Macular Degeneration

One of the most commonly expressed concerns from patients is the fear of developing age-related macular degeneration. This concern is justified, as age-related macular degeneration (AMD) is the leading cause of permanent vision loss in people 60 years of age or older.  The exact cause of AMD isn’t known, although it’s more common in people with a family history. It’s also more common in Caucasians, females, and smokers, although age is the greatest risk factor.

Macular seen on computer monitor

What is AMD?

AMD is degeneration of the small, specialized part of the retina called the macula, which provides us with our fine focus and detail vision. It is the central part of the retina that is responsible for central vision used in reading or seeing details. It is a slowly progressive condition, but may be so mild that vision loss isn’t noticed. Although peripheral (side) vision is valuable in mobility and in providing awareness of the environment, peripheral vision gives only about 20/200 resolution. In contrast, the macula in a normal healthy eye generally has 20/20 vision (with glasses, if needed). This means that the macula is ten times better at resolving detail than the peripheral retina.

Early symptoms include trouble seeing small print, blurriness, or distortion in the center of vision. In some people, central vision loss may deteriorate quickly and require treatment to stabilize or prevent further vision loss.

It is important to understand that AMD, by itself, does not lead to total blindness, as the peripheral vision is left intact. The term “legal blindness” is used to describe vision which cannot be improved to better than 20/200 with glasses or contact lenses, and is a definition used to determine eligibility for social services.

Woman having eye examined

What Is the Difference Between Wet and Dry AMD?

Dry AMD is the most common form of macular degeneration. In the earliest stages of macular degeneration, drusen begin to develop in the retina. Drusen are yellow, crystal-like deposits that consist of waste products that the retinal cells cannot break down.  Occasionally, dry AMD may progress to severe central vision loss.  Unfortunately, there are no treatments for dry macular degeneration. 

Wet AMD in a less common and more aggressive form of macular degeneration. Abnormal, fragile blood vessels form beneath the retina which can lead to swelling and bleeding in the retina.  If caught early, further vision loss may be minimized by the use of medications that are injected directly into the eye to help shrink the abnormal blood vessels.

 What is the Treatment for AMD?

There is no treatment for Dry AMD other than Vitamins.  Studies have proven that patients with moderate to advanced Dry or Wet AMD are less likely to get worse if they take a combination of antioxidant vitamins and minerals known as the AREDS2 formula. AREDS stands for Age-Related Eye Disease Study.  For people with mild AMD or who only have a family history of it, the AREDS2 formula may not be beneficial, but a multivitamin is recommended.  

For active bleeding and leaking in Wet AMD, treatment with anti-VEGF injections is indicated to stop the abnormal blood vessels and preserve vision. Commonly used anti-VEGF medications are Avastin, Eylea, or Lucentis.

Other Recommendations for AMD:

  • Amsler Grid: This is a home test to monitor for any changes due to AMD. You should notify your eye doctor immediately if you have new blind spots, distortion, or other changes on the grid.
  • Diet: Antioxidants, such as fruits and green vegetables, have been proven to reduce the risk of AMD, as well as frequent consumption of fish high in omega-3 fatty acids.
  • Smoking: Smoking has been linked with AMD and smoking cessation is strongly recommended.
  • Sun Protection: Sun damage to the retina has been linked with AMD

For those who have already suffered vision loss to AMD, there are many resources available. Support groups and psychological counseling are often helpful in making the adjustment to life with reduced vision. A low-vision specialist can be invaluable as a resource. Patients can be trained to use their peripheral vision more effectively, and a low-vision specialist can help in selecting magnification devices and non-optical daily living aids. Many patients find that with the right tools and training, daily living tasks can be accomplished independently and that life can be surprisingly normal and fulfilling.

Where Can I Get More Information?

To schedule an appointment call 414-271-2020.

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