Advances in retina and nutrition in amd


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Advances in retina and nutrition in amd

  1. 1. ADVANCES IN RETINA AND NUTRITION IN AMD The Retina Centers Of Washington Georgetown University Rockville- Arlington officesT.S. Melki, MD December 15, 2012
  2. 2. Anatomy of the Retina
  3. 3. Age-Related Macular Degeneration (AMD) Defined  AMD= disease associated with aging that gradually destroy sharp, central vision.  AMD can advance so slowly that people notice little change in their vision. In others, it can progresses much faster and may lead to a loss of vision in both eyes.  Two types: Dry and Wet AMD
  4. 4. Dry AMD  Occurs when the light-sensitive cells in the macular slowly breakdown, cause gradually blurring central vision.  Three stages of dry AMD:   1- Early AMD: several small or medium-sized drusen. Patients have no symptoms.   2- Intermediate AMD: many medium-sized or one or more large drusen. They can see a blurred spot in the center of their vision.   3- Advanced Dry AMD: in addition to drusen, patients have a breakdown of light sensitive cells, causing blurred spot in the center and getting bigger over time.
  5. 5. Wet AMD  WetMD occurs when abnormal blood vessels behind the retina start to grow under the macular.  These new blood vessels tend to be very fragile and often leak blood and fluid.  The blood and fluid raise the macular from its normal place, causing macular edema.  Lossof central vision occur quickly without treatment.
  6. 6. Wet AMD
  7. 7. EpidemiologyThe Beaver Dam Eye Study:  30% individuals aged >75 have some form of AMD  7% of those have an advanced formRecent studies: 8 million Americans to be at risk of developing advanced AMD in the next 5 years
  8. 8. Epidemiology  The cause of AMD remains unknown  Mild association between hypertension and AMD  Smokinghas been demonstrated to be the most consistence modifiable risk factors  Greater levels of plasma vascular endothelial growth factor (VEGF), von Willebrand factor, and fibrinogen, as well as increased plasma viscosity, in patients with AMD
  9. 9. Treatment for Dry AMD  Once dry AMD reaches the advanced stage, no treatment can prevent the vision loss.  However, treatment can delay and possibly prevent intermediate AMD from progressing to the advanced stage.  The National Eye Institute’s Age-Related Eye Disease Study (AREDS) : taking a specific high-dose formulation of antioxidants and zinc reduces the risk of advanced AMD.
  10. 10. INDICATION FOR AREDS  Extensive intermediate drusen ( 64- 124 µm in diameter)  At least one large drusen (≥ 125 µm in diameter)  Noncentral geographic atrophy  Advanced AMD in 1 eye
  11. 11. AREDS 2  Examine the effects of high supplemental doses of dietary xanthophylls ( 10 mg lutein and 2 mg zeaxanthin) and ω−3 LCPUFAs (DHA and EPA) on the development of advanced AMD.  Results are likely to be announced in the second quarter of 2013
  12. 12. We Are What We Eat- Ho et al. analyzed the risk of early AMDin a cohort of 2167 individuals whose CFHand HTRA1 genotyping was known.( CFH Y402H variant : ↑ AMD risk 11x HTRA1 A69S allele: ↑ AMD risk 15x )- Increase intake of zinc, ᵦ-carotene, ω−3fatty acids and lutein/zeaxanthin eachsignificantly reduced the hazard ratio ofAMD development .
  13. 13. We Are What We EatOverall, the data suggest that weare not entirely at the mercy of ourgenes. A well-balanced dietincluding foods rich in zinc, ω−3fatty acids and antioxidants mightavert the genetic decree.
  14. 14. Wet AMD case 1
  15. 15. Wet AMD case 1- s/p 1st IVA
  16. 16. Wet AMD case 1-recurrent
  17. 17. Wet AMD case 1-s/p 2nd IVA
  18. 18. AMD case 2
  19. 19. AMD case 2 (cont.)
  20. 20. AMD case 2 – s/p IVA
  21. 21. Case 3-Before IVL
  22. 22. Case 3: After IVL – 5 weeks
  23. 23. Case 3: 2 mos- slightly increasing fluid
  24. 24. Case 3: after reinjected IVA
  25. 25. Case 4: Before IVA
  26. 26. Case 4: After IVA – 6 weeks
  27. 27. Case 5
  28. 28. Case 5- Fluoresceine
  29. 29. Case 6- Before and after IVA
  30. 30. Case 7: Wet AMD, 2-mo s/p IVA
  31. 31. Questions are welcomeThank you for your attention