseehome.com) can help detect when intermediate or late-stage dry AMD converts to wet AMD. This system will contact the patient’s doctor if significant changes are occurring with respect to the progression of AMD disease.
- Make lifestyle changes. These include maintaining a well-balanced diet, taking recommended nutritional supplements, and following the rules for good eye health.
Proactivity empowers the patient with personal charge of eye health, and it is a wise investment in preservation of functional vision and quality of life.