Age-Related Macular Degeneration

Abbreviations
AMD
ARMD


INTRODUCTION

Eyesight is partly determined by genetics (inherited) and partly by nutrition and the environment (acquired). When we were born, we had good eyesight as newborns, and as little boys and girls growing up. Our eyes are either like those of our parents, grandparents or great-grandparents. If they had "strong eyes", we too have strong eyes. If they had "weak eyes", we too have weak eyes. However, not all parents with good eyesight give rise to children with good eyesight. Many poor children have good eyesight despite their "poor nutritional intake" and they spend a lot of time playing outside under the bright hot sun, even at noon. 

What then causes eyesight to deteriorate? Our eyesight deteriorates as we age. The macula degenerates as we age, giving rise to age-related macula degeneration (AMD or ARMD).

At age between 40-42, almost all adults have lens and macula changes, that they need bifocals to help them read and get on with life. When you see a person holding the newspaper about 3 feet from his/her face, you automatically know he is 40 and above. A person less than 40 usually does not have to hold the newspaper this far to be able to read it. This is more obvious in males. Females usually do not need glasses to read the newspaper or a book. So it is harder to tell if a woman is past 40.

Can we cure AMD or ARMD? No, at least not yet. Can we slow down the process? Yes, by eating proper nutrition. What should we eat? It depends on whom we are asking, which community we are studying, what our references are and which group of nutritionists are advising us.

MALAYSIA

In the old days, Malayans hardly wore glasses. Big fat men wore glasses to read newspaper. Big fat women wore cat-eye styled eyeglasses, fondly referred to as "spek mata kucing". These were favorite characters depicted in Lat's cartoon pages, Malaysia's top cartoonist.

Many Malaysians today wear eyeglasses (spectacles) or dark sunglasses (shades). Some wear ones with variable tint. Eyeglasses are expensive luxury items and not many who need them can get them at affordable price.

Malaysia is a hot humid country with temperatures ranging from 24 (night) to 31/32 (day). It has indigenous tribes in various parts, in peninsula Malaysia and Borneo. The ones living in the peninsula are grouped as Orang Asli, now re-termed Orang Asal (original dwellers or sons of the soil). They have their own simplistic  lifestyles which are different from how mainstream Malaysians live and dine.

Malaysia has a small Indian population. However, the Malays of the western coastal states of Perlis, Penang, Perak. Selangor, Malacca, and Negeri Sembilan have large widespread Indian populations. The rest of the Malay States have isolated Indian populations at rubber estates and other local farming locales. The Indians believe that brinjals (eggplants) give good eyesight. Brinjals are cooked as part of Indian curries (dalca) or coated with tumeric-salt mixture and then fried. These are eaten with either plain hot white rice or accompany briyani rice (nasi briyani). Nasi briyani has become a national favourite and is now served at most weddings and official dinners. Sometimes an oily rice (nasi minyak) is served instead of nasi briyani.

Case:

An 11-year old schoolgirl experienced problems viewing text and numerals written on the blackboard in class at school. She was short-sighted. She started wearing eyeglasses at age 12 and sat at the rear of her classroom. Throughout her primary, secondary, and tertiary studies, she needed countless changes of eyeglasses as her eyesight continued to deteriorate; at least annual change of eyeglasses. She wore contact lenses at 21-22 as a university student. 

At 41, she was diagnosed of gestational diabetes mellitus (GDM) at her last pregnancy (para6 gravida6; P6G6). At 42, she experienced changes in her lens; she became bifocal and needed glasses for far-sight to be able to read road signs and signboards properly. At 50 she had abnormalities involving the retina.

Fundoscopy - Ophthalmoscopic exam of the human retina.

At 59, she wears eyeglasses with plastic lens costing her RM790 by mail order. What is wrong with her eyesight? She has macular degeneration + astigmatism. 

Blood chemistry at 59
(After 13-hour overnight fasting AND after 20 days of 13-hr Ramadan fasting)

Renal profile: normal
Liver function test: normal
Fasting lipid profile:
  HDL-cholesterol (HDLC): 0.90 mmol/L (W 0.78-2.20; Direct inhibition method)
  LDL-cholesterol (LDLC): 3.57 mmol/L (W 2.33-4.70; calculated Friedewald formula)
  Total cholesterol (TC): 5.02 mmol/L (normal 3.6-6.3; Cholesterol oxidase method)
  Triglycerides (TG): 1.21 mmol/L (W 0.46-1.60; GPO-PAP method)
Fasting blood sugar (FBS)/Fasting blood glucose (FBG): 5.5 mmol/L 

BP: 140/90
BMI: >30

AUSTRALIA

Five hours flight down-under from Malaysia is Australia. Australia is noted for clean air, clean environment, good food, good nutrition and good health.

The indigenous people of Australia are the Aborigines or "Abo".  They are evolutionary linked to the indigenous people of the archipelago just above Australia and south of the Asian mainland. It is generally believed that Australia was part of a bigger land mass south of the Asian mainland, and indigenous people walked the Earth on one enormous land mass.

The hunting skills of the indigenous people point to their sharp vision. Most hunt with a blowpipe and poison darts.They are able to locate small objects like watering holes in boulders and what lies in the immediate surrounding. A tour of the Australian outback gives a good idea of their skills that have kept them alive for years immemorial.

The Australian Aborigines are noted to have super sight, but for a limited time of their life span. Their newborns are born with super sight and the aboriginal children continue to have super sight in adulthood till approximately age 40, where their sight begins to deteriorate from habitual practice and modern ill-health. They did not suffer from macular degeneration till age 40.

Today, Australia is a melting pot of many cultures since mass immigration began in the 1800s. Its cuisine is varied and reflects its various immigrant communites. The Australian-Egyptian oily rice dish uses large sliced Bombay onions fried in butter. The rice is then mixed in and steamed till done. The aroma is that of buttery fried onion. This type of rice dish is mostly served at festivities - eg Aidilfitri (Eid-ul-Fitr) at Perth Mosque.

Do immigrant communities have poorer vision than the Aborigines? Yes, but before age 40.

THE AMAZON

The Amazon River basin is hot and humid with thick equatorial jungles and thick undergrowth. It houses several tribes, some isolated and some who have mixed with more civilized communities. They are highly skilled hunters on land and on the river.

AFRICA

African tribes are skilled hunters in the arid and dusty safari setting, where trees are minimal and shrubs abound. Mirages are common. Hunters must be able to tell where the animals are hiding among the trees and shrubs, or where they are grazing ... near watering holes or creeks.


External links:

Pinterest: normal vs macula degenration
https://www.pinterest.com/pin/289778557269264673/
https://www.pinterest.com/pin/130745195412073753/?lp=true

Adam
http://pennstatehershey.adam.com/content.aspx?productId=42&pid=42&gid=000243

Wikipedia: Macular degeneration and Hypertensive retinopathy
https://en.wikipedia.org/wiki/Macular_degeneration
https://en.wikipedia.org/wiki/Hypertensive_retinopathy

Diabetic retinopathy
https://decisionmakerplus.net/case-report-post/diabetic-retinopathy-without-macular-edema-2/

ABC: Australian Aborigines with super sight
http://www.abc.net.au/news/2015-04-08/prince-harry-may-struggle-to-keep-up-with-aboriginal-super-sight/6378066

OPS: Online education
https://www.opsweb.org/page/onlineedu4CEC?

Stanford Medicine: Clinical pictures of retina
https://stanfordmedicine25.stanford.edu/the25/fundoscopic.html

Visuals
https://medivisuals1.com/ophthalmoscopic-view-of-normal-retina-10512303x.aspx

YouTube videos
https://youtu.be/QukG5RRqjZo
https://youtu.be/-iuumsGWo6k
https://youtu.be/YP1nbM3x-uU
https://youtu.be/8cX3ifSar9s
https://youtu.be/3RyOItWYJQM
https://youtu.be/8FWIfcmlWn4