Marilyn Fred
Marilyn Tompkins Bellert Age-related Macular Degeneration (AMD) is the most common cause of blindness among seniors. Around 10-12% of Americans over 80 have this eye condition. If our 466 living class members are average (who knows?), that would mean 46-56 of us had AMD by 2022. Over age 85, the numbers rise to 40-45%. For our class, that equals 186-210 members would experience AMD by next year. I am interested because the number of AMD cases in our class already includes me.
AMD is a serious eye problem that comes in two main types: wet and dry, plus a variety of rare sub-types. The dry form is less likely than the wet form to result slowly or suddenly in total or partial blindness. About 20% of dry AMD patients shift to wet AMD. As Skip Granger describes in My Eyes and Me and Magic Make Three, his AMD suddenly turned wet, one eye at a time.
What does “wet” mean? Abnormal blood vessels grow in the back of the eye and can leak blood into the core vision in the center of the eye. This leaking causes loss of vision.
Dry AMD can also lead to loss of vision. In my own case of advanced dry AMD, I still have clear and sharp core vision, but it is in the middle of a fuzzy donut that obscures whatever is around the core. Reading a book in my lap is impossible, but I can see well straight ahead. My peripheral vision from the corners is still very good. This means I can work on my computer, watch TV, and drive fairly safely. Only “fairly” because loss of depth perception is common to dry AMD. I haven’t rear-ended another vehicle. Yet. However, I have missed the measuring spoon when pouring vanilla into the cake batter, because I could not see that the vanilla bottle was not lined up with the spoon.
If blood vessels in the back of the eyes of a dry AMD patient begin to leak, the AMD is then classified as wet and more serious symptoms ensue.
What’s this about eye injections, which Skip Granger mention in his story? Sounds like torture, doesn’t it? Yes, advanced AMD patients, both wet and dry, can receive medications by injection that will slow the progress of the problem and can prevent a shift from dry to wet AMD. Lots and lots and lots of numbing drops prevent pain for most patients, leaving only a sensation of pressure when the needle goes into the eyeball. Sometimes, a patient feels nothing, not even pressure. On the other hand, one of our classmates told me that his injections always cause pain.
Afterwards, most of us find vision blurry for several hours and must wear very dark glasses due to discomfort caused by glare. I choose to get my injections in the late afternoon, avoiding as much glare as possible. I can usually see well again within three or four hours, but my eyeballs feel tired and irritated until the next day. These injections have kept my condition stable for the past two years.
Retinologists are eagerly watching the testing of a number of new drugs which will reverse some cases of dry AMD and improve outcomes for some cases of wet AMD. These new medications utilize stem cells produced in laboratories. Every year my retinologist says that he expects a medication that could return my eyes to better vision and eliminate deterioration will be available within the coming year. Sigh. Here’s hoping that one of these years, this medical dilemma will be solved while I’m still alive and can benefit. And that my insurance will continue to pay for most of it.
Meanwhile, Skip has learned to use the voice-to-text tools on his computer and has continued to write stories for the website and emails to friends. I’ve been more cavalier about managing AMD since I can still drive, type, and still read books, computers, and mechanical dials like the oven temperature, thanks to a huge, lighted magnifying glass. I have increased the size of text on my computer and enhanced the contrast, which helps me a lot. The accessibility tools allow for a variety of adjustments to help people with limited vision. But – just in case – I had better get busy like Skip and learn to use voice to text.
Since the number of seniors with AMD accelerates rapidly after age 80, don’t neglect regular eye exams. In the earliest stages, special eye vitamins can slow the progression of AMD. If vision suddenly declines, eye surgery as soon as possible can save what’s left of the vision.
Fred Elder
Marilyn does a good job with her explanation, but asked me to add on a bit as I have wet AMD. I will confess, each eye injection (now about every ten weeks) hurts, which surprises me for in many areas of my body, pain bothers me little.
I have been on this AMD path for several years and have advanced from Dry to Wet AMD. I am also now on my third drug (Eylea HD). Each drug change was because the prior drug was losing efficacy and each drug change involved a shortening of the time interval between eye injections – sometimes as short as every four weeks. I am now receiving an injection every ten weeks and am relatively stable.
What have I learned? Well, this is truly medical practice. By that, I mean the interval between injections is clearly based upon a vision test and eye images at each injection, not based upon some ‘medical fact’ as to the requisite time between injections. In short, it is trial and test. So far, with a few reasonably significant set-backs, the inject and test (vision exam plus eye image) system is working. I can see reasonably well and drive as I want. Aside, I take an Uber to and from my eye injections. No driving for me on those trips.
I too try to have my injections in the afternoon. I then come home and take a nap, eat, and go to bed. I seem to be fully recovered by the next morning, with some occasional low level residual eye pain.
It is clear that my vision is not as good as it once was. However, my walking is also not as good as it once was! So, I choose to stay the course and hope for continuing good results. I am fortunate in that between Medicare and my Medicare Advantage Insurance, I pay nothing out of pocket for these relatively expensive eye injections. I am unfortunate in that my current, long term medical care provider (physician) is retiring and I will soon transition to someone who has not seen me through all of these various iterations, trials, failures and successes.
Editor’s Note: Since the number of seniors with AMD accelerates rapidly after age 80, don’t neglect regular eye exams. In the earliest stages, special eye vitamins can slow the progression of AMD . Daily looks at a graphic called the Amsler Grid (a chart dense with lines and dots) can alert you to changes in your vision. After an AMD diagnosis, regular monitoring by a retina specialist is essential. If vision suddenly declines, eye surgery as soon as possible can save what’s left of the vision. Blindness is not inevitable for AMD patients.
