Doctor Raises Macular Degeneration Awareness

By Jessica Goodman
Times-News Staff Writer

Published: Monday, March 30, 2009 at 4:30 a.m.
Last Modified: Sunday, March 29, 2009 at 9:14 p.m.

Two years ago, Gisela Hennig, 83, noticed straight lines weren’t so straight.

“I was sitting on my porch and I noticed the window sides were kind of crocked,” she said. “I didn’t know what was wrong, but something wasn’t kosher.”

She went to the ophthalmologist and was referred to Dr. Robert Park, the retina specialist at Carolina Ophthalmology. He diagnosed her with age-related macular degeneration.

“Age-related macular degeneration is a disease that affects a deep layer of cells underneath the eye,” said Park.

The eyes work similarly to a camera, explained Park. In a camera, light enters and is focused on film. In the eye, light is focused onto a light sensitive layer known as the retina. The most sensitive area of the retina is a yellow-colored area called the macula. According to Park, the area is about the size of a pencil eraser. Macular degeneration occurs when the RPE cells, which feed and support the light sensitive cells in the macula, are damaged. When the RPE cells are damaged, the light sensitive cells die and vision worsens. The central vision will gradually be lost to the point of legal blindness. Macular degeneration is the leading cause of legal blindness in the western world, explained Park.

“With time, (sufferers of macular degeneration) notice they’re developing a black spot or a gray spot,” said Park.

Helen Letner, 67, thought she was suffering from cataracts at first.

“The right eye just kept getting worse and worse,” she said.

When she went to see her eye doctor, her doctor realized it wasn’t the cataracts that were affecting her eyes. She was diagnosed with macular degeneration.

“It’s frightening because none of us want to go blind,” said Letner.

There are two forms of macular degeneration. Eighty-five percent of people have the dry type of macular degeneration, which is characterized by RPE cells becoming diseased and dying. Blindness gradually develops over the years. Treatment for the dry type of the disease is mostly preventive or to slow the disease’s progression and stabilize a person’s vision. Patients are encouraged to stop smoking and increase their intake of leafy vegetables, nuts and fish or fish oil.

“It’s a disease that’s very common,” said Park.

Both Letner and Hennig have the wet form of age-related macular degeneration. Fifteen percent of patients have the wet form of macular degeneration.

With the wet form, “new blood vessels grow from a deep layer of the eye called the choroids into the space under the RPE cells,” said Park. “The new blood vessels are fragile and leak blood and fluid causing rapid central vision loss.”

“If they’re looking at a door frame or look at perhaps a telephone pole, they may notice a section of the pole disappears or the pole is bending,” said Park. “They may be able to see the beginning or the end of a sentence, but not the middle.”

Legal blindness quickly develops with the wet form. Treatment is centered around stopping new blood vessels from growing. Park uses a new drug called Lucentis, introduced in 2005, which helps prevent new blood vessels from growing. Patients usually get multiple injections into the eye from four months to two years. According to Park, 96 percent of patients have stabilization of their disease with 40 percent having improvement of eyesight.

“The first time I was here, I couldn’t see the big E on the chart,” said Letner. After her first injection, she could see several lines down.

“I was a little scared,” said Hennig. “There’s a new medication and it seems to help.”

The average age of the loss of sight related to macular degeneration is 65. The earliest onset of the disease is 40. Symptoms include blurry vision, blind spots and the appearance of crooked lines.

“I couldn’t imagine going blind,” added Park, when asked why he wanted to raise awareness. “Sight it precious.”

Park suggested contacting your eye care professional immediately if you see any of the symptoms.