Many patients coming to the Arkansas Acupuncture Center have age-related macular degeneration (AMD), a degenerative disease of the retina that affects the macula. The retina is the area in the back of the eye made up of light sensitive cells, called rods and cones, which transmit messages to the brain by way of the optic nerve. The macula is located in the center of the retina and is the part of the eye we look out from. The heavy concentration of cones in this area allows for detailed vision. Macular degeneration is a condition in which the cells in the macula start to degenerate. What may begin as a small blurry spot in the center of our visual field can eventually deteriorate into a blank spot that can enlarge over time leaving only peripheral vision. Imagine holding a hand right in front of your eyes; you can see around it, but that's all.

The eyes require normal blood circulation for nourishment and healthy regeneration of cells. The capillaries that bring nourishment to the eyes are very small. If these tiny blood vessels are damaged or blocked for any reason, regeneration of cells is limited. In the absence of regeneration from normal blood flow, there is degeneration.

Although we talk about two types of macular degeneration, "dry" and "wet," there is really only one type, the "dry", and the progression of dry into a more serious condition, "wet."  All macular degeneration is the dry type.  About ten to fifteen percent of cases of dry progress to wet.  Wet AMD is diagnosed when abnormal blood vessels grow through the retina. This is called neovascularization. In a healthy eye, there is a barrier that prohibits neovascularization. When the retina is weak, the barrier begins to break down. When the eye is starved of sufficient blood flow, new blood vessels grow as a way to bring nutrients and oxygen to the cells.

It is called wet AMD because the abnormal blood vessels tend to be weak and can leak fluid or blood into the vitreous, a gel in the area between the retina and the front of the eye that keeps the eyeball from collapsing. When leaking occurs the patient may lose vision very quickly. It is the presence of abnormal blood vessels that determines the diagnosis of wet AMD, not the leaking of fluid. Some patients will never leak fluid even though they have wet AMD.

When a patient with AMD experiences sudden vision loss, often indicated by the presence of wavy lines in the visual field, it is important to contact their retinal specialist immediately so they can have the leaking stopped. At this point conventional medicine is necessary to stop the leaking or bleeding. (See When Conventional Treatments Are Necessary.)  Patients receiving Avastin, Lucentis or laser therapy can be treated with acupuncture while undergoing these injections or laser. Restoring normal blood circulation with acupuncture can help the eye heal from western medical intervention, including surgery. In cases where patients are partaking in research for drug therapy, receiving acupuncture may skew the results of the research since they will most likely be gaining vision as a result of the acupuncture. In these cases, patients may want to postpone acupuncture.

About half of the AMD patients at the Arkansas Acupuncture Center are treated for wet AMD, and many have wet AMD in one eye and dry in the other. Patients with wet AMD may lose vision very quickly and are more likely to "try anything", including acupuncture.

When a patient with wet AMD has active leaking but is not a candidate for conventional intervention such as Visudyne or Lucentis, the treatments can help to restore vision by aiding the eye in the natural cleansing process. Supplements and proper diet help to strengthen blood vessels in patients with wet AMD, such as avoiding cold foods, icy drinks, spicy foods and artificial sweetners.

Wet or Dry Macular Degeneration; What You Need to Know

I find that most of my patients are confused when their “dry” macular degeneration has gone to “wet,” often misinformed about their condition.   They are told that they no longer have the “dry” type, now they have “wet” macular degeneration, as if this was a new condition and the old “dry” macular degeneration had gone away.  It doesn’t turn to “wet.”   It progresses to wet.

The disease is Macular Degeneration.  Wet is an aspect of the disease where develop abnormal, unwanted blood vessels in the retina. The problem is the new blood vessels are weak and tend to leak.  That is why they call it “wet” macular degeneration.  Why someone decided to differentiate the two into different conditions is a mystery.  And why doctors seem not to know there is only one disease, macular degeneration with occasional growth of abnormal blood vessels, is a greater mystery.

Macular Degeneration describes a condition where there is insufficient blood getting to the area that feeds the macula in the center of the retina. The cells need normal blood circulation to regenerate.  This applies to all the tissue of the body; when circulation is compromised for any reason the tissue degenerates because regeneration of cells requires the nutrients and oxygen carried in the blood.  This is why we age.  Blood circulation being less efficient, the blood does not get deep into the tissue, not allowing for normal regeneration of cells so the whole body degenerates.  The eyes are degenerating too.  Hence, Age Related Macular Degeneration. 

Too often patients stop coming to the clinic for treatments because their macular degeneration turned from “dry” to “wet.”  It is this misconception about there being a difference between dry and wet AMD that causes this reaction.  They believe that the treatments can no longer help them, that since they now have the “wet” kind their condition can be helped by getting shots of Avastin or Lucentis.  Although these treatments may be necessary to stop the leaking, they do not help the macular degeneration, the drugs only help the leaking.  The cells of the retina continue to degenerate because they still have macular degeneration.

If you have wet macular degeneration, you still have the dry.  There are situations where a person develops abnormal blood vessels in the absence of macular degeneration.  This is referred to as neovascularization and can occur in any area of the body, and is often related to the development of tumors.