Macular Degeneration

Macular Degeneration

Treatment(s) Used:
Acupuncture, Nutritional and Dietary

Many patients coming to the Arkansas Acupuncture Center have age-related macular degeneration (AMD), which is often referred to as dry macular degeneration, an eye disorder 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 you can see.

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. Dry macular degeneration refers to the disease macular degeneration. Wet macular degeneration is a progression of the disease. In a healthy eye there is a barrier that prohibits blood vessels prohibits from new, unwanted blood vessels from growing through the retina (as is the case with most organs of the body). Because the barrier the keeps blood vessels from growing through the retina breaks down, tiny, abnormal blood vessels start to grow through the retina. These blood vessels tend to be weak and can leak fluid into the vitreous. About ten to fifteen percent of cases of dry progress to wet. Wet AMD is diagnosed when it is observed that abnormal blood vessels are growing through the retina. This is referred to as neovascularization; the development of new blood vessels. 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 determine if this is caused by leaking vessels. It is imiportant to have the leaking stopped. At this point conventional medicine may be 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 receiving treatment for wet AMD with conventional therapy; usually shots in the eye that help to control the bleeding and growth of unwanted blood vessels. Many have wet AMD in only one eye. 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 sweetner, and eating foods high in vitamin K, such as kale and alfalfa.

The cause of macular degeneration is the build-up of amyloid beta plaques in the back of the eye. This is the same substance that causes Alzheimer’s disease. Druzen deposits are often present in patients with amd. These are fatty deposits that build up in the retina.

What You Need to Know About AMD Treatment

The micro acupuncture, alternative medicine acupuncture treatment for macular degeneration performed at the Arkansas Acupuncture Center is not a cure, but a treatment that helps the eyes to heal. We use micro acupuncture, a Danish technique developed by Per Otte for the treatment of degenerative eye disorders.

The macula contains about 6 million cells (in an area of about a 16th of an inch). These cells only live for about two days, regenerating constantly. Healing occurs because when we stimulate a more normal blood flow, the eyes will function more normally, allowing for the removal of debris such as plaques, and consequent regeneration of cells. But this doesn’t happen overnight. The acupuncture treatment for macular degeneration takes time. Each patient will respond differently, and there is no way to determine where the benefit will occur. The treatment for macular degeneration is a very effective therapy that can help a person gain vision, and at the very least maintain a level of vision. Often when patients are losing vision very quickly we work to keep the vision the person has. When patients are stable, we can in most cases see an increase in the vision. AMD treatments can help patients vision become more stable.

I find that most of my patients are confused when their “dry” macular degeneration has gone to “wet.” 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 macular degeneration treatment with acupuncture is helpful for macular degeneration, but will not necessarily stop the growth of abnormal blood vessels, but could possibly prevent a worsening of the condition.

The disease is Macular Degeneration. Wet is an aspect of the disease where the patient develops 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.

Macular degeneration, often referred to as age-related macular degeneration (AMD) is the leading cause of severe vision loss in people over age 50.

It is estimated that 15 million Americans have some form of age-related macular degenerationand incidence continues to rise as a result of the increasing percentage of older adults.

Unfortunately, most won’t know they have it until they begin to suffer vision loss. AMD is the leading cause of blindness and central vision loss among adults over age 65.

AMD defined. AMD is a chronic eye disease that causes a deterioration of the light-sensitive cells in the small central portion of the retina, known as the macula, causing blurred vision and eventually a blind spot in the central visual field. The cause of macular degeneration is basically a blockage of the normal blood flow to the tissue in the back of the eye.

Pathologically, AMD results from retinal pigment epithelium (RPE) dysfunction or loss associated with the degeneration of photoreceptor cells. The RPE is a single layer of closely packed, brown colored cells forming part of the blood retina barrier, and is particularly susceptible to oxidative stress because of the layer’s high consumption of oxygen. When the blood retina barrier breaks down blood vessels can grow through the retina. This is referred to as neovascularization, or growth of new blood vessels.

When neovascularization occurs, patients are diagnosed with what is referred to as “wet” macular degeneration. We will talk about this condition shortly.

During normal aging, drusen forms under the retina. Drusen are small, yellowish spots of deteriorating tissue associated with aging and age-related macular degeneration. Drusen contain proteins common to the extracellular deposits associated with atherosclerosis, Alzheimer’s disease and Parkinson’s disease. These plaque deposits are referred to as amyloid beta.

As drusen increase in size and number, they can interfere with proper functioning of the retina, damaging or killing the light-sensitive cells.

Basically, drusen are waste products that build up in the retina, interfering with proper circulation of blood to the back of the eye. The lack of oxygen and nutrient necessary to allow for proper regeneration of cells leads to a degeneration of the tissue. Hence macular degeneration.

We all have some drusen associated with aging.

This form of age-related macular degeneration is called “dry” macular degeneration. Dry macular degeneration is considered one of two types of age-related macular degeneration. Dry AMD will progress to “wet” AMD in about 10 to 15 percent of cases.

Despite the well-established correlation between the presence of drusen and AMD, the underlying cause of drusen formation and its role in RPE and photoreceptor cell degeneration are not fully understood.

Because the macula’s light-sensitive cells provide the ability to experience sharp, detailed vision, patients will experience blurring of central vision and possible total loss of central vision. This can have a devastating impact on the ability to enjoy activities of daily life, such as reading, driving, or even recognizing the face of a friend or family member. The central vision is crucial for our ability to live a normal life.

Wet Macular Degeneration

Wet AMD occurs when abnormal blood vessels start to grow under the macula. When the tissue breaks down in the retina it damages the blood retina barrier. As a result, abnormal blood vessels can then grow through the tissue in the back of the eye.

We call it wet AMD because these new, unwanted blood vessels are weak, and often leak blood and fluid into the vitreous, damaging or killing light-sensitive cells. This is referred to as vitreous hemorrhage. This type of hemorrhage is painless and, early on, may be seen as cobweb-like floaters in one’s vision. It can often result in rapid vision loss, sometimes overnight.

The RPE is a monolayer of pigmented cells forming part of the blood retina barrier and is particularly susceptible to oxidative stress because of the layer’s high consumption of oxygen. When this barrier breaks down, unwanted blood vessels can grow through the retina. When unwanted blood vessels appear, the patient is diagnosed with “wet macular degeneration.”

The blood retina barrier is supposed to stave off the growth of abnormal blood vessels, but when it breaks down blood vessels can grow through the retina, causing blind spots.

Abnormal blood vessels grow as a result of oxidation and the deterioration of the retina.

The purpose of the barrier formed by the RPE is to stave off the growth of abnormal blood vessels, but when it breaks down, blood vessels can grow through the retina. (blood vessels are not supposed to grow through the retina – remember the importance of an unobstructed or clear pathway of light – there are no blood vessels anywhere between the cornea and the surface of the retina)

(All of the organs of the body, including the eyes, are protected by a barrier that prohibits the formation of unwanted blood vessels. Ie blood brain barrier)

Stages of Macular Degeneration

There are three stages of AMD defined in part by the size and number of drusen under the retina. It is possible to have AMD in one eye only, or to have one eye with a later stage of AMD than the other.

Early AMD is diagnosed by the presence of medium-sized drusen, which are about the width of an average human hair. People with early AMD typically do not have vision loss, possibly only blurry vision.

Intermediate AMD People with intermediate AMD typically have large drusen, pigment changes (damage to the pigment cells) in the retina, or both. Again, these changes can only be detected during an eye exam. Intermediate AMD may cause some vision loss, but most people will not experience significant symptoms.

Late AMD. In addition to drusen, people with late AMD have vision loss from damage to the macula. Late AMD can be either the dry or wet type, or both.

Not everyone with early AMD will develop late AMD. For people who have early AMD in one eye and no signs of AMD in the other eye, about five percent will develop advanced AMD after 10 years. For people who have early AMD in both eyes, about 14 percent will develop late AMD in at least one eye after 10 years.

The distinction between “wet” and “dry” macular degeneration isimportant, especially when discussing treatment with your patients. People who are being treated for AMD by acupuncture will often stop treatment when their “dry” AMD “turns” to wet, thinking that they can no longer be helped. They believe that they no longer have dry macular degeneration, and now only have wet AMD. Basically, the underlying condition remains the same, with the addition of the complication of neovascularization – growth of new blood vessels. Dry AMD “progresses” to wet. They still have dry AMD.

The tissue will often continue to degenerate even if patients are receiving injections to stave off the growth of blood vessels. If you can explain to them that they may still continue to lose vision from the “dry” type, even though they are receiving treatment for the “wet” type, it could save their vision.

Although approximately 80 percent of patients with age-related macular degeneration have dry AMD, wet AMD is responsible for 80 to 90 percent of severe loss of vision or legal blindness associated with this disease.

My definition of Macular Degeneration

Age-related macular degeneration is the deterioration of the retina due to the lack of regeneration. Plaque and fatty deposits (amyloid beta anddrusen) prohibit the proper movement of blood into the tissue necessary to allow for normal regeneration of cells. Dead cell waste and fatty deposits build up, inhibiting the growth of new cells, and diminishing the health of the RPE, which can potentially allow for the growth of blood vessels through the retina.

Our body is continually regenerating cells. The health and survival of all the tissue of the body depends on it. In a healthy body circulating blood carries oxygen and nutrients to cells and removes waste products making room for the regeneration of new cells. When circulation is compromised plaques and fatty deposits further inhibiting circulation. Aging is the process by which diminished circulation and free radical damage cause destruction of tissue; the cells of the body degenerate. Basics.

Spleen Qi Vacuity – integrity of the tissue

Phlegm – build up of plaque and drusen

Kidney and Liver Yin – eyes not being nourished, congenital stuff

In most cases, AMD patients will display vision loss concentrated in the central portion of the retina, however, it is not unusual for a patient to have retinal degeneration that, although diagnosed as AMD, does not display the usual pattern of vision loss; the disease is not necessarily affecting the macula. It is a more general deterioration, but is serious and warrants treatment. For patients, this is a better scenario as they will be slower to lose their central vision.

Most patients are eager for someone to explain what is going on with their vision. If you can explain it in a way they understand, they will greatly appreciate it.

For more information about acupuncture treatment for macular degeneration contact us today!