Drusen, Progressing AMD, and Scare Tactics

I am not big on scare tactics. I think they are tacky. I really don’t like them when they distort the truth or play on half information to prey on the uninformed.

Unhelpful scare tactics

With that said, forgive me if I saw red while looking at a black-and-white ad in the AARP magazine from February/March 2021. The ad started out with: “It’s only a matter of time, until...” Below that were pictures of a clock with an ever-growing black spot at its center. The rest of the ad implied their product could reduce the risk of that happening.

Now that that advertisement has scared the bejesus out of hundreds if not thousands of people with early-stage age-related macular degeneration. I have a news flash for you: it ain’t necessarily so.

My experience with advanced dry AMD

The photos were supposed to depict severely advanced AMD, also called geographic atrophy. A personal note here, I have had geographic atrophy and legal blindness for the past five years or so, and I have yet to see big, black blobs. I have seen a few, other, weird things but not big, black blobs. My blind spots are more like smudges on glasses. I can sort of see through them, but things also get “lost,” or I only glimpse bits and pieces. Like I said, no black blobs thus far.

Diving deeper into drusen

But don’t just take my word for it. Good grief, no. According to the article entitled "Is Drusen Area Really So Important? An Assessment of Risk of Conversion to Neovascular AMD Based on Computerized Measurements of Drusen" we discover that only 15% of people with small drusen go on to develop large drusen. ¹

What do drusen look like?

Big, fat, squishy-looking drusen (my characterization) are trouble. Drusen are piles of fatty, metabolic waste that our eyes have not been able to process. In my parlance, they are simply “eye poop.” Not to get too scatological about this, but drusen in early AMD are dry-looking little rabbit “jellybeans.” If you have been told you have the bunny beans variety, you have an 85% chance of NOT seeing big, black blobs.

But even big, squishy-looking drusen are not necessarily a death sentence for your vision. According to the article, only 26% of those with large drusen in both eyes go on to advanced disease within five years. And even after ten years, the rate of progression to advanced AMD is only 71%. That leaves over a quarter of you who just might dodge the bullet! (I am optimistic. So shoot me.)²

It's not inevitable

So, no, big, black blobs are not inevitable. You have a good chance of not seeing them even if you don’t ingest handfuls of vitamins and bushels of kale.

How do vitamins help?

Okay, one more thing before I go: remember, while “we” are working hard to get there, dry AMD has no cure and - more importantly in this case - no treatment. Vitamins are supplements, not treatments. They are not proven to treat disease.

Once more, the vitamins advertised in this advertisement were found to be effective in slowing AMD only in specific subsets of people with AMD. The National Institute of Health article "AREDS2 Supplement for Age-Related Macular Degeneration" states the AREDS2 formula has not been shown to prevent early AMD from progressing to intermediate AMD. The formula may help keep the intermediate disease stage from turning to advanced age-related macular degeneration. It may also keep an intermediate stage eye from joining its partner in the advanced disease stage. But, it is not a sure defense against big, black blogs in the center of your vision.³

Hopefully, now, if you see an ad with big, black blobs where clock faces should be, you won’t experience heart failure. Caveat emptor, grain of salt, and all that... Remember, looking at ads, it ain’t necessarily so.

Editor's Note: As of August 2023, 2 drugs known as complement inhibitors — Syfovre® and Izervay™ — have been approved by the US Food and Drug Administration (FDA) to treat geographic atrophy (GA).