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Be aware of macular degeneration by Heather Woolwine Public Relations There’s an old cliché that fits the concept of blindness: you don’t know what you’ve got until it’s gone. While the saying itself might be worn out, the concept of paying attention to eyesight is not. Indeed, thinking about the loss of one’s sight can make you realize just how precious it really is.   February is age-related macular degeneration awareness month, and Esther Bowie, M.D., Storm Eye Institute, offered information concerning the onset, treatment, and prevention of age-related macular degeneration. ‘Out damned spot! Out I say!’ Vision loss for age-related macular degeneration begins with a blurry spot in a person’s central vision. So, like Lady Macbeth in the famous Shakespearean play of similar title, people may find themselves rubbing at a spot that will never go away. But unlike Lady Macbeth, they’re not imagining it.   The condition affects patients more than 50 years of age, and is more common in white women versus other ethnic or gender groups. According to Bowie, there are two types of age-related macular degeneration, dry and wet. With the dry type, there are pigmentary changes, atrophy and deposits in the macula called drusen. With the wet type, abnormal blood vessels form and eventually hemorrhage, resulting in loss of central vision. People afflicted with either type do maintain peripheral vision, but that seems a small consent to those who suffer from macular degeneration.   “Currently, there is no cure for either type and there’s no real treatment for the dry type,” Bowie said. “Those patients diagnosed with the dry type take a combination of vitamins designed to delay the progression towards the wet type of macular degeneration. This vitamin combination, called AREDS, works as an antioxidant. These multivitamins are available as I-CAPS and Ocuvite Preservision. These patients are also strongly encouraged to quit smoking, be healthy, and control any blood pressure or cholesterol issues to slow the disease’s progression.”   Once the dry type turns into the wet type, patients typically have a large blurred spot in their central vision and have some more options. Bowie said photodynamic therapy, which requires a cold laser after the infusion of a dye called Visiudyne, can produce good results and stops further vision loss. Another treatment, Macugen, involves an intraocular injection in the eye every six weeks for two years. Still, some patients may be eligible to use a thermal laser treatment.   “There are several new treatments being investigated at the moment, most notably ranibizumab (Lucentis) which works as an anti- VEGF (anti-vascular endothelial growth factor) to not only stabilize, but also improve vision,” Bowie said. “So far the results are promising and involve a monthly intraocular injection that causes the abnormal blood vessels to recede and it also seems to decrease scarring from the disease.”   This drug is currently not available for patient use, but is a sibling to bevacizumab (Arastin) which is used for constricting blood vessels in colorectal cancers.   “With extensive consent and pending university approval, SEI may begin using Arastin to treat the wet type of macular degeneration, as we now know that even though it is a bigger molecule than Lucentis, it still seems to work. In addition to being aware that this is not approved for FDA use yet, patients should also know that this experimental method is not covered by health insurance,” Bowie said.     Preventing Macular Degeneration The key to preventing just about anything is to receive regular check-ups, no matter what the issue. The same is true for macular degeneration. Bowie recommended visiting an ophthalmologist once a year for a healthy eye exam and to seek treatment immediately if a patient begins noticing changes or differences in vision.   “It’s not only important to monitor your vision, but you should also know your family eye health history. In addition, all health problems should be controlled and under the care of a family physician, as well as quitting smoking. This is one of the major causes of blindness in patients more than 50 years old,” she said.   Some symptoms to look for include a gradual decline in central vision, requiring more light to see or read than usual, a sudden spot or central vision loss, or letters becoming crooked and distorted while reading.    Welcome Dr. Bowie Esther Bowie, M.D., recently arrived on the MUSC campus. A resident here in 1998, the Jamaican born and raised native completed her fellowship at the University of Iowa prior to joining the MUSC and SEI faculty and staff. She is married to Jerome Lyn-Sue, M.D., and mother to daughter Rachel, four months. Look for an upcoming profile on her in a future issue of The Catalyst.   Friday, Feb. 24, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island papers at 849-1778, ext. 201.