How to Treat Age-Related Macular Degeneration

Approximately 30% of people over age 70 suffer from age-related macular degeneration (AMD) – a common condition that causes significant vision loss. Professor Anat Loewenstein, Head of Retina at the Eye Department, explains the diagnostic methods, the importance of early detection, and new treatments that are changing how we manage this disease

Understanding Age-Related Macular Degeneration 

Age-related macular degeneration affects the center of the retina – the area responsible for sharp vision – and is considered the most common cause of vision loss in older adults. It typically appears after age 50, with around 30% of people over 70 experiencing some form of the condition. As life expectancy increases, the prevalence of AMD continues to grow.

"The disease results from the aging process of the retinal layers and the supporting cells beneath them," explains Professor Loewenstein. "This isn't just a medical issue but also a family and social challenge, since many patients require ongoing assistance in managing the disease and treatment."

From "Dry" to "Wet": Stages of the Disease 

 According to Professor Loewenstein, there are two main stages of the disease. "The first stage is 'dry' macular degeneration, where there are no abnormal blood vessels," she explains. "At this stage, yellow deposits accumulate under the retina – a byproduct of natural wear and tear in the photoreceptor cells, the light sensors in the outer layers of the retina." In other words, this is a natural aging process in the vision cells that gradually causes a decline in visual acuity over the years. "

These cells convert light energy into electrical signals that allow us to see," adds Professor Loewenstein. "Due to their intense activity, they are under constant strain, and like any cell in the body – they wear out and regenerate. The accumulation of cell debris is an integral part of the aging process." 

The real challenge begins when the disease progresses to the second stage: "wet" macular degeneration. "This occurs when abnormal blood vessels grow under the retina, which leak fluid and blood into the retina – and the walls aren't strong enough to prevent this leakage," describes Professor Loewenstein. "Once there's blood or fluid in the retina, vision becomes impaired." The statistics are concerning: "10% of those with dry AMD progress to 'wet' AMD – we're talking about significant numbers." 

 It's worth noting that dry macular degeneration can also progress in another direction: in some cases, the condition worsens to geographic atrophy, where large non-functioning areas develop, causing substantial vision loss.

Treatment Breakthroughs: From Monthly Injections to Twice a Year

Until recently, AMD patients needed to visit the hospital for eye injections every month or two at most. This placed a heavy burden – not only on patients themselves, but also on family members, medical staff, and the entire healthcare system. 

"People spend about ten hours on each treatment – from pre-treatment anxiety, through examinations, to post-treatment recovery," describes Professor Loewenstein. "Many come with a companion, since pupil dilation causes temporary blurring, and these are typically elderly patients."

The good news is that treatment for the "wet" stage of the disease continues to improve. Since 2006, eye injections have been available that slow disease progression. "You can compare their impact to penicillin – a treatment that completely changed patient prognosis," says Professor Loewenstein.

In recent years, new treatments have become available that only require injections 3-4 times per year. "This is a dramatic change that greatly eases the burden on patients, their families, and the entire system," she says. "Studies conducted for FDA approval found that these treatments are at least as effective as monthly injections – and sometimes even more so." 

According to her, initial treatment includes injections of older-generation medications, and if adequate results aren't achieved after several injections – patients can switch to newer treatments, approved by all health maintenance organizations. "I have a patient who faints with every injection due to needle phobia," she shares, explaining that thanks to the new generation treatment given at a higher dose, he only needs an injection once every six months. "For someone like that, the difference between a monthly injection and twice a year is enormous." 

 Progress has also been made in treating "dry" AMD. "There's currently a new treatment approved by the FDA, " says Professor Loewenstein. "It doesn't improve vision, but it slows the growth rate of the degenerated area, which is an important achievement."

The Key to Preventing Deterioration: Early Detection 

One of the most critical factors in managing the disease is early detection of the transition from "dry" to "wet" macular degeneration. Therefore, Professor Loewenstein's recommendation is "first and foremost, get examined by an eye doctor after age 50."

If early signs of dry AMD appear, it's important to be aware that this is a risk factor, and the doctor will determine your personal risk level based on the examination. "The most important thing is that if vision declines in one eye between examinations – you should get checked immediately," emphasizes Professor Loewenstein. "Unlike temporary pain or a sharp sensation, vision decline requires examination."

 For those diagnosed with "dry" AMD, there are important preventive steps. "Taking specific vitamins reduces the risk of transitioning from dry to wet form by about 25%, according to research," she explains. "These vitamins are at higher doses than the daily recommendation, so they should only be taken with family doctor approval." Additionally, it's recommended to see an eye doctor 2-3 times per year.

Professor Loewenstein also recommends regular self-monitoring: "For people with dry AMD and risk factors, I recommend checking vision in each eye separately once a week, making sure you can read with the same clarity. The other eye sometimes compensates for the decline, and sometimes deterioration goes unnoticed."

Impressive Results – When Treatment Guidelines Are Followed 

Research results regarding success rates in reducing deterioration risk are encouraging. "There's a 95% chance of preserving vision and a 45% chance of achieving vision improvement," emphasizes Professor Loewenstein. However, she stresses that success depends on adhering to regular monitoring and following the treating physician's treatment guidelines. 

"In cases requiring treatment, we typically start with monthly injections, then transition to another treatment given about 4 times per year," she adds. "It's essential to follow the instructions." 

Another important aspect is maintaining a healthy lifestyle. "Today we look at the human body holistically," says Professor Loewenstein. "The disease is also related to blood flow, so what's good for the heart is good for macular degeneration too. Smoking worsens the disease and reduces treatment response, while moderate physical activity 4-5 times per week and a Mediterranean diet including nuts, fish, and olive oil – have been found in questionnaire studies to protect against age-related retinal degeneration."

Like Medicine continues to advance. "There are constant developments and new innovations," says Professor Loewenstein. "There are currently studies aimed at improving existing treatments – for both the dry and wet forms of the disease." Among other things, she mentions development of a home OCT device for self-monitoring between treatments, which has been approved in the United States, is about to begin commercial use, and is expected to change the monitoring routine in the future. 

The Bottom Line 

"It's important first of all to know about the disease's existence," concludes Professor Loewenstein. "Then you know you need to take the vitamins, monitor your vision, and if there's a decline – go immediately for an examination. Early detection and proper treatment can make all the difference in preserving vision and quality of life."

This is only for your information, kindly take the advice of your doctor for food, medicines, exercises and so on.   

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5 Signs It's Time to Replace Your Migraine Medicaiton

If you're one of the roughly 12% of people who experience migraines, you know this is far more than just a bad headache. The throbbing pain, nausea, sensitivity to light and sound, fatigue, and muscle aches can make a migraine attack genuinely debilitating — and finding the right treatment plan can feel like a journey in itself.

But here's something many migraine sufferers don't realize: even a treatment plan that works well at first may not work forever. Migraines are complex, and your needs can change over time. Knowing when to revisit your current approach — and bring that conversation to your doctor — can make a real difference in your quality of life. Here are five signs it may be time to do exactly that. 

1. Your Migraine Patterns Have Changed 

Every treatment plan is built around your specific symptoms and patterns. If those patterns shift, the plan may no longer be the right fit.

Migraines can evolve as your brain and nervous system become more sensitive to pain signals and inflammation — a process known as central sensitization. When this happens, attacks may feel more intense, occur more frequently, last longer, or include symptoms you haven't experienced before. Any noticeable change in your migraine patterns is worth mentioning to your doctor sooner rather than later.

2. Your Attacks Aren't Getting Better 

If your migraines aren't improving with your current medication — or if you regularly need additional rescue medications just to get through an attack — that's a signal your prescription may not be doing enough.

That said, patience is important here. Migraine medications often take time to reach their full effectiveness, and doctors typically begin with lower doses to let your system adjust gradually. Most people need a trial period of 8 to 12 weeks before they and their doctor can accurately assess whether a treatment is truly working. If you're well past that window and still struggling, it's time for a conversation. 

3. Your Medication Feels Less Reliable 

Than It Used To When a medication starts taking longer to kick in, wears off faster than it used to, or seems to need higher and higher doses to manage an attack, that's a red flag worth discussing with your doctor.

One possible explanation is medication overuse headache (MOH) — a cycle that can develop when frequent use of migraine medications actually increases central sensitization and lowers your pain threshold. Over time, your brain begins to depend on the medication, making you more prone to a return headache once it wears off. If this pattern sounds familiar, your treatment plan likely needs re-evaluation.

4. The Side Effects Are Outweighing the Benefits 

Migraine medications, like most treatments, can come with side effects. That's one reason doctors start with low doses. Common side effects include nausea, fatigue, dizziness, chest or neck tightness, skin flushing or tingling, weight changes, sleep disruption, and mood shifts. 

Some side effects are mild and manageable. But if they're significantly interfering with your ability to go about your day — or making you feel nearly as bad as the migraines themselves — the balance has tipped in the wrong direction. That's a conversation worth having with your doctor to explore alternatives. 

5. Something in Your Overall Health Has Changed 

Your general health and life circumstances have a bigger impact on migraine treatment than many people realize. Changes in your body or lifestyle can affect both how frequently migraines occur and how well your medication works.

Let your doctor know if you're pregnant or going through menopause, experiencing significant weight changes, dealing with new diagnoses, starting new medications, going through a stressful period, changing your diet, or shifting your activity levels. Even changes in work schedule or health insurance coverage are worth mentioning. 

You don't have to wait until you notice your medication failing. Keeping your doctor informed of your overall health picture helps ensure your treatment stays as effective as possible — and that you stay ahead of problems before they fully develop. 

Living with migraines means staying actively engaged with your own care. The earlier you recognize these warning signs and speak up, the better your chances of finding a treatment approach that truly works for where you are right now.

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Salt and Blood Pressure: How Much is Too Much?

Salt is one of life's great pleasures. It makes food taste of something, and a meal without any at all can feel oddly empty. Yet we are also told, again and again, that too much of it is quietly bad for us, particularly for our blood pressure. So what is the truth, how much is genuinely too much, and, perhaps most surprising of all, is the salt shaker even the real culprit? Here is a clear, practical look at salt and your blood pressure, without the scare tactics.

Why Salt and Blood Pressure Are Linked

The connection comes down to water. Salt, or more precisely the sodium in it, causes your body to hold on to extra fluid. That additional fluid means there is more volume pushing through your blood vessels, which raises the pressure inside them, rather like turning up the flow through a garden hose. Over the years, that added pressure strains your heart and damages your arteries, which is why a diet high in salt is linked to a greater risk of high blood pressure, and in turn heart disease, stroke, and kidney trouble. 

 It is worth saying that not everyone responds to salt in the same way. Some people are what researchers call salt-sensitive, and their blood pressure rises noticeably with a salty diet, while others are affected less. The catch is that there is no easy way to know which you are, and salt sensitivity tends to increase with age. Blood pressure also naturally creeps up as we get older, which is exactly why watching your salt becomes more valuable with each passing year.

The Numbers: How much is too much

Here are the figures that matter, and they are simpler than you might expect. A little context first: your body needs only a tiny amount of sodium to function, far less than most of us eat. 

The general limit: health authorities recommend that adults keep sodium below 2,300 milligrams a day. That is roughly the amount in a single teaspoon of table salt. 

The ideal target: for the best results, and especially for anyone with high blood pressure, the aim is no more than 1,500 milligrams a day. 

What most of us actually eat: the average adult takes in around 3,400 milligrams a day, roughly half as much again as the upper limit, and more than double the ideal.

One point often causes confusion, so it is worth clearing up. Sodium and salt are not quite the same thing. Table salt is only about 40 percent sodium by weight, so when a label lists sodium, that is the number to compare against the limits above. In practice, the daily 1,500 milligrams of sodium works out to a bit under a teaspoon of actual salt. 

You do not need to weigh your food or count every milligram. Simply knowing that a teaspoon a day is the ceiling, and that most people sail well past it, is enough to guide sensible choices.

The Great Surprise: It Is Not the Salt Shaker 

Here is the single most important thing to understand, and it changes everything about how to cut back. When doctors ask patients about salt, people often say, "Oh, I hardly use any, I never reach for the salt shaker." And they are usually quite sincere. But the salt shaker is not where most of our salt comes from. 

 Around 70 percent or more of the sodium we eat is already in packaged, processed, and restaurant food before it ever reaches our plate. The salt you sprinkle on at the table is a small part of the picture. This is genuinely good news, because it means the most powerful way to cut your salt is not to suffer bland home cooking, but simply to eat fewer heavily processed and restaurant foods.

Where the Salt Is Really Hiding

 

Much of the sodium we eat comes from foods that do not even taste especially salty. The worst offenders are often a surprise:

Bread and rolls. Not salty to the tongue, but we eat so much of it that it becomes a leading source. Deli meats and cured meats, such as ham, bacon, sausages, and packaged sliced turkey. 

Canned soups and packaged broths, which can hold a large share of a day's sodium in a single bowl. 

Pizza and other prepared savory dishes. 

Cheese, particularly the harder and processed kinds. 

Sauces and condiments, including soy sauce, ketchup, salad dressings, and gravies. 

Salty snacks, such as chips, crackers, and salted nuts. Canned vegetables and beans, unless labeled no salt added. 

Restaurant and takeout meals, which are very often far saltier than anything you would make at home. 

Simple Ways to Cut Back Without Losing Flavor

 
Reducing salt does not mean eating dull food. The trick is to lean on other flavors and to be a little choosier at the shops. Here are the changes that make the biggest difference:

Read the label. This is your most powerful tool. Compare the sodium figures on similar products and choose the lower one. Look for the words "low sodium," "reduced sodium," or "no salt added," and be a little wary of anything over about 400 milligrams per serving. 

Cook more from fresh. Fresh fruits, vegetables, grains, and unprocessed meats are naturally low in sodium, and cooking at home puts you in charge of how much goes in. 

Rinse canned foods. Draining and rinsing canned beans and vegetables washes away a good portion of the sodium. 

Season with something other than salt. Herbs, spices, garlic, onion, a squeeze of lemon, a splash of vinegar, and black pepper all bring food to life without a grain of salt. A bright hit of acid, in particular, does much of what salt does. 

Go easy on the salty condiments, or measure them out rather than pouring freely.

Eat out a little less, and ask. When you do dine out, you can request that a dish be made with less salt, and sauces and dressings served on the side. 

Give your taste buds time. This is the encouraging part. After a few weeks of eating less salt, your palate genuinely adjusts, and foods you once enjoyed begin to taste too salty. Cutting back gradually makes the change almost painless. 

The Potassium Half of the Story
There is a second, less famous side to this. While sodium raises blood pressure, the mineral potassium helps to lower it, by easing tension in the blood vessel walls and helping the body shed excess sodium. Many of us do not get enough of it. 

Potassium-rich foods include bananas, potatoes and sweet potatoes, beans and lentils, leafy greens, tomatoes, oranges, and yogurt. Happily, these are exactly the sort of fresh, whole foods that are also low in sodium, so filling your plate with them helps on both counts at once. One important caution, though: if you have kidney disease or take certain blood pressure or heart medications, too much potassium can be harmful, so check with your doctor before making a point of increasing it, and be careful with the potassium-based salt substitutes sold in shops.

What Cutting Back Can Actually Do 

Is the effort worth it? For many people, yes, and encouragingly quickly. Trimming your sodium by around 1,000 milligrams a day has been shown to improve blood pressure and heart health. In those who are salt-sensitive or already have high blood pressure, moving toward the lower target can reduce the top blood pressure number by a meaningful amount, sometimes as much as a modest medication would.

That said, honesty matters here too. Not everyone will see a dramatic change, because people vary in how strongly they respond to salt. But since there is little downside to eating a bit less, and a good deal of potential benefit, it is a sensible and low-risk change for almost anyone, particularly as we get older. 

When to Talk to Your Doctor  

Salt is only one piece of the blood pressure puzzle, alongside weight, activity, alcohol, stress, and family history. It is worth a conversation with your doctor if: 

You have high blood pressure, or have not had it checked in a while. 

 You are unsure what sodium target is right for you, since the ideal amount can depend on your health and medications. 

You have kidney disease or heart failure, which change the advice on both sodium and potassium. 

You are considering a salt substitute, especially a potassium-based one, which is not safe for everyone.

This is only for your information, kindly take the advice of your doctor for food, medicines, exercises and so on.   

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