Dr. Melki

1. 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

2. Anatomy of the Retina

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. 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. 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. Wet AMD

7. 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

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. 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. 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. 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. 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 .

13. 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.

14. Wet AMD case 1

15. Wet AMD case 1- s/p 1st IVA

16. Wet AMD case 1-recurrent

17. Wet AMD case 1-s/p 2nd IVA

18. AMD case 2

19. AMD case 2 (cont.)

20. AMD case 2 – s/p IVA

21. Case 3-Before IVL

22. Case 3: After IVL – 5 weeks

23. Case 3: 2 mos- slightly increasing fluid

24. Case 3: after reinjected IVA

25. Case 4: Before IVA

26. Case 4: After IVA – 6 weeks

27. Case 5

28. Case 5- Fluoresceine

29. Case 6- Before and after IVA

30. Case 7: Wet AMD, 2-mo s/p IVA

31. Questions are
welcome
Thank you for your attention