Fact vs Fiction

Debunking myths surrounding macular degeneration.

Photo by Jordan Pysz.

Elias C. Mavrofrides, MD

Without the retina, vision is impossible. The retina is the light-sensitive layer of tissue that sits at the back of the eye. When light hits the retina, it

triggers impulses that pass through the optic nerve and travel to the brain, where the visual images are developed.

At the center of the retina is the highly specialized macula, which enables central vision for detailed tasks such as reading, driving and recognizing facial features. The macula can deteriorate due to aging and other factors. The condition that results is macular degeneration.

“Macular degeneration is a weakening in the center of the retina, the macula” describes Elias C. Mavrofrides, MD, a board-certified, fellowship-trained retina specialist at Florida Retina Institute. “Generally, when we talk about macular degeneration, we mean weakening of the retina as people get older.

“There are some types of macular degeneration that occur in younger individuals, but for the most part, we think of people who are elderly and age-related macular degeneration. Weakening of the macula affects the strongest part of our vision, which is why macular degeneration can be so debilitating.”

“Macular degeneration is the leading cause of blindness in US citizens over the age of sixty,” elaborates Matthew A. Cunningham, MD, another board-certified, fellowship-trained retina specialist at Florida Retina Institute. “While it is usually an age-related condition, it also has a genetic component. In some families, macular degeneration is inherited.”

Age and heredity are non-modifiable risk factors for macular degeneration. Nothing can be done to change those. But there are modifiable risk factors as well, including diet and smoking. Smoking is known to contribute to the development of macular degeneration as well as to make it worse.

Wet and Dry

“There are two forms of macular degeneration – the non-exudative and the exudative, otherwise known as dry macular degeneration and wet macular degeneration,” Dr. Cunningham describes. “The majority of patients affected with this disease have the dry form.

“Dry macular degeneration essentially occurs when deposits of material called drusen form under the retina and begin to damage the surrounding tissue. This damage can lead to distortion of vision and vision loss, and to the development of wet macular degeneration.”

Wet macular degeneration develops in about ten percent of patients who have the dry form. With wet macular degeneration, abnormal blood vessels begin to grow underneath the retina in a process called choroidal neovascularization. These abnormal blood vessels can leak fluid or bleed, which can cause sudden vision loss.

“Wet macular degeneration is the more aggressive form,” Dr. Mavrofrides notes. “People with this form can develop swelling and bleeding in the retina that can lead to scarring and deteriorating vision. This vision loss occurs more rapidly than the vision loss with dry macular degeneration.”

Dr. Cunningham points out how many people mistakenly believe it’s worse to have the wet form of the disease. The retina specialist explains why that isn’t necessarily true.

“I tell my patients they can lose vision from both forms of macular degeneration, but the way they lose it is different,” he says. “With dry macular degeneration, patients develop atrophy, and with that, they lose tissue. Significant tissue loss in the center of the retina will cause vision loss.

“With wet macular degeneration, vision loss is typically due to bleeding and scar tissue formation. The main difference is that dry macular degeneration progresses at a much slower pace. But patients can lose the same amount of vision from both forms.”   

Circulating Misconceptions

There are other misconceptions about macular generation that commonly circulate among patients. Many of these myths are aided by non-factual internet sites and misleading pamphlets sent to patients in the mail. One such misconception is that nothing can be done for macular degeneration. Another is that people who get it are destined to lose vision.

“People often think of macular degeneration as being devastating to everyone’s vision,” Dr. Mavrofrides observes. “In actuality, a very large number of people have milder cases of the disease and never experience severe vision problems.

“The diagnosis of macular degeneration in and of itself does not mean a patient is going to have severe vision problems. The degree of the condition, whether it is mild, moderate or severe, is a better indicator of how much patients should be concerned about their vision.”

Dr. Cunningham and Dr. Mavrofrides also debunk the myth that nothing can be done for macular degeneration. Today, they say, there are effective treatments for the disease.

“There are two forms of macular degeneration – the non-exudative and the exudative, otherwise known as dry macular degeneration and wet macular degeneration.” – Dr. Cunningham

“For patients with dry macular degeneration, the vitamin supplementation known as AREDS 2 was found to reduce the risk of converting from dry macular degeneration to wet,” Dr. Cunningham discloses. “But a myth we hear frequently from patients is that AREDS 2 can actually reverse dry macular degeneration and improve vision. That is simply not true.

“With wet macular degeneration, we found that the level of a molecule called vascular endothelial growth factor, or VEGF, is up-regulated. And by decreasing the level of VEGF with injections of medications that are antibodies against VEGF, we can cause regression of the abnormal blood vessels. However, we cannot make them disappear. This is not a cure.”

“When I first started in practice fifteen years ago, these injections were not available,” Dr. Mavrofrides remembers. “There was very little we could do to keep patients from progressing from good vision to permanently damaged vision in a short period of time.

“Today, multiple medications are available that we can inject into patients’ eyes to control the progress of wet macular degeneration. These injections are not a cure. They will not fix all of the damage in every patient, but they have been proven over and over in numerous studies to be extremely beneficial in controlling wet macular degeneration.”

Not There Yet

Dr. Mavrofrides and Dr. Cunningham are quick to caution patients about claims of “cures” for macular degeneration. They stress that there are no miracle cures for this disease. They are myths, and patients should not be misled by such claims. The doctors also caution against unapproved treatments and trials, even those that seem to show promise, such as stem cell therapy.

“There is a growing cohort of stem cell clinics popping up across the US, and I am very careful to tell my patients that stem cells are not an FDA-approved drug therapy,” Dr. Cunningham reports. “These clinics promise that by injecting stem cells into patients’ eyes, they can reverse the damage done by macular degeneration.

“I stress to my patients that this claim has not been proven in randomized clinical trials. And I am very emphatic in telling them to be extremely careful about becoming involved in experimental trials at stem cell clinics. In the future, stem cells may have a very powerful role in the treatment of macular degeneration. But they do not have a role in treatment at this time.”

Dr. Mavrofrides also has concerns about unapproved treatments for macular degeneration, including stem cell therapy.

Photo by Jordan Pysz.

Matthew A. Cunningham, MD

“Sometimes, patients with more severe cases of macular degeneration do research, trying to find a miracle cure that does not exist,” he observes. “They tell me about vitamins that claim to reverse severe macular degeneration or eye drops that reverse it or even electrical current therapies. These things are the equivalent of snake oil. They do not consistently hold up under good scientific analysis or provide significant benefits.

“Stem cells are often brought up as a treatment for macular degeneration. We certainly hope that the technology continues to improve, and stem cells will one day be beneficial for macular degeneration. However, preliminary treatments have caused more damage to the retina and more vision loss, not improvement.

“The retina is an extremely complex piece of tissue, and its organization is very important to proper function. There is more involved than simply injecting stem cells into the retina to reverse the weakness. The retinal tissue also has to be very well organized, and it is very difficult to repair the complexity of the retina.”

And without the retina, vision is impossible.

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    • Florida Retina Institute

      Founded by James A. Staman, MD in 1979, Florida Retina Institute has 19 locations throughout Central Florida, North Florida, and Southeast Georgia. They have proudly delivered Excellence in Vitreo-Retinal Diseases and Surgery for 40 years. T... Read More

    • Matthew A. Cunningham, MD

      Matthew A. Cunningham, MD, is board certified by the American Board of Ophthalmology. He earned a bachelor of science degree from the University of Florida in Gainesville and a Doctor of Medicine degree cum laude with honors in research from t... Read More

    • Elias C. Mavrofrides, MD

      Elias C. Mavrofrides, MD, is board certified by the American Board of Ophthalmology. He earned a bachelor of science degree from the University of Florida in Gainesville and a Doctor of Medicine degree from the University of Florida Co... Read More