Authors: Stacey Chillemi,Dr. Michael Chillemi D. C.
Macular translocation surgery:
Macular translocation surgery is a treatment that can be used if the abnormal blood vessels are located directly under the fovea. To start the procedure, your surgeon detaches the retina, shifts the fovea away from the CNV and relocates it over healthy tissue. When the CNV is exposed, the surgeon can remove the CNV with tiny forceps or use a hot laser to destroy blood vessels without damaging the fovea. This surgery can be successful for preserving vision, and in some instances improving vision, if your vision loss is recent, the extent of CNV is limited and the tissue around the fovea is healthy. This surgery is not widely used.
The newest treatment
being used for macular degeneration involves use of drugs called
anti-vascular endothelial growth factor (anti-VEGF) medications
. These drugs help stop new CNV from growing by blocking the effects of a growth factor these blood vessels need to thrive. Anti-VEGF medications are injected directly into your eye. Some anti-VEGF agents that have been approved for use or are currently being investigated for treating macular degeneration include:
Macugen:
Pegaptanib (Macugen) is approved for the treatment of wet macular degeneration. This drug is given as a series of injections into the vitreous fluid in the eye. It helps to prevent further vision loss by stopping the formation of new blood vessels and decreasing leakage from existing blood vessels.
Lucentis:
Like Macugen, ranibizumab (Lucentis) is an anti-VEGF drug used to treat wet macular degeneration. It also impedes new growth of abnormal blood vessels and helps dry up leaking vessels. However, ranibizumab may be able to reverse some of the effects of macular degeneration, not just prevent further vision loss.
Bevacizumab (Avastin):
Some doctors are prescribing this drug, which is closely related to ranibizumab, hoping that it will have effects. Bevacizumab hasn't been approved by the Food and Drug Administration (FDA) as a treatment for macular degeneration, but it has been approved as a treatment for colon and rectal cancer. That means that the use of this medication to treat macular degeneration is currently considered an off-label use of the drug. Still, some physicians are using bevacizumab injections to treat wet macular degeneration.
Other emerging treatments, ongoing studies
Therapies under study include:
Kenalog:
Triamcinolone (Kenalog) is a steroid drug used to treat eye inflammation and swelling (edema). Clinical trials are under way to determine whether Kenalog injections, alone or in combination with other therapies, might improve vision in people with macular degeneration. Some ophthalmologists are using Kenalog injections in combination with photodynamic therapy, hoping to maximize the therapeutic effect of photodynamic therapy.
Rheophoresis:
In this procedure, blood is removed from your body, filtered and then returned to your body. The idea behind this therapy is that rheopheresis may remove substances from your blood that contribute to poor blood flow in the blood vessels nourishing your retina.
There are other ongoing studies investigating the use of
implantable optical devices
. Because research into new treatments for macular degeneration is ongoing, it is a good idea to visit your doctor periodically to see if a new treatment might be available.
Diet
Nothing you do can change your race or genetic makeup or keep you from getting older — major risk factors for macular degeneration. However, the following measures may help prevent or delay the progression of macular degeneration:
Eat foods containing antioxidants -
A nutritionally balanced diet with plenty of leafy greens, fruits and other vegetables may be among the most important factors in promoting good retinal health. People at high risk of the advanced stages of macular degeneration may be able to lower that risk with a dietary supplement of antioxidants, zinc and copper. Antioxidants are substances that prevent oxidative damage to tissue, such as the retina.
Foods with antioxidants are those rich in vitamins A, C and E -
It helps to eat a nutritionally balanced, low-fat diet containing five or more servings of fruits and vegetables every day. People who eat diets rich in vegetables, particularly leafy green vegetables may have a lower risk of macular degeneration.
High levels of the antioxidants lutein and zeaxanthin in your blood may help protect your retina, although there are no conclusive studies demonstrating that supplements of these nutrients can slow vision loss. Lutein and zeaxanthin are nutrients found in high concentrations in egg yolks, corn and spinach. The National Eye Institute is currently sponsoring a clinical trial to assess the efficacy of lutein and zeaxanthin in lowering the risk of macular degeneration.
Take supplements -
Research called the Age-Related Eye Disease Study (AREDS) showed that a daily supplement of 500 milligrams (mg) of vitamin C, 400 international units (IU) of vitamin E, 15 mg of beta carotene (often as vitamin A — up to 25,000 IU), 80 mg of zinc (as zinc oxide) and 2 mg of copper (as cupric oxide) reduced the risk of progressing to moderate or severe vision loss by up to 25 percent. For people with moderate to advanced macular degeneration, the findings from AREDS indicate that taking high doses of zinc, beta carotene, and vitamins C and E is effective in reducing the risk of further vision loss.
Eat fish
-
Regular consumption of fish and the omega-3 fatty acids found in fish can result in a reduced risk of macular degeneration, according to the findings of a study published in July 2006. Use discretion if you're considering more frequent consumption of fish; certain types of fish may contain high levels of toxins and other contaminants.
Wear sunglasses that block out harmful ultraviolet light -
Orange-, yellow- or amber-tinted lenses can filter out both ultraviolet light and blue light. The main purpose of these glasses is to protect the surface of your eye and the skin of your eyelids. Because ultraviolet light has also been associated with the development of cataracts, the use of sunglasses may help reduce the risk of cataracts as well. Look for glasses that filter 99 percent to 100 percent of ultraviolet A (UVA) and ultraviolet B (UVB) rays. UVA penetrates deeper, while UVB has a more superficial effect.
Manage your other diseases -
If you have cardiovascular disease or high blood pressure, take your medication and follow your doctor's instructions for controlling the condition.
Get regular eye exams -
Early detection of macular degeneration increases your chances of preventing serious vision loss. If you are older than 40, get an exam every two to four years and if you are older than 65 get an exam every year or two. If you have a family history of macular degeneration, have your eyes examined more frequently, perhaps annually.
Screen your vision regularly -
If you have received a diagnosis of early-stage macular degeneration, your doctor may suggest that you regularly monitor your vision at home with an Amsler grid. Doing so may help you to detect subtle changes in your vision at the earliest possible time and seek help promptly.
If you have some vision loss because of macular degeneration, your eye doctor can prescribe optical devices called low-vision aids that will help you see better for close-up work. Or your doctor may refer you to a low-vision specialist. In addition, a wide variety of support services and rehabilitation programs are available that may help you adjust your lifestyle.
Lifestyle:
Use caution when driving.
Seek help traveling -
Use public transportation or ask family members to help, especially with night driving.
Travel with others -
Contact your local area agency on aging for a list of vans and shuttles, volunteer driving networks or ride shares.
Get good glasses
Use magnifiers
View with large type on the Internet
Obtain specialized appliances -
Some clocks, radios, telephones and other appliances have extra-large numbers.
Have proper light in your home -
This will help with reading and other activities.
Remove hazardous things in the home -
Eliminate throw rugs and other possible tripping hazards in your home.
Ask friends and family members for help
Socialize with friends - Do not stay in the house all day.
Use the Internet -
The Internet is a good source for support groups and resources for people with macular degeneration.
Talk to your doctor -
Ask your doctor about receiving professional help to make your home safer and more convenient for you to use.
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Motion sickness occurs when the body is sensitive to changes of movement in different directions or under conditions where visual contact with the actual outside perspective is lost. The balance center of the inner ear then sends information to the brain that conflicts with the visual clues of actually standing still in the inside cabin of a ship or airplane.
Symptoms
Dizziness
Fatigue
Nausea, which may progress to vomiting
From one third to one-half of airline passengers will experience some degree of motion sickness when encountering heavy turbulence.
Causes
It has been found that fear or anxiety can cause these symptoms. Some individuals seem to be naturally prone to motion sickness since childhood. Any type of transportation can cause motion sickness. It can strike suddenly, progressing from a feeling of restlessness to a cold sweat, dizziness and then vomiting. Motion sickness may quiet down as soon as the motion stops. The more you travel, the more easily you will adjust to being in motion.
Prevention
You may escape motion sickness by planning ahead. If you are traveling, reserve seats where motion is felt least:
By ship,
request a cabin in the forward or middle of the ship, or on the upper deck.
By plane,
ask for a seat over the front edge of a wing. Once aboard, direct the air vent to your face.
By train,
take a seat near the front and next to a window. Face forward.
By automobile,
drive or sit in the front passenger's seat.
If you are vulnerable to motion sickness:
Focus on the horizon
or on a distant, stationary object. Do not read.
Keep your head still,
resting against a seat back
Don't smoke
Don’t sit near smokers
Avoid spicy foods
Avoid alcohol
Don't overeat