Advances in retina and nutrition in amd
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ADVANCES IN RETINA AND NUTRITION IN AMD
The Retina Centers Of Washington www.retinaone.com
Georgetown University Rockville- Arlington offices
T.S. Melki, MD December 15, 2012
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Anatomy of the Retina
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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
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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.
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Wet AMD Wet MD 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.
Loss of central vision occur quickly without treatment.
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Wet AMD
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Epidemiology
The Beaver Dam Eye Study:
30% individuals aged >75 have some form of AMD
7% of those have an advanced form
Recent studies:
8 million Americans to be at risk of developing advanced AMD in the next 5 years
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Epidemiology
The cause of AMD remains unknown
Mild association between hypertension and AMD
Smoking has 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
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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.
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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
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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
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We Are What We Eat - Ho et al. analyzed the risk of early AMD in a cohort of 2167 individuals whose CFH and HTRA1 genotyping was known.
( CFH Y402H variant : ↑ AMD risk 11x
HTRA1 A69S allele: ↑ AMD risk 15x )
- Increase intake of zinc, ᵦ-carotene, ω−3 fatty acids and lutein/zeaxanthin each significantly reduced the hazard ratio of AMD development .
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We Are What We Eat
Overall, the data suggest that we are not entirely at the mercy of our genes. A well-balanced diet including foods rich in zinc, ω−3 fatty acids and antioxidants might avert the genetic decree.
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Wet AMD case 1
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Wet AMD case 1- s/p 1st IVA
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Wet AMD case 1-recurrent
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Wet AMD case 1-s/p 2nd IVA
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AMD case 2
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AMD case 2 (cont.)
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AMD case 2 – s/p IVA
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Case 3-Before IVL
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Case 3: After IVL – 5 weeks
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Case 3: 2 mos- slightly increasing fluid
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Case 3: after reinjected IVA
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Case 4: Before IVA
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Case 4: After IVA – 6 weeks
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Case 5
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Case 5- Fluoresceine
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Case 6- Before and after IVA
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Case 7: Wet AMD, 2-mo s/p IVA
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Thank you for your attention
Questions are welcome