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Macular Degeneration: The Facts
Published in Journal of the American Optometric Association, Vol. 62, No. 7, pp. 511-512, July 1991.
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Age-related (AMD) or senile (SMD) macular degeneration is an unfortunate misnomer for one of the common garden variety syndromes of blindness.
Fact one:
MD is confusing and counterproductive for several reasons. For one, all elderly people do not show evidence of macular degeneration (MD). Additionally, the label contributes to nosologic chaos. This logic, followed through, would justify new language such as age-related cancer, senile stroke, etc.
Fact two:
Just about every scientific paper dealing with MD begins with the point exemplified by David Newsome and his colleagues at the LSU Eye Center at Louisiana State University.1
“Macular degeneration…is the leading cause of severe visual loss in the United States and western Europe in persons aged 55 years or older…(it) is of unknown cause.”
As a matter of fact, history will confirm that our present notions of prevention and cure have not significantly progressed since MD was first described in the scientific literature over a century ago.
Fact three:
Even the public is constantly reminded of the deadly frustration of MD.2 The following is excerpted from Newsweek.
“After AIDS and cancer, the medical crisis Americans fear most is blindness…More than half of all Americans with low vision have macular degeneration, a deterioration of the retina that is the number one cause of visual deficiency in the elderly…Ophthalmologists often fail to refer patients to low-vision organizations…’I can’t stand the fact that many of my colleagues abrogate their responsibility,’ says Dr. Eleanor E. Faye, who was a pioneer in developing low-vision as a clinical specialty. ‘No orthopedist would tell a patient, well, the bone is knit and your arm is bent at a 45-degree angle but there’s nothing more I can do for you.’”
Fact four:
Granted, there is only a low, albeit positive, correlation between the number and quality of reports. Nonetheless, there is no question that if there are no publications, there cannot be any of quality!
On this premise, we simply inventoried the number of MD publications in one of our leading scientific listing services (Index Medicus). Three points are evident. During the 10 year period 1980-1989, there were 609 articles of which 202 are in foreign languages (and therefore not readily available for study). In other words, there were approximately 40 articles per year available in the English language.
Secondly, the overall annual increase in the number of reported articles has been minimal–in fact, almost zero during this decade. In contrast, there has been an explosion of information on AIDS from 320 articles in 1983 to approximately 6,000 in 1989. The importance of this comparison is heightened when one realizes that while there are obvious differences in these two syndromes, there are also commonalities. This confirms the sharp difference in the interest in AIDS research and the relative lack of concern for MD.
Thirdly, a more intensive scrutiny of Index Medicus reveals that MD reporting appeared in 26 admittedly arbitrary categories. Interestingly but not surprisingly, much attention was devoted to the pathophysiology of MD. Noteworthy and understandably, palliation (largely with laser) was accorded much space. On the other hand, prevention received hardly any attention (only three articles during the 1980s). And most relevant here, etiology averaged just two or three reports annually.
Fact five:
Even the sparse literature makes it clear that macular degeneration is a chronic disease. This translates into the obvious fact that it must be a multifactorial origin and that it should follow ecologic principles. This is now part of a new and emerging hypothesis eloquently stated by Richard Young of the UCLA Jules Stein Eye Institute.3
“A course of action intended to retard the progress of macular senescence and thereby postpone its ultimate transition to degenerative disease can be based on the general principle of preventing unnecessary damage to retinal molecules. Identification of an environmental source of molecular damage–solar radiation (or comparable radiation produced by artificial sources)–provides the foundation for a program of preventive medicine against AMD. Two general strategies are suggested: Optimize the body’s natural defenses against photodynamic effects by dietary means, and, most importantly, protect the eye against the harmful effects of bright sunlight…”
Fact six:
There are many unresolved pieces to the puzzle. What we need now is an organized effort to put them all together. This will definitely take more than the usual two or three articles per year! These brief words are intended to catalyze interest in a more intense and structured approach to the ecology of macular degeneration.
References Cited:
- Newsome DA, Swartz M, Leone N, et al. “Oral zinc in macular degeneration.” Arch. Ophthalmol. 1988; 106(2):192-8.
- Seligman J. “Making the most of sight: A brighter future for the millions of Americans with ‘low’ vision.” Newsweek 1990; 92-3.
- Young R. “Solar radiation and age-related macular degeneration.” Surv. Ophthalmol. 1988; 32(4):252-69.