A protocol for the evaluation and treatment of atrophic age-related macular degeneration.

BACKGROUND: Age-related macular degeneration (ARMD), the leading cause of vision loss in aging Western societies, is (in part) a nutrition-responsive disease that can be stabilized through environmental intervention. The atrophic form of the disease constitutes nearly 90% of cases, yet a standardized ophthalmic and systemic evaluation protocol does not exist.

METHODS: A basic science and epidemiologic rationale for evaluating atrophic ARMD using a standardized low-cost, "low-technology," clinical approach is presented. The protocol is based on optometric physiological optics and ARMD retinal physiology/pathophysiology.

RESULTS: The ophthalmic component involves baseline and serial measurements of contrast sensitivity (CSF), low-luminance, low-contrast visual acuity (SKILL), and glare recovery (GR) in each eye. The systemic component includes self-administered evaluation of nutritional status (food and supplement intake), exercise and activities of daily living associated with ARMD (night driving/glare adaptation disturbance and dark green-leafy vegetable/plant food consumption).

CONCLUSIONS: The literature supports careful baseline and serial evaluation of high-risk patients using germane parameters of ocular function and systemic health specific to ARMD. This "ARMD workup" is analogous to a glaucoma workup, but involves less equipment and chair time. Any optometrist can obtain these measurements using inexpensive testing protocols. (Part II of this paper presents serial environmental intervention case report data.)