Dame Judi Dench, the actress who plays the steely-eyed boss keeping watch over James Bond, revealed she is losing her sight to macular degeneration.
"I can't read scripts anymore because of the trouble with my eyes," Dench, 77, told the Mirror. "And so somebody comes in and reads them to me, like telling me a story."
The macula is a small area in the center of the retina responsible for fine vision -- the kind needed to read or detect details in faces. With age, the macula can break down, and the blood vessels underneath can leak, causing blurriness and, eventually, a blind spot right in the center of the visual field.
"The most distressing thing is in a restaurant in the evening I can't see the person I'm having dinner with," Dench said.
Age-related macular degeneration is the leading cause of vision loss in people over 60, according to the National Eye Institute. In 2004, an estimated 1.75 million Americans had the disease -- a number likely to grow as the boomer population ages.
"It can be a visually devastating disease," said Dr. Martin Friedlander, chief or Retina Services at the Scripps Clinic in La Jolla, Calif. "Particularly because it affects people at a time in their lives when they are more dependent on their fine, or central, vision to do the things we all would like to enjoy in the golden years: read, play games, watch TV, enjoy art, and look at our grandchildren's faces."
Dench has a 15-year-old grandson, Sam.
The cause of age-related macular degeneration is unknown, but genes can contribute to it.
"People with a family history of macular degeneration have a higher risk," said Dr. Sophie Bakri, professor of ophthalmology at the Mayo Clinic in Rochester, Minn.
Dench revealed that her mother, too, lived with the disease.
Being white, female and blue-eyed, like Dench, may also increase the risk macular degeneration, according to the Mayo Clinic.
There are two types of macular degeneration: Dry, which is caused by a breakdown of the light-detecting cells of the macula; and wet, which is caused by the growth of abnormal, leaky blood vessels. Dench said she has the dry form in one eye and the wet form in the other.
"The presence of both forms in one person is not at all unusual," said Dr. Marco Zarbin, chairman of New Jersey Medical School's Institute of Ophthalmology and Visual Science in Newark.
Although neither form can be cured, both can be treated with the goal of slowing the degeneration and preventing vision loss.
"The most important innovation in the treatment of age-related macular degeneration ever was the introduction of drugs that block the action of vascular endothelial growth factor," said Zarbin, describing injectable drugs like Lucentis, which was approved by the U.S. Food and Drug Administration in 2005, that thwart the growth of abnormal blood vessels in wet macular degeneration. "That has allowed hundreds of thousands of people to preserve their vision and their independence."
In some cases, dry macular degeneration can be slowed with high doses of vitamins A, C and E as well as zinc and copper, Bakri said. And a tiny telescope can be surgically implanted into the eye to magnify the field of vision.
Experimental stem cell-based and gene therapy approaches have shown promise in treating macular degeneration, but Bakri said they're not yet ready for the clinic.
Dench told the Mirror she's getting injections and believes the disease has "arrested." Whatever happens, she has no plans to retire from acting.
"I'm very conscious that I'm in the minority in that I love what I do," she said. "And how lucky to be employed at it -- how incredibly lucky."