DEAR DR. DONOHUE: My sister, who is only 54, has been diagnosed with macular degeneration in both eyes – the dry kind. We have been unable to find anything about it. We did find that the dry kind is the worse kind, and that laser treatments don’t work for it. Is this true? She is on a drug called Vitalux and must take it every day. – B.T.

ANSWER: The retina is the backmost layer of the eye. The retina converts visual images coming into the eye into electric signals that are transmitted to the brain so we can see. In the center of the retina is a small, round area – the macula – responsible for central and distinct vision. Macular degeneration is a deterioration of that most important area. The person who has it sees an opaque smudge in middle of the visual field. Off to the side, vision remains intact.

Dry and wet macular degeneration are the two kinds of this disorder. The dry kind is the more common kind. Dry macular degeneration usually progresses slowly. The wet variety comes from a growth of fragile blood vessels in the macular area. Those vessels leak fluid. Loss of vision with wet macular degeneration is rapid, and for that reason, it is the worse of the two kinds. People can have both varieties at the same time. Wet macular degeneration responds to sealing of the leaky vessels with lasers. One procedure is called photodynamic therapy. It also responds to eye injections of medicines that stop the growth of these fragile blood vessels.

Your sister’s medicine, Vitalux, is a combination of vitamins C and E, beta carotene, zinc, copper, lutein (LOO-teen) and zeaxanthin (ZEE-ah-ZAN-thin). The latter two are antioxidants essential to macular health. It’s available in Canada. Similar products can be found in the U.S. This combination slows the progression of macular degeneration from the moderate to the advanced stages.

A new study is currently being conducted to see if varying the doses of those vitamins and minerals or adding omega-3 fatty acids would be more effective.

DEAR DR. DONOHUE: I am 75 and have been taking Exelon for my memory. I had an MRI scan and was told that my brain is shrinking and that I have Alzheimer’s disease. Please explain about the shrinking. – J.A.

ANSWER: Everyone’s brain shrinks with age. It’s not a sign of Alzheimer’s disease. Memory problems are one of Alzheimer’s signs, but memory defects are not the only sign. Alzheimer’s patients often are confused, find it hard to name common objects (a clock, a spoon, a pen), cannot concentrate and reason, and find simple math tasks like balancing a checkbook impossible. Frequently, they are lost in what should be familiar places.

The Alzheimer’s booklet discusses this common affliction in great detail. Readers can order a copy by writing: Dr. Donohue – No. 903, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: As with many people who are addictive by nature, I find myself at cocktail hour drinking 6-7 ounces of vodka daily. What lasting effects does excessive alcohol have on the body? I am concerned. – B.M.

ANSWER: Authorities in the use and abuse of alcohol say two drinks a day for men and one drink a day for women are the safe limits. A drink is 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof whiskey. Your 6-7 ounces of vodka equal a little more than four drinks a day. Over the years, excessive amounts of alcohol can lead to heart damage (cardiomyopathy), nerve damage (neuropathy) and degeneration of the cerebellum, the part of the brain controlling movement and balance. Such volumes of alcohol can inflame the pancreas (pancreatitis), raise blood pressure, inflame the stomach and esophagus, and lead to liver cirrhosis.

Granted that not everyone drinking these quantities of alcohol comes down with all or any of the above, but the danger is there. You’d be prudent to cut back.

DEAR DR. DONOHUE: I am a 78-year-old woman with a torn rotator cuff and arthritis in my left shoulder. My doctor says nothing can be done short of a complete shoulder replacement. Is this true? Should I get a second opinion? – E.W.

ANSWER: The rotator cuff is a “cuff” (much like shirt cuff) of four tendons that arise from four back muscles. Those tendons swing around the shoulder joint to hold it in place. Small rotator-cuff tears heal on their own. Large tears require surgical correction. Some tears call for shoulder joint replacement, especially when the joint itself is arthritic.

More than 23,000 Americans will have their shoulder joints replaced this year. Almost all will have gratifying results. They’ll be able to move their shoulder without pain. The shoulder has an excellent blood supply, so healing this joint is much faster than healing a knee or hip replacement. Furthermore, the shoulder, unlike the knee or hip, doesn’t have to support body weight, another point in its favor.

A second opinion is always worthwhile. If the second doctor agrees that you need a new joint, I say go for it.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com