AMD: Keeping Your Eyes at Their Healthiest

BrightFocus Foundation
“AMD: Keeping Your Eyes at Their Healthiest”
May 25, 2016
Transcript of Teleconference with Dr. Gayatri S. Reilly
of The Retina Group of Washington, D.C.
1:00–2:00 p.m. EDT

Please note: This chat has been edited for clarity and brevity.

MICHAEL BUCKLEY: Hello, I am Michael Buckley with the BrightFocus Foundation. Welcome to today’s BrightFocus Chat, “AMD: Keeping Your Eyes at Their Healthiest.”

If this is your first time joining us, welcome. Let me take a moment to tell you about BrightFocus and what we will do today. BrightFocus funds some of the top scientists in the world. We support research that is trying to find cures for macular degeneration, glaucoma, and Alzheimer’s. We share the latest news from these scientists with families impacted by these diseases. We have a number of free publications and plenty of materials on our website, www.BrightFocus.org.

The BrightFocus Chats are another way of sharing this information. That is why today we are joined by Dr. Gayatri S. Reilly from The Retina Group of Washington, D.C. She will discuss how people concerned with macular degeneration can keep their eyes as healthy as they can be.

Now, let’s turn to Dr. Reilly. Dr. Reilly, thank you for joining us today. I would like to start with you telling us about your background and what you do at The Retina Group of Washington, D.C.

GAYATRI REILLY: Thanks. I am really excited to be here again today. I have been with The Retina Group for the past 2 years. What we do as a group is we evaluate and treat a variety of retinal conditions including—and one of our biggest components is dry macular degeneration—but including wet macular degeneration, retinal detachment, diabetes, and hypertensive retinopathy as well.

I have been in this area now for about 5 to 7 years or so; prior to that I grew up in New York and did a lot of my training up in New York. I’ve come down here and continued to work with the residents in the Washington, D.C. area to help with their training. Again, I am really excited to be a part of this today.

MICHAEL BUCKLEY: Great. Well, thank you, Dr. Reilly. This month, May, is Healthy Vision Month, and there are a lot of folks with dry macular degeneration that don’t have the same treatment options as those with wet macular degeneration. That is why today we decided to focus on ways that people can keep their eyes at their healthiest. Before we start that discussion, Dr. Reilly, I was wondering if you could give us a quick overview of dry AMD and how it relates to the more advanced forms of that disease.

GAYATRI REILLY: Dry macular degeneration can be asymptomatic, meaning you don’t have any symptoms and wouldn’t know you have it without getting a regular dilated eye exam. You can collect deposits in the center portion of the vision that, though we can see them on examinations, as I mentioned, you may not notice it. Over time it can cause damage to the retinal layers, and over time, as it progresses, there can be some changes to the vision where the vision is not as clear as it used to be; you may have difficulty with reading, and there may be some distortion to the vision. But, more or less, most commonly—as I mentioned—you don’t have any symptoms.

What can happen over time is that these retinal layers in the center portion of the vision continue to get a bit thinner and thinner, as time progresses. That can lead to the development of what we call wet macular degeneration, which is when blood vessels from the layer underneath the retina have the ability to come into the retina now that these layers are so thin, and they can cause bleeding and can cause fluid, which can cause a dramatic decrease in vision.

MICHAEL BUCKLEY: I was wondering—obviously the big overarching question today is, “What can people do to care for their eyes?” How can they keep their eyes as healthy as possible from macular degeneration?

GAYATRI REILLY: The first thing I always recommend is seeing your regular eye doctor. That is the first, and in the forefront of things—keeping annual exams and making sure you always have a dilated exam in order to be able to detect any of these changes that I am mentioning.

The other thing that we all can do is avoid smoking. We know that smoking when you have dry macular degeneration significantly increases your risk of a much more aggressive—and a much worse—prognosis, with development of wet macular degeneration.

Have a healthy diet. Green leafy vegetables, the more spinach and kale and green vegetables that we can eat, the healthier it is for the center portion of our vision. We know that dietary omega-3s are very helpful, which we find in seafood and various fish and just having an overall healthy diet. Not just using vitamins and vegetables and things like that, but just being healthy overall is something that can really help with dry macular degeneration.

MICHAEL BUCKLEY: Sure. Those all sound like great points. Is exercise helpful for eye health?

GAYATRI REILLY: Exercise is always helpful. When it comes to exercise, being in good shape, not being obese or having a significantly elevated BMI. We do know that it certainly keeps the inflammation in the body, which also impacts the inflammation in the eye, as low as possible. It is hard to know exactly how much these different factors play a role, but we do know that obesity, hypertension, all of these things which are associated with being overweight can certainly make the eyes much worse.

MICHAEL BUCKLEY: It is interesting. I really appreciate that advice. The first listener question that we have comes from Colleen from Ottawa. She is wondering about sunglasses. Specifically, she has a question—and I will follow up on it—she is wondering if there is macular degeneration in a family tree, should very young children wear sunglasses? If you could expand on that and just discuss sunglasses in general.

GAYATRI REILLY: So, sunglasses as early as possible are always recommended specifically for macular degeneration, but also for a variety of other conditions in the eye itself. They don’t have to be particularly expensive. What you need is a simple pair of sunglasses that block both ultraviolet A and ultraviolet B rays. These are the harmful wavelengths that can cause cataracts that you hear commonly, but especially have been implicated in macular degeneration. Most of the sunglasses that you can find in the stores, they are usually well labeled. Like I said, there doesn’t have to be anything specific about them, but they must block ultraviolet A and ultraviolet B.

MICHAEL BUCKLEY: Great. And to the question about small children when there is a family history, John from New York has a similar question about the hereditary nature. Would you be able to address both Colleen from Ottawa and John from New York about the hereditary nature of this, particularly going all of the way down to small children? At a base level, is macular degeneration hereditary, and what should people do when there is a family history?

GAYATRI REILLY: So, typically we don’t see macular degeneration until you are over the age of 50, but there is absolutely a very strong genetic component to it. We are learning this more and more, that different genes that are both protective and certain genes that are actually harmful, that cause a lot of this inflammation in the eye. We wouldn’t see any signs of macular degeneration in most people below the age of 50, but certainly in any patient that has a family history of macular degeneration, they are at a much higher threshold and much higher concern about careful follow-up.

MICHAEL BUCKLEY: Great. I appreciate that. We have two questions that relate to diet and nutrition. Jeanette from St. Louis and Melanie from Michigan both have questions related to AREDS. I was wondering, Dr. Reilly, could you tell our listeners today about what AREDS is, and we could take a few questions off of that?

GAYATRI REILLY: Absolutely. So, fortunately we have a very, very large clinical trial that was done back in 2000 or 2001 that was looking at nutritional supplements—specifically vitamins C and E, beta-carotene, zinc, and copper—looking at if it could decrease the risk of developing more advanced forms of macular degeneration, such as wet macular degeneration.

The same research group in 2005 or 2006 began a second study, which is called the AREDS2, to see if there could be any improvement in the formulation. But even the original formulation—which again was looking at vitamins C and E, beta-carotene, zinc, and copper—found that it decreases the risk of developing wet macular degeneration and advanced forms of dry macular degeneration by about 30 to 40 percent. It has been found that, in eyes that are already at higher risk, meaning they have a certain level of dry macular degeneration, over a 5-year period, there is at least about a 25 percent reduction in the overall risk of advanced macular degeneration.

The second trial that I was mentioning, this AREDS2 formulation, was looking at adding antioxidants. We have heard a lot about different kids of antioxidants. You might have heard of lutein and zeaxanthin and these omega-3 fatty acids, to see if any of the antioxidants were protective or even better than the original. Realistically, we found that if you are having a healthy diet and you are already a nonsmoker, the original AREDS formulation does a great job at protecting and trying to prevent the advanced form of macular degeneration. If you are lacking in your diet a little bit or you don’t tend to get a lot of antioxidants, or if you are a previous smoker, removing the beta-carotene and adding these antioxidants was very helpful.

MICHAEL BUCKLEY: That is great. For our listeners who may want to ask their doctor or do some of their own research, I will spell out that acronym one more time. AREDS stands for Age-Related Eye Disease Study. This is something that you can ask your physician about. Also, I meant to mention earlier, BrightFocus has a number of free materials about macular degeneration, and we have one called The Essential Facts of Macular Degeneration, and that is available at our website BrightFocus.org, or you can call 1-800-437-2423 for our materials on The Essential Facts that discuss the AREDS. We have a couple more questions about AREDS. Jeanette from St. Louis is wondering, “Can AREDS supplements contain too much zinc?”

GAYATRI REILLY: That is a good question. That is something we are looking at and trying to better evaluate each year with these trials to make sure that everything that is in these supplements is number one, helpful, and number two, not harmful. Basically, in terms of looking at all of the components, vitamin E—sometimes you have heard about risks of prostate cancers and things. Zinc we have heard also has a risk for cardiovascular health. All of these antioxidants have been found to be safe for patients and have not been found to cause any increased risks of any other issues.

MICHAEL BUCKLEY: Well, great. Related to that, Melanie from Michigan, her ophthalmologist mentioned something called MacuHealth Vitamins. I was wondering if you could help her and other listeners that are trying to evaluate the different types of AREDS formula vitamins that they might see. Do they vary by cost or effectiveness? What should a consumer be looking for when they go out to try to get AREDS formula vitamins?

GAYATRI REILLY: Well, exactly what you just said needs to be in the formulation. It needs to say the AREDS formula is in that vitamin. Because vitamins in general are not FDA-sanctioned, there are other things that can be put into them. Sometimes you can have other antioxidants and things. What we know with the AREDS formula is that those specific vitamins and antioxidants are what is recommended. There are a lot of different brands out there, different companies that make them, and they are all very similar, but you do want to make sure that they say the AREDS or the AREDS2 formula on the bottle itself.

MICHAEL BUCKLEY: Great. Now I would like to move on to the topic you mentioned earlier about how dry macular degeneration can become wet macular degeneration. Oguelo from Maryland has that question. How can he keep dry macular from becoming wet? For our listeners, how is wet macular degeneration treated and monitored?

GAYATRI REILLY: That is a great question, and first, as I mentioned earlier, having appropriate and annual exams with your eye physician is number one, because they can tell you what is going on, what is changing. When you already have dry macular degeneration, there are two ways of monitoring things at home. There is an Amsler grid that we have had for a very long time, which is a grid that basically looks like a sheet of graph paper that can be used to detect any changes that can be suggestive of wet macular degeneration. There is also a newer device called the ForeseeHome device that is a bit more sophisticated in its techniques of trying to detect any changes that would be suggestive of wet macular degeneration.

The idea is that with close followup and with these home monitoring devices, we want to detect wet macular degeneration, if it was to develop, as early as possible. We do have excellent treatment for wet macular degeneration, which includes injections to the eyes that do a very good job of maintaining vision and trying to prevent vision from getting worse. But one thing that we absolutely do know is that the earlier that we can have it detected, the better it is overall for expectations and maintaining vision.

MICHAEL BUCKLEY: Great. I appreciate that. I would like to talk about some of those home monitoring devices. The Amsler grid, which you described very well—for our listeners, this is something that BrightFocus offers for free. They are magnetic, so you can put them on your refrigerator as a reminder to keep monitoring your AMD. Amsler grids are available free of charge from BrightFocus, and you can call 1-800-437-2423 if you would like an Amsler grid. Dr. Reilly, this ForeseeHome monitor, could you tell us a little bit about how it works? This is something that may be new to a lot of the folks that are with us today.

GAYATRI REILLY: Sure, absolutely. It is a device that you actually have in your house that gets connected to your landline, basically. What it does is that it is a 3-minute test that you take per eye, and it is projecting a series of dashed lines with a little bit of an elevation to it. This test is something that we would expect to be similar over time, and the idea is that it is very, very easy to use and doesn’t require significant computer savviness or anything. The idea is that over time, if there has been a change that perhaps is not noticeable in terms of visual changes yet, that this device is able to notice an area that might be distorted and might be suspicious for wet macular degeneration.

It is constantly being monitored. What that means is that each one of these tests that you do every day goes to a center, and your physician gets a report of all of these tests. If there is ever a deviation from normal, there is an alert that gets generated, and this alert communicates with your physician to contact you in order to come in, get evaluated, see if there have been any changes.  What it was able to find-—in the clinical trial looking at its effectiveness—is that it could detect changes (1) way before patients were able to notice any changes, and (2) when the vision was still excellent. For example, when the vision was still 20/20, 20/25, or 20/30, which for most people would not be at a level where they would be able to detect the change.

MICHAEL BUCKLEY: Well, that is interesting. Certainly a question that a lot of people have about new technologies is about the cost. Could you tell us a little bit about this and if it would be covered by Medicare?

GAYATRI REILLY: That is a great question and one that I am really excited to say we have recently had changed. It is now approved and has passed Medicare review. It has been paid for patients who have Medicare. If there is Medicare with supplemental, there is no cost at all for the patient. Patients who have Medicare without a supplemental, the cost is $15 per month. What is also exciting is that other insurances are also starting to cover it--we don’t know the exact numbers when compared to Medicare—but other private insurances and commercial insurances are also starting to cover it. If there is no insurance at all, the cost is $75 per month.

MICHAEL BUCKLEY: Now, is this something that in your practice at The Retina Group of Washington, D.C.—do you use this? Do you have any examples of how some of your patients have used this with their own treatment?

GAYATRI REILLY: I do, and what is exciting about it is that it gives a patient a chance to proactively do something. A lot of the things we have talked about—maintaining a healthy diet, taking vitamins, and having very constant follow-up—are all very, very important, but this is something that we are able to provide to patients and allow them to be a bit more proactive in the whole process. I have had a lot of patients on it who have been very happy, and they feel a little bit more at ease knowing that they are constantly being monitored and knowing if there have been any changes.

We have had patients that have had an alert. I can think of one I saw in the past few weeks that came in and their vision was completely unchanged. It was 20/20. They had noticed no changes to how they were reading, they had no blurriness, no distortion, but the ForeseeHome had triggered an alert because there had been a change in this patient’s exam. Upon further examination, there was a transformation from dry macular degeneration to wet macular degeneration. Again, it all goes back to when we are detecting the wet macular degeneration. We know that the earliest signs of it, these are eyes that we can educate and really be able to tell patients that, hopefully, with proper treatment that they should be able to maintain it and do quite well in the overall process.

MICHAEL BUCKLEY: Wow. That is fantastic. Before we move into a few more questions from our listeners, I want to remind people about the Amsler grid and the ForeseeHome monitor in case they have questions. The Amsler grid, as we mentioned a minute ago, we have them free of charge here at BrightFocus. We also have information on the ForeseeHome monitor that you can request by calling us any time at 1-800437-2423.

Dr. Reilly, you talked about wet macular degeneration. A woman from New York brings up the injections that people receive and is wondering, is that something that could someday be available in a pill? I was wondering if you could tell our listeners a little bit about the injections. I think that might cause some anxiety in people.

GAYATRI REILLY: Yeah. I was going to say it is a common area of a lot of anxiety. The good news is that whenever you are talking to a patient for the first time about an injection, everybody has the same expression of having an injection to the eye sounding extremely terrible and painful. The good news about injections is that you don’t have a lot of pain associated with it. It is something that is done very quickly in the office with good anesthesia, and it is tolerated very, very well. But there are things in the future—just as the listener has asked, there are eye drops that are always being investigated, oral medications being investigated. To date there hasn’t been anything that has gotten through the clinical trial process, because it is very difficult to get to the back portion of the eye, which is where the wet macular degeneration is, and that is why these injections are able to get the medication to the appropriate area. There is a clinical trial that is going to be looking at eye drops soon, looking at if that will be a potential new approach in place of or in addition to injections.

MICHAEL BUCKLEY: Well, that is great. We have a question from Lorraine from New Hampshire, who is wondering, what type of person should take AREDS? Is it someone with dry macular or wet macular? Who should be looking for the AREDS?

GAYATRI REILLY: That is a great question. What the clinical trial was able to determine is that it is for patients who already have dry macular degeneration. So it is not meant to be used prophylactically or if you do not have any history of macular degeneration. It is for patients who already have dry macular degeneration to a certain level. This is where your eye provider can certainly help with guiding you on whether you have this level of dry macular degeneration. It hasn’t been found to be beneficial in the clinical trial, as I mentioned, prophylactically or for wet macular degeneration. These are areas where we don’t have quite as much data to suggest. What it is used for right now is patients with a certain level of dry macular degeneration.

MICHAEL BUCKLEY: Great. And I want to reiterate the point you made before about being sure to look at the label and make sure you see AREDS on there. Ed from Maryland is wondering about the ForeseeHome monitor and how to know if you are eligible to use that home monitoring device.

GAYATRI REILLY: It does require a prescription from your eye care provider. So it is a prescription that goes to the company and, again, it requires a full examination. If you are the appropriate candidate for it, then your doctor has to send a prescription to the company. Once the prescription is received, the company will call the patient and start to deliver the device to the home and go on with testing, education, and training.

MICHAEL BUCKLEY: We have time for just one or two more questions. Mary from Alabama is wondering about moisture drops for your eyes. Do those have any effect on AMD?

GAYATRI REILLY: No. You know, I think lubricating eye drops do a great job when there are a lot of different circumstances where your eyes get dry—whether it is from reading, or on the computer, or watching TV—and keeping the eyes as lubricated as possible can certainly help your overall eye health, but they are not really associated with or would cause any harm or benefit to the macular degeneration process.

MICHAEL BUCKLEY: I would just like to ask one question here. In your experience in your clinic, is there a recurring misperception or piece of misinformation that your patients have? Is there something that you, on a recurring basis, have to correct someone’s perception of macular degeneration—their knowledge of it?

GAYATRI REILLY: Yes, absolutely. The biggest misperception  is that having a diagnosis of macular degeneration means that you are going to go blind. That is where education and having close annual examinations and having excellent treatment now—really, you can tell most patients that this is a condition that progresses and it will require monitoring and follow-up—probably for the rest of your life—but we have great medications that help to maintain the vision at a very good level.  A lot of patients are still able to drive, able to read, and it is not a condition that means that in 5 or 10 years you definitely will go blind. That is what has changed so much over the past couple of decades with both having these monitoring devices as well as better and better treatments.

MICHAEL BUCKLEY: That is great to hear. I can imagine that this has to be very disturbing news that people receive, so [your point] is really encouraging. Thank you for that.

I want to give a very special thanks to Dr. Gayatri Reilly from Washington, D.C., for joining us today. You’ve given us great tips and information to help keep our eyes at their healthiest. I want to thank everyone who joined the call and submitted questions for us to ask Dr. Reilly. In about a week from now we will be posting a recording and a written transcript of this Chat on our website, www.BrightFocus.org. You can also listen to this Chat and download previous Chats on iTunes and SoundCloud.

I would like to mention again that we do have information about the Amsler grid and about monitoring AMD. Call 1-800-437-2423, and you can order this, along with the transcript of today’s call and any other materials that may be helpful to you and your family.

Our next Chat topic will be “Meeting the Challenges of Macular Degeneration: A Story of Hope.” That will be on June 29, 2016. You can always call BrightFocus free of charge at 1-800-437-2423. You can always find these resources on our website, www.BrightFocus.org. Once again, Dr. Reilly, I want to thank you for taking time out of your schedule today. I think that all of us found this information very useful.

GAYATRI REILLY: Thank you for having me.

MICHAEL BUCKLEY: Our pleasure. Again, thank you everyone for being a part of today’s BrightFocus Foundation Chat. Hope you have a great day. Thanks!

BrightFocus Foundation: 1-800-437-2423 or visit us at www.BrightFocus.org. Available resources include:

• Information on research funded by BrightFocus
• Amsler grid
• Information sunglasses and macular degeneration
• Information on the ForeseeHome monitoring device
• The Essential Facts of Macular Degeneration
• Information on AREDS and AREDS2 vitamins
  • AREDS2 Formula:
    • 500 mg vitamin C
    • 400 IU vitamin E
    • 10 mg lutein
    • 2 mg zeaxanthin
    • 80 mg zinc
    • 2 mg copper