What Is Macular Degeneration?
Age-related macular degeneration (AMD) is a problem with your retina. It happens when a part of the retina, called the macula, is damaged. With AMD, you lose your central vision. You cannot see fine details, whether you are looking at something close or far. But your peripheral (side) vision will still be normal. For instance, imagine you are looking at a clock with your hands. With AMD, you might see the clock’s numbers but not the hands. AMD is very common. It is a leading cause of vision loss in people 50 years or older. The specialists at Reingold Eye Center diagnose and provide AMD treatment using advanced procedures.
Two types of AMD
This form is quite common. About 80% (8 out of 10) of people who have AMD have the dry form. Dry AMD is when parts of the macula get thinner with age and tiny clumps of a protein called drusen grow. You slowly lose central vision. There is no way to treat dry AMD yet.
This form is less common but much more serious. Wet AMD is when new, abnormal blood vessels grow under the retina. These vessels may leak blood or other fluids, causing scarring of the macula. You lose vision faster with wet AMD than with dry AMD.
Many people don’t realize they have AMD until their vision is very blurry. This is why it is important to have regular visits to an ophthalmologist. He or she can look for early signs of AMD before you have any vision problems.
Who Is at Risk for AMD?
You are more likely to develop AMD if you:
Having heart disease is another risk factor for AMD, as is having high cholesterol levels. Caucasians (white people) also have an elevated risk of getting AMD.
How is AMD Diagnosed and Treated?
During an eye exam, your ophthalmologist may ask you to look at an Amsler grid. This grid helps you notice any blurry, distorted, or blank spots in your field of vision. Your ophthalmologist will also look inside your eye through a special lens. He or she can see if there are changes in the retina and macula.
Your ophthalmologist will put dilating eye drops in your eye to widen your pupil. This allows him or her to look through a special lens at the inside of your eye.
Your doctor may do fluorescein angiography to see what is happening with your retina. Yellow dye (called fluorescein) is injected into a vein, usually in your arm. The dye travels through your blood vessels. A special camera takes photos of the retina as the dye travels throughout its blood vessels. This shows if abnormal new blood vessels are growing under the retina.
Optical coherence tomography (OCT) is another way to look closely at the retina. A machine scans the retina and provides very detailed images of the retina and macula.
Optical coherence tomography angiography (OCTA) is another way to look closely at the blood vessels in and under the retina. This is like fluorescein angiography but does not use a dye.
Dry AMD treatment
Right now, there is no way to treat the dry form of AMD. However, people with lots of drusen or serious vision loss might benefit from taking a certain combination of nutritional supplements. A large study (AREDS and the later AREDS 2 study) found those people may slow their dry AMD by taking these vitamins and minerals daily:
Your ophthalmologist can tell you if vitamins and minerals are recommended for your dry AMD, as not all forms will benefit from the AREDS supplements. Beta carotene should not be used by smokers as it raises the risk of lung cancer.
Eye-healthy foods: Dark leafy greens, yellow fruits and vegetables, fish, and a balanced, nutrient-rich diet have been shown beneficial for people with AMD.
Wet AMD treatment
To help treat wet AMD, there are medications called anti-VEGF drugs. Anti-VEGF treatment helps reduce the number of abnormal blood vessels in your retina. It also slows any leaking from blood vessels. This medicine is delivered to your eye through a very slender needle.
Laser surgery may also be used to treat some types of wet AMD. Your eye surgeon shines a laser light beam on the abnormal blood vessels. This reduces the number of vessels and slows their leaking.
Talk with your ophthalmologist about ways to treat your AMD.
Vitamins for AMD
People who have a certain form of age-related macular degeneration (AMD) may benefit from a specific mix of vitamins and minerals. Taking these nutritional supplements might help slow this eye disease.
About 8 out of 10 people with AMD have the dry form. This condition is due to a breakdown or thinning of the macula. Dry AMD usually begins when tiny, yellow deposits called drusen form under the retina. Eventually, the macula may become thinner and stop working properly.
Many people with AMD have drusen. These alone do not cause vision loss. But when drusen grow in size or number, you are at risk for getting early or intermediate AMD. There are not always symptoms with these stages of AMD, though people with intermediate AMD might start to notice a blurred spot in their central vision.
Advanced AMD develops when cells in your macula begin to break down. This is when the blurred spot in your central vision starts getting bigger and darker. That is what robs you of your central vision.
Dry AMD and AREDS Vitamins
AREDS 2 (Age-Related Eye Disease Study 2) was a very large research study. It looked at taking vitamins and minerals daily for AMD. This study found that certain nutritional supplements could help some people who have a lot of drusen. These supplements may also help people who have lost a lot of vision in at least one eye from AMD. Taking the following nutritional supplements every day may help these people lower their risk of getting late-stage or wet AMD:
It is important to remember that nutritional supplements are not a cure for AMD, but they may help to slow the disease in some people with early- to mid-stage AMD.
Should you take nutritional supplements for AMD?
Talk with your ophthalmologist about whether nutritional supplements are recommended for you. Here are some topics to discuss:
Macular Degeneration and Low Vision: Making the Most of Low Vision
If you have AMD, you can learn how to make the most of your vision. Often, you can still do many of your favorite things with special low-vision tools. These can include different kinds of magnifying tools, handheld computers, electronic items, and more.
Also, you can learn how to use your side vision to help you do things. A vision rehabilitation specialist can teach you how this works. They also can help you find many low-vision support services and tools.
Ask your ophthalmologist to help you find a vision rehabilitation specialist in your area. The goal is to learn new ways to be as independent as possible.
Test your vision with the Amsler grid.
AMD causes your vision to change over time. You may not notice these changes when they happen. But you need to catch vision changes as soon as possible. Treating them early can help slow or stop further loss of sight. You should use an Amsler grid every day to monitor your vision. One is below for you to use.
Here is how to use the Amsler grid:
Call your ophthalmologist right away if you notice that any lines or parts of the grid look wavy, blurry, or dim.
Genetics and Age-Related Macular Degeneration
Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in the United States. Nearly two million Americans have AMD. This number is projected to more than double over the next two decades.
Anyone can develop AMD, but lifestyle and diet are major factors in an individual's risk. And it's clear that genetic factors have a lot of influence on when AMD might start and how it progresses.
Many Genes Influence AMD Risk, But Two Stand Out
Large genome-wide association studies have identified over 30 genes associated with the risk of developing AMD. These kinds of studies look for genes that are more common in people with certain conditions. If a lot of people have a particular variation of a gene and also have a particular condition—while other people without the variation don’t have the condition—that gene is said to be associated with the condition. Variants in all 30-plus of these genes contribute to different levels of risk of developing AMD.
Variations in two genes have been more closely connected to both developing AMD and whether it progresses to the advanced stages of the disease. These are:
The presence of these genetic variants doesn’t mean that someone will definitely develop AMD. These variants mean that one may have a higher risk of AMD or developing advanced disease in the future.
The complement cascade is an essential part of the body’s immune system. It controls a series of proteins that protect against invading pathogens like bacteria and viruses. Complement can sometimes incorrectly target the body’s healthy cells, including cells in the retina.
Some researchers believe that inflammation and immune mechanisms are part of what causes AMD. The connection between complement gene variants and AMD supports this theory. There are several variants of the complement genes, and they create different levels of AMD risk.
While scientists are intensively researching ARMS2/HTRA1, the role of these genes in AMD is not yet understood. It appears there is a strong connection, but we don’t yet know what these genes do.
Other genes associated with increased AMD risk are involved in cholesterol and lipid (fat) metabolism, collagen production, DNA repair, protein binding, and cell signaling. Research on these genes and their role in disease onset and progression is still underway.
In addition, certain gene variants can have a protective effect against AMD, reducing an individual’s risk of developing the disease. These include variants in other parts of the complement and immune gene groups and other genes that affect lipids.
Genetic Testing and The Future of AMD
Genetic testing is available for some of the AMD risk genes. However, the American Academy of Ophthalmology does not currently recommend genetic testing for AMD. Gene therapy is not available for the prevention or management of the disease, so there is no benefit in identifying which genes are involved in any individual’s case of macular degeneration.
As future studies shed more light on AMD and individual genotypes—and if treatment tailored to individuals becomes available—genetic testing for AMD may become helpful. We may one day have targeted therapies for AMD based on the individual’s genes and lifestyle.
In the meantime, anyone with a family history of AMD should have their eyes examined as recommended by an ophthalmologist, get enough exercise, eat a well-balanced diet, and quit smoking. If you have AMD, existing treatments, including vitamin supplements and medications, can be very effective.
Age-Related Macular Degeneration Vision Simulator
How does age-related macular degeneration affect your vision?
Age-related macular degeneration is a condition that affects your central vision. This is the vision that allows you to see fine details. People with AMD have trouble doing things like reading, driving, finding buttons on their phones, and recognizing faces. AMD usually doesn’t affect your side (peripheral) vision.
Symptoms of AMD include having things look blurry or noticing wavy or blank areas in your field of vision. The simulator below shows how someone with AMD might lose sight over time, with a blank area gradually masking their central vision.
What Does Macular Degeneration Look Like?
Ophthalmologists can only see the effects of AMD by looking closely at the retina. They use a special camera to shine light onto the back of the eye (fundus) and take pictures. Ophthalmologists call these pictures fundus photographs.
Drusen are fatty deposits under the retina. Hard drusen are not a sign of AMD. Soft drusen are closer together and form larger deposits. They can be an early sign of AMD.