The macula, short for ‘macula lutea’, is literally a ‘small yellow spot’ (from Old English and Latin) at the back of the eye. If you are looking at something, you are directing the light of the scene onto the macula, which gives you detailed vision and the perception of colour. In healthy people, the macula allows for perception of the most important visual elements in our lives: words on a page, detail in a painting or other scene, and the faces of loved ones. Without the macula, our world is a blur of grayish indistinct images and shadows. The U.S. National Eye Institute estimates that by 2020, 50% of the population over 80 will be affected by macular degeneration (ARMD, or AMD).
In a space barely a couple of millimeters in diameter, thousands of nerve cells sit waiting for light to land on them so they can send information regarding colour and fine detail to the brain. Just like any other machine that burns energy, waste is produced. Gram for gram, the macula burns through more fuel than any other tissue in the body, and like any other machine that uses energy, it will produce waste products at a greater rate than any other tissue in the body. The waste products accumulate and must be carried away by the eyes’s blood circulation in order to keep the nerve cells healthy. In healthy people, this is not usually a problem. However, in some people, especially the elderly, smokers, those with circulation problems, and people of northern European descent, the ‘garbage cleanup’ can fail, creating a slow accumulation of toxic waste from the normal functioning of the macula. These toxins destroy the protective tissues of the eye and this leads to loss of central vision.
Losing central vision is potentially catastrophic, depending on what you enjoy and what you do for employment. Central vision allows us to recognize details in words and in faces. Loss of this ability means you can only really rely on peripheral, or side, vision. If you read, use computers, or do anything that relies on detailed or color vision, you will lose this ability and will need to learn to adjust your life to accommodate for it. There are many tools and techniques available to assist with this, but once the vision is lost, it will not return.
There are two types of macular degeneration: Dry and wet. 
The dry form can smoulder for years and progress very slowly, with an accompanying slow loss of central vision. The wet form often follows the dry form, and this is when the tissue behind the macula begins to break apart, allowing new thin blood vessels to grow into spaces they don’t belong. This leads to bleeding inside the eye and even retinal detachments. 
Treatment for bleeding and retinal detachments can significantly improve your chances of losing sight, and so prompt attention to troubled vision is critical.
The best treatment for macular degeneration is prevention. People who smoke are 5X more likely to develop this condition, so clearly smoking should be reduced or eliminated. Diet is also key – diets rich in omega-3 and omega-6, with lutein, zeaxanthin, and vitamin A. If these words are complicated, allow me to simplify things by offering these three simple rules, adapted from Michael Pollan’s advice in his common sense book ‘In Defense of Food: The Eater’s Manifesto’.
- Eat Food, Real Food: Fresh, organic, unprocessed food is what we have evolved to eat. Anything else is suspect. If it doesn’t spoil, it’s not ‘real’ food.
- Eat Mostly Plants: Diets should be rich in colorful berries and deep red and green vegetables. Kale, spinach, broccoli, fresh sprouts are all great and can be easily mixed into smoothies with blueberries, blackberries, raspberries, banana, and protein powder to make an excellent meal substitute that actually cleans your intestines and blood. Meat is fine, but not as the main staple, not at every meal. Our Western diets emphasize meat and carbs, like potato, with only a brief mention of veggies, fruit, and berries. We need to reverse this, where we eat mostly plants, small amounts of carbs, and small portions of meat.
- Don’t Eat Too Much: Eat more frequent smaller meals. Eat until you are satisfied, not splitting at the seams. Keep things like apples, berries, nuts, snap peas, and peeled carrots around for when you are peckish. Grazing is OK, so long as you’re eating the right stuff. Avoid keeping salty, crunchy, and sweet snacks in your house, including pop. These represent empty calories that will only add more toxicity to the tissues of the body, including the eyes.
Finally, getting the blood moving helps to clear the toxicity from the body. You don’t need to be an athlete and workout with weights. Simple walking can be effective. Just try to sustain the activity for at least 30 minutes daily, and ensure your heart rate is running a little higher than usual. Obviously, if you have medical concerns, you should consult with your physician before engaging in anything you feel could be a risk. Walking is a good option for most people.
Macular degeneration is relatively common, and in some cases it will arise even in very healthy and fit people. Lifestyle definitely contributes to the problem, and so we should all take inventory of how we treat ourselves. As I tell my patients: You have the choice to view yourself as an old clunker, or as a high-performance vehicle. Those who choose to view themselves as old clunkers will persist in neglecting the operational and maintenance needs of their ‘machine’ and will pay the price in time. In my next article on macular degeneration, I will describe a simple way to check if you have trouble with central vision.