Medical Model

Meet the Growing Challenge: Treating Macular Degeneration

By Mary E. Boname, OD, MS, FAAO

Our aging population is providing more cases of macular degeneration. Serve this growing need by discussing UV protection and lifestyle changes, and by providing early detection and early treatment. Technology is advancing; educate yourself on improved detection and treatment options.

With the Baby Boomer generation (those between 1946-1964) aging into senior citizens, macular degeneration is increasingly being diagnosed. The prevalence of this condition led me to focus services in my practice to address, and sometimes prevent, macular degeneration. Taking steps to prevent and treat macular degeneration is the right thing to do, but it also is a great practice builder as you are providing services vital to the health of your community.

Institute Screening for all Patients

Patients who have a family history of macular degeneration are the most susceptible to this disease, but with the occurrence of it so common today, I screen all patients. I take a baseline digital retinal photo and then review the image with patients letting them know if and where I see potential for disease inside their eyes. I point out details such as their optic nerve, the blood vessels and macula. I explain to my patients that my policy is to photograph the retina at each annual exam (similar to a dentist requiring an x-ray annually), and, more frequently if they have diabetic or hypertensive retinopathy, AMD or a retinal hole, tear or degeneration that should be monitored more frequently.

Since I require a baseline retinal photograph for each patient, everyone is screened and that creates an ideal opportunity to discuss prevention of potentially blinding eye diseases, like AMD and glaucoma with annual eye examinations, good nutrition and protecting the retina from UV damage. I charge for the photo taken and advise the patient there will be a charge. I participate with Medicare and Horizon BCBS for medically based eyecare. The billing code is 92250 and the diagnosis would be 362.57 (drusen) or 362.51 (dry AMD).

Prescribe High-Quality Sunwear

I explain the effect that ultra violet radiation has on this part of the eye and why it is important for patients to protect their eyes from the sun with quality sunwear: “Sandy, your eyes look like they are in good condition, but I am concerned that you still do not own a pair of quality sunglasses. It is important for all of us to protect our eyes from the damaging effects of the sun, and especially if you have a parent who has macular degeneration, as you do. Before you leave today, we will help you pick out a pair of sunglasses you will want to wear–and that will protect your eyes.”

Educate Nutrition and Personal Habits

In addition to explaining the importance of sun protection, I point out how smoking triples the risk of developing AMD. I also explain the importance diet plays in prevention. For instance, according to the Mayo Clinic, eating kale, spinach, broccoli, peas and other vegetables, which have high levels of antioxidants, including lutein and zeaxanthin, may also reduce the risk of macular degeneration.

I am careful not to sound judgmental discussing the role personal habits play in prevention. For example, even if I am pretty sure a patient is a smoker, I might say: “I am not sure if you are a smoker, George, but in case you are, I wanted to alert you to the increased risk of smokers to developing macular degeneration which you told me both your father and grandfather were diagnosed with. It is very important that you avoid smoking. Smoking triples a person’s risk of developing wet macular degeneration.”

To a patient who has described a diet that is less than optimal, I might say: “It’s great that you just started that new exercise regimen, Jennifer! I also want to mention how important it is to include a lot of leafy green vegetables in your diet like kale, spinach and broccoli. Taking the other measures we discussed like protecting your eyes from the sun and quitting smoking, along with adding these vegetables to your daily diet, may help significantly reduce the risk of macular degeneration.”

Talk Supplements

In addition to protecting eyes through the use of quality sunwear, a better diet and avoiding smoking, I recommend that all patients, and especially those who are 50 and over, or those with a family history of macular degeneration, take MacuHealth, a macular degeneration-focused nutraceutical I recently started prescribing. Macuhealth is the ONLY ophthalmic nutriceutical I recommend. I do not carry it in the office, but I give my patients a written script for Macuhealth with LMZ3. The script has a toll-free number my patients can call, and I provide them with my code, 10239, which identifies them as my patient. It is $75 for a 90-day supply. Macuhealth is only available through a Doctor of Optometry or Ophthalmology or by dialing the toll-free number on the Rx pad. It is NOT available in drugstores or on other web sites.

I just began this past December (2012) prescribing Macuhealth for my patients, and already,over two-thirds of them have ordered an auto-shipment of Macuhealth, and are pre-appointed for an office visit with me to evaluate the effect the nutraceutical has on the number of macular and retinal drusen present.

Educate that in an Era of Electronic Screens and CFL Lightbulbs, All Are At Risk

More research needs to be conducted in this area, but evidence is beginning to emerge that the blue light emitted from electronic devices like laptops and mobile devices, along with the light emitted from compact fluorescent(CFL) lightbulbs, increases macular degeneration risk.This is one more reason to take precautions regardless of your age or family history. Explaining the possible role these modern forms of light play in increasing macular degeneration risk, I also emphasize the importance of annual comprehensive examinations in protecting eye health.

Related ROB Articles

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Macular Degeneration Testing: Alert Patients to Value of Nutraceuticals

Improve Medical Eyecare Treatment Compliance by Tailoring Regimens to Lifestyle

Mary E. Boname, OD, MS, FAAO, is the owner of Montgomery Eye Care, P.A., in Skillman, NJ. To contact her: mboname@mecnj.com.

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