- The Washington Times - Monday, May 17, 2004

Walter Ross, a 90-year-old New York City resident and former Reader’s Digest roving editor, is legally blind from age-related macular degeneration he has had for 37 years. He can’t see enough to read or drive, and facial features appear fuzzy because of the disease, which affects his central vision.

“Don’t be sorry for me,” the upbeat nonagenarian says. “I’m able to do whatever I feel like doing, except drive in the Indianapolis 500.”

For the past 15 years, Mr. Ross has written a newsletter called Eyes Only for a nonprofit volunteer membership group helping others with the disease. He does so with the help of a computer program that reads aloud what he types.

“People were very unaware of [AMD] when I got it, and the first eye came before I understood what was happening,” he says.

Norman Burton, 70, of Kensington, another AMD victim, has been luckier. He has some peripheral vision in his left eye and is hoping to stem the loss in his right eye by taking part in a clinical trial being conducted by Dr. Karl Csaky at the National Eye Institute, part of the Bethesda-based National Institutes of Health.

The purpose of the treatment, which involves computer software as well as laser surgery, is to stop fluid leaking into feeder vessels in the retina in the back of the eye and ultimately, if possible, to prevent the growth of new vessels. Left unattended, such vessels can grow and lead to complete vision loss.

Unlike Mr. Burton, Mr. Ross has been unable to get help for a disease that is the leading cause of vision loss in adults 50 and older and which the Association for Macular Diseases Inc. — the New York-based nonprofit to which Mr. Ross belongs — says afflicts to some degree one-quarter of men and one-third of women by age 75.

Mr. Ross says the lesions in his eye were too close to the macula — the center portion of the retina that makes central vision and sharpness of perception possible — to try any form of treatment.

Mr. Burton sought help immediately when he noticed his right eye weakening. Even after only one month of weekly sessions as one of Dr. Csaky’s 20 research subjects, he has noticed some improvement. “It’s slight, but I can tell it hasn’t gotten worse,” he says.

The procedure, which can take several hours, begins with an injection of dye into the arm that will fill in the vessels in the area under study. A special imaging machine then scans and photographs the area in two dimensions. The resulting image is aligned by computer with an invisible infrared image to enable Dr. Csaky to pinpoint the exact portion of the vessel he wants to close off with the laser, preventing damage to the surrounding tissue. The experimental treatment works only on so-called wet AMD.

In wet AMD, abnormal blood vessels form beneath the macula and leak blood and fluid that damage the macula’s photoreceptor cells. Wet AMD progresses rapidly, often dramatically. In dry AMD, which accounts for as many as 90 percent of all cases, yellow-white deposits called drusen form in the retinal tissue beneath the macula. Dry AMD results in slightly blurred vision and can lead to wet AMD, which causes vision loss.

Dry AMD has three stages: early, intermediate and advanced. Any wet AMD is considered advanced.

At present, no treatment is available for dry AMD, and medical researchers are only cautiously optimistic about helping or delaying onset of the wet version. While fighting off the progress of wet AMD in his right eye, Mr. Burton is able to use magnifying devices to shop and read, but he no longer drives.

It is known that AMD has a genetic as well as an environmental component. Smokers are particularly vulnerable, as are people with a history of hypertension, cardiovascular disease, sun exposure, light skin and eye color, and farsightedness.

The disease affects 1.5 million Americans in an advanced form, with another 7.3 million in the intermediate stage. According to figures supplied by the NEI, the leading cause of blindness among white Americans is AMD or 54 percent of all blindness. Currently, 2,700 District residents have AMD, as do 27,000 Marylanders and 36,000 Virginians.

The best news to date is only relative and resulted from an NEI-sponsored study showing that high levels of antioxidants and zinc helped delay progression of dry AMD in about 25 percent of the cases. Lutein, a pigment found in dark green vegetables, and other nutrients are best taken in supplement form if recommended by a doctor; diet alone does not always seem to guarantee results.

Lutein is found in a normal retina, says Dr. Frederick Ferris, NEI clinical director, who adds, “We think if God put it there, she must have something in mind — a reason to be there.” A large trial is planned with thousands of patients to randomly assign them lutein. Another dietary aid about to be studied is fish oil because it’s clear in studies, he says, that people who eat omega-3 fatty acids found in cold-water fish have a slower progression of AMD.

The only new treatment to have come along in the past five years for helping wet AMD, Dr. Ferris says, is called photodynamic therapy. Dye is injected into a vein, which circulates through the eye and is absorbed by energy from an infrared laser. The dye characteristically sticks to and kills abnormal vessels. Unlike some laser surgery, it does not harm surrounding healthy tissue. However, it is temporary and may have to be repeated on a monthly basis.

Another approach that shows promise, again for wet AMD only, involves isolating and finding a way to neutralize proteins that stimulate the growth of blood vessels.

“In terms of treatment, we are doing better in the last 20 years, but we still have a long way to go,” Dr. Ferris says. “At present, there is nothing for the dry [type]. We have to continue working to see why it develops.”

Dr. Richard Spaide, a research-oriented physician at the Manhattan Eye, Ear, Nose and Throat Hospital in New York, is helping investigate the white blood cells that grow under the retina along with the blood vessels to understand how they behave. What he foresees is a combination approach that takes advantage of different treatment methods, depending on the type or problem, much as cancer is approached today.

“It probably won’t be one thing; we probably will be able to subtype,” he says. “A lot points to oxidative damage that you can’t attack at [age] 75 when the horse is out of the barn.”

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