Age-related macular degeneration (AMD), also known as macular degeneration, is a common eye disorder. It’s caused by deterioration of the macula, a small area in the center of the retina in the back of the eye.
Macular degeneration causes central vision loss. Your central vision is what you see in front of you when you’re looking straight ahead.
Your peripheral vision is what you see on the side when you’re looking straight ahead. Macular degeneration doesn’t cause total blindness because it doesn’t affect your peripheral vision.
It’s estimated that 11 million Americans have this disease. It’s the number one cause of vision loss.
There are two types of macular degeneration:
Dry macular degeneration affects about 85 to 90 percent of people with the condition. It occurs due to small yellow deposits called drusen developing under the macula.
Wet macular degeneration affects the remaining 10 to 15 percent. It occurs when abnormal blood vessels develop under the retina and macula.
Macular degeneration is a progressive disease. This means that it’ll get worse over time.
You may not notice vision problems in the early stages of the disease. You’re also less likely to notice vision changes when they affect both eyes at the same time.
The signs and symptoms of dry macular degeneration include:
- a reduction in central vision
- a distortion of straight lines in your field of vision
- the need for brighter lighting
- difficulty adapting to low lights
- trouble recognizing faces
- retinal damage
Some symptoms of wet macular degeneration resemble those of dry macular degeneration, such as visual distortions and reduced central vision.
If you have wet macular degeneration, you may also experience:
- a blurry spot in your field of vision
- a dark spot in the center of your vision due to blood vessels bleeding or leaking fluid
- hazy vision
- rapidly worsening symptoms
Wet macular degeneration progresses more quickly than dry macular degeneration.
There’s currently no cure available for macular degeneration, but your doctor can recommend options to help slow the disease progression.
Treatment for wet macular degeneration
If you have wet macular degeneration, you’ll benefit from working with a low-vision rehabilitation specialist. The specialist can teach you how to adjust to and cope with vision loss.
Your doctor may also inject a medication directly into your eye to stop the growth of new blood vessels.
These medications are known as anti-vascular endothelial growth factor (anti-VEGF) drugs.
They include ranibizumab (Lucentis) and aflibercept (Eylea). It can take several weeks of treatment before you notice a difference.
Another treatment option is photodynamic therapy.
Your doctor injects a medication into a vein in one of your arms and then uses a special laser to close up leaking blood vessels. This type of therapy can improve your vision, but you may need multiple treatments.
Photocoagulation is another option. This involves the use of high-energy laser beams to destroy abnormal blood vessels.
The purpose of this therapy is to help stop bleeding and reduce further damage to your macula. However, the laser can cause scarring and leave a blind spot on your eye.
Even if photocoagulation is successful, abnormal blood vessels can regrow, and you’ll have to return for another treatment.
Treatment for dry macular degeneration
If you have dry macular degeneration, your doctor may also suggest that you work with a low-vision rehabilitation specialist.
In addition, they may recommend surgery to help improve your vision. During the surgery, they’ll implant a telescopic lens in your eye to replace the natural lens. This magnifies your field of vision.
It isn’t known why some people develop macular degeneration while others don’t. However, certain factors can increase your risk for developing the disease.
These risk factors include:
- being over the age of 55 years old
- having a family history of macular degeneration
- being overweight
- having cardiovascular disease
- having high cholesterol
Research has shown that macular degeneration disproportionately affects white people more than other populations.
It’s important to have annual eye exams even if your vision appears normal. You should tell your doctor about any vision changes you experience too.
Your doctor can conduct a variety of tests to diagnose macular degeneration.
For example, they can use special eye drops to dilate your eyes and then check the back of your eyes for signs of fluid, blood, or yellow deposits.
Other tests include the following:
Amsler grid test
During an eye exam, they can also check your field of central vision by asking you to look at an Amsler grid.
An Amsler grid has a basic grid pattern with a dot at the center. If some of the lines on the grid appear irregular, it can be a sign of wet macular degeneration.
You can also use an Amsler grid at home. Just follow the steps below:
- Wear your glasses or contact lenses as normal.
- Hold the Amsler grid about 12–15 inches away from your face.
- Cover one of your eyes with your hand.
- Focus your other eye on the dot at the center of the grid.
- Notice whether the lines on the grid are faded, dark, broken, wavy, or otherwise irregular.
- Repeat on the other side.
Amsler grids are used for diagnosis as well as monitoring. The idea is to look for changes in the alignment of the lines, which indicate disease progression.
Your doctor will let you know how often you should use the grid at home.
In fluorescein angiography, your doctor injects a colored dye into a vein in your arm. The dye will eventually travel to your eye, allowing your doctor to examine the blood vessels there. Then, they’ll use a special camera to take pictures of your eye.
They’ll examine these pictures to look for problems and changes in your blood vessels and retinae.
Indocyanine green angiography
Indocyanine green angiography is similar to fluorescein angiography. In this test, your doctor injects your arm with indocyanine green dye.
They can use this test to confirm the results of fluorescein angiography and to diagnose which type of macular degeneration you have.
Optical coherence tomography
Optical coherence tomography involves taking cross-sectional images of the retinae and checking for swelling, thickening, or thinning.
After you’re diagnosed with macular degeneration, your doctor may also use this type of test to see how your eyes respond to treatment.
Certain vitamins may help to slow the progression of late macular degeneration affecting only one eye or intermediate macular degeneration.
The National Eye Institute (NEI) has sponsored two large studies that examined the role of nutritional supplementation in the disease. The studies are known as Age-Related Eye Disease Study (AREDS) and AREDS2.
In the initial study, researchers found that daily supplementation reduced the 5-year risk of intermediate disease progressing to late disease by 25–30 percent. It also reduced the risk of vision loss by 19 percent.
The original AREDS multivitamin formula, based on the findings from the 2001 study, includes:
- 500 milligrams (mg) of vitamin C
- 400 international units (IU) of vitamin E
- 80 mg of zinc
- 15 mg of beta carotene
- 2 mg of copper
Beta carotene isn’t recommended for people who currently smoke or used to smoke. It increases their risk for developing lung cancer, according to a landmark 1994 study involving men who smoke.
According to a 2010 literature review, beta carotene increases the risk of lung cancer in women who smoke as well.
In 2013, the AREDS2 formula was introduced. It replaced beta carotene with two other carotenoids:
- 500 mg of vitamin C
- 400 IU of vitamin E
- 80 mg of zinc
- 10 mg of lutein
- 2 mg of zeaxanthin
- 2 mg of copper
Consider asking your doctor for advice on which vitamin brand to try.
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Experts haven’t determined a way to prevent macular degeneration. However, you can help reduce your risk for the disease by maintaining a healthy lifestyle.
- quitting smoking if you smoke
- eating a healthy diet as often as possible
- maintaining a moderate weight
- exercising as much as possible
One of the complications of macular degeneration is being unable to perform certain tasks on your own. As the disease progresses, it becomes increasingly difficult to read or complete other activities.
It’s common for people with macular degeneration to be unable to drive a car. If your doctor diagnoses you with macular degeneration, you may have to complete a vision test periodically to ensure you’re capable of operating a car.
Other complications are described below.
Depression and anxiety
Up to 39 percent of people with macular degeneration experience some form of depression, which can be partially attributed to vision loss.
Anxiety is also common. However, people with the condition and people without the condition ultimately experience similar rates of anxiety.
Speak with your doctor if you’re experiencing the symptoms of depression or anxiety.
They can suggest treatments, such as medication, counseling, or a support group for people with vision impairments, to help improve your mental health.
As your vision decreases, your brain may compensate by creating false images or hallucinations. This isn’t a symptom of a mental health problem.
It’s estimated that anywhere from 10 to 40 percent of older people with visual impairment experience hallucinations due to low-vision stimulation.
You should discuss your hallucinations with your doctor or a support group. They can help you find ways to cope.
Macular degeneration isn’t preventable, but it’s possible to diagnose the condition early with regular dilated eye exams. Early treatment can help slow the disease progression and minimize vision loss.
If you’re experiencing the symptoms of macular degeneration or notice other changes in your vision, make an appointment to see your doctor.