Question about Macular Degeneration

Fermata

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  1. Attending Physician
    My father has had it for some years now but is only 49 years old. He's worried to death that he's gonna go blind but he can't get help because the majority of work done in the field now seems to be only for the 55+ age range.

    Can anyone help me by getting some information on the topic?
     
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    Andrew_Doan

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    1. Attending Physician
      Originally posted by Fermata
      My father has had it for some years now but is only 49 years old. He's worried to death that he's gonna go blind but he can't get help because the majority of work done in the field now seems to be only for the 55+ age range.

      Can anyone help me by getting some information on the topic?

      49 years of age is young to receive the diagnosis of AMD.

      This is what he can do:

      1) regular follow-ups (yearly if stable, sooner if there are changes)

      2) weekly Amsler grid. If he perceives a change, i.e. wavy lines or new area of distortion, then he should be examined by an ophthalmologist who can evaluate and treat any new wet AMD. Early treatment is the key when there is a new choroidal neovascular membrane.

      3) If he qualifies, then Ocuvite Preservision Tabs, but only if he's a non-smoker.

      These vitamins help slightly in some patients.

      http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=11594942
       

      TomOD

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        RheoTherapy blood filtration

        We have a few docs here really excited about this potential treatment:

        "FDA Study for Dry Age-Related Macular Degeneration: There are twelve investigational sites in the United States enrolling 180 patients; 20-30 will be enrolled at Carolina Eye Associates. RHEO blood filtration is a new, experimental treatment for previously untreatable dry age-related macular degeneration (AMD).

        Volunteers Needed: Volunteers in good general health between the ages of 50 and 85 who have some vision loss due to dry age-related macular degeneration are invited to participate. Across the nation, 180 patients will be randomized into 2 groups; 120 in the treatment group; and 60 in the placebo control group. Patients will receive 8 treatments (actual or placebo) and the results between the groups will be compared after 3, 6, 9 and 12 months of follow-up.

        Initial Study Results - Initial results from other such studies show great promise. In a recent 30 patient FDA study at the University of Utah, the results suggest that certain patients with Dry AMD experienced improvement in their vision when they received apheresis treatments using an investigational blood filtration procedure. In addition, a 40 patient European study recently concluded that Rheopheresis safely and effectively improved vision in some AMD patients. No serious treatment-related adverse events occurred in either study.

        Treatment: The RHEO treatments are similar to blood donation. They consist of establishing two IV lines, one in each arm. The patient's blood will be routed through a blood pump containing two blood filters. The first filter separates the plasma from the blood cells and directs the plasma to the second filter. The second filter sieves out certain high molecular weight proteins like LDL cholesterol and others. The treated plasma is recombined with the patient's cells and the reconstituted whole blood is pumped back into the patient through sterile tubing. Except for starting the IVs, the entire procedure is essentially painless and takes about 2 to 3 hours. No anesthesia is required nor does the patient receive anyone else's blood and the procedural risks are low.
        Research demonstrates that this technique removes undesirable protein and waste materials that "sludge-up" the blood, just as an oil filter removes impurities from the oil in a car. Once free of this excess material, capillary blood flow increases, especially to the macula. This research believes that as oxygen and nutrient delivery are restored by fresh blood flow, living cells that were dormant or deteriorating revive and begin to heal. And if enough cells are rejuvenated in the macula, patients may experience improved vision. Some researchers believe that AMD is something like "hardening of the arteries" in the eye. This study is designed to show that the removal of LDL cholesterol and other "bad" substances from the blood will improve the circulation to the eye, hopefully leading to better vision. Patients receiving the placebo treatments do not have the blood filtering.
        RheoTherapy blood filtration is a brand name form of therapeutic apheresis. Therapeutic apheresis is an accepted medical treatment that has been in use for 30 years in the U.S. for other diseases."

        http://www.clinicaltrials.gov/ct/show/NCT00078221?order=9
         

        Richard_Hom

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          Originally posted by Andrew_Doan
          "...3) If he qualifies, then Ocuvite Preservision Tabs, but only if he's a non-smoker.

          Dr. Doan,

          1. What is the relationship between smoking and "eye" vitamins?

          2. As 49 years old is a bit young, I wonder if a second opinion wouldn't be appropriate. Am also wondering if it is "wet" or "dry"

          Regards,
          Richard_Hom
           

          Richard_Hom

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            Originally posted by Richard_Hom
            Dr. Doan,

            1. What is the relationship between smoking and "eye" vitamins?

            2. As 49 years old is a bit young, I wonder if a second opinion wouldn't be appropriate. Am also wondering if it is "wet" or "dry"

            Regards,
            Richard_Hom

            Dr. Doan,

            Is it lung cancer? And if so, what is the mechanism?

            Richard_Hom
             

            Andrew_Doan

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            1. Attending Physician
              Beware: RheoTherapy is not clinical proven to work, and there's no good scientific basis why it helped the treatment group in the initial study. Any study supported by drug companies, i.e. "Vascular Sciences Corporation", should be evaluated with this information in mind.

              In fact, the non-treated group did worse than the natural history of AMD. It sounds like there may gave been some bias when selecting patients for the non-treated group. The initial studies only had 28 treated and 15 untreated patients. I will like to see the data when there are hundreds of patients enrolled.

              When I see strong data, then I'll consider it.
               

              Andrew_Doan

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              1. Attending Physician
                Originally posted by Richard_Hom
                Dr. Doan,

                1. What is the relationship between smoking and "eye" vitamins?

                2. As 49 years old is a bit young, I wonder if a second opinion wouldn't be appropriate. Am also wondering if it is "wet" or "dry"

                Regards,
                Richard_Hom

                High dose beta-catotene (one of the AREDS vitamins) is contraindicated in smokers because there is a significant correlation with increased lung cancer risk.

                http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14988220

                In regards to daily supplements, people can take them separately, but beta-carotene was in the original AREDS study:

                http://www.bausch.com/us/vision/products/vitamins/ocuvitepreservision.pdf
                 
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