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Clinical Crossroads Update
July 2, 2008

Update: A 76-Year-Old Man With Macular Degeneration

JAMA. 2008;300(1):91-92. doi:10.1001/jama.300.1.91

In a Clinical Crossroads article published in May 2006,1 Jorge Arroyo, MD, discussed the epidemiology and pathophysiology of age-related macular degeneration (AMD). The discussion centered on Dr G, a 76-year-old semiretired surgeon devastated by the loss of depth perception in his right eye because it prevented him from continuing to practice surgery. Three years prior to the conference, Dr G noticed subtle vision changes, which progressed, resulting in a diagnosis of AMD. After the diagnosis, Dr G received photodynamic therapy to the right eye 5 times, twice with the experimental addition of intraocular triamcinolone. Despite these treatments, Dr G lost vision in his right eye. At the time of the conference, Dr G was primarily concerned with protecting the vision in his left eye, allowing him to maintain autonomy and function with general ease. Dr Arroyo suggested that Dr G meet with a visual rehabilitation specialist to discuss strategies to help him overcome the functional limitations of his vision loss. Dr Arroyo also advised Dr G to adhere to a diet high in fruits, vegetables, fish, and nuts and to take a daily Age-Related Eye Disease Study (AREDS)–recommended antioxidant and zinc formulation. Finally, Dr Arroyo recommended that Dr G's depressive symptoms be addressed and treatment provided if necessary.