WILMINGTON – By the time many of the 10 million people suffering from age-related macular degeneration (AMD) get their diagnosis, they have already suffered irreversible vision loss. But a Wilmington doctor is trying to help change that.
“It’s a devastating diagnosis,” said Dr. Edward Paul, a Wilmington doctor who treats the disorder. “You can still see peripherally, to the sides, but you lose the center of your vision. Four in five patients go functionally blind. You can’t read. You can’t drive. You can’t make out faces. I’m not exaggerating when I say, for many patients, it feels like a death sentence.”
According to Dr. Paul, AMD is more common than glaucoma and cataracts combined, yet it remains a mystery to physicians. Doctors do know the disease is hereditary – a patient who’s parent has the disease has a 50 percent chance of also having AMD. The disease affects primarily Caucasian patients, 60 percent of whom are women. AMD affects one in eight Americans over 60 and one-third of those over 75.
Because AMD impacts older patients, who frequently have other health and mobility issues and often live alone, the resulting blindness can destroy their independence.
“There was a time when we couldn’t even halt the progress of the degeneration, even in the early stages,” Paul said. “It’s devastating. A doctor would have to tell a patient, ‘you need to make plans, you need to prepare for blindness.’”
Modern treatments – including lifestyle changes, protective eye-wear and a regimen of vitamins – can now stop the progress of AMD, but, as Paul says, “we can’t roll it back. We can’t undo the damage.”
The best offense against AMD, according to Paul, is a good defense.
“There’s a great deal we still don’t know about macular degeneration. But what we do know is that catching it early is crucial. The earlier we can detect it, the better.”
Paul’s office is one of three in the state to offer a new vision test that can do just that (the other two are in Charlotte and at the Duke Eye Center, which focuses on research and does not usually take in patients). The AdaptDX machine, which Paul starting using in September of 2016, allows doctors to diagnose AMD years before it presents as blindness.
“It’s reliably predicting macular degeneration 92 percent of the time,” he said.
Paul said the machine can also detect what he calls “wet macular degeneration,” which involves bleeding in the eye, often linked to diabetes. Paul said that this type of disease is much less common than age-related macular degeneration, and involves different treatment, but that early detection is equally crucial.
The test takes about seven minutes. Patients are situated in a black-out room and have their retina exposed to a bright light. Paul said, “It’s called bleaching your retina, but it’s in no way chemical. It’s a flash of light, basically the brightest light you’ve ever seen.”
After the flash, patients use a clicker – “that’s your Jeopardy buzzer,” said Paul – to respond to faint pulses of light. The test measures how long it takes the eye to recover from the initial flash.
Paul likens the test to walking into a movie theater.
“Imagine it’s bright summer day and you walk right into the movies, and you go into that darkened theater,” he said. “How long does it take for your eyes to adjust?”
The time it takes to adjust to darkness is called rod interept (RI) measured in minutes. A normal RI is under 6, but RIs over 6.5 (or six and a half minutes) are an early warning sign of AMD.
“It’s a very good indicator,” Paul said. “Once you hit that six and half minute mark, we still have to do follow up work, but we know we need to look at it.”
Medicare and most insurances cover the test for patients who meet at least three of the following criteria: over age 50, related to someone with AMD, Caucasian, a smoker, overweight, suffering from high blood pressure or high cholesterol levels and having difficulty seeing at night.
According to Paul, the company that manufactures the test equipment took care that the test would be covered for most at-risk patients, though Paul said he would go further.
“If the test were free, I would give it to everyone over 50,” he said.
For patients without insurance, or those who don’t meet the criteria, the test runs about $75.
“I’m confident that this will be the standard of care very soon,” Paul said.