This article addresses a common eye condition - age-related macular degeneration, or AMD. AMD mainly affects older people and can cause vision problems, making it imperative for them to understand the condition. For a full overview of this eye problem, we will cover the most asked questions and provide details about its management.
Understanding Age-Related Macular Degeneration (AMD)
AMD affects the part of the retina in the back of your eye - the macula. The role of the macula is to help you see fine details clearly, for example, to recognize faces or read. Changes can occur in the macula as part of the aging process. Thus leading to age-related macular degeneration.
Unfortunately, age-related macular degeneration cannot be completely reversed. Catching the condition early and treating it tends to slow down AMD progression and prevent severe vision loss.
AMD can manifest in one eye or both eyes, and it does not typically affect peripheral vision, only central vision.
Age-Related Macular Degeneration Symptoms
Age-related macular degeneration develops slowly. Vision changes associated with AMD are gradual, not sudden. So you might not notice any warning signs or symptoms in the early stages.
As the condition progresses, patients may experience the following symptoms of AMD:
Blurry vision
Distorted vision
Central vision loss
Difficulty seeing in low light
Difficulty recognizing faces or distinguishing colors
Seeing straight lines as wavy
A blind spot (dark patch) in the center of the vision field
A person with AMD is not completely blind, but the loss of central vision may make it hard to perform everyday tasks, like driving, reading, and watching TV.
While it primarily affects vision, AMD does NOT cause headaches directly. Some individuals may experience eye strain or discomfort, which could lead to headaches. If you're experiencing headaches along with vision changes, consult your doctor for a proper evaluation.
Age-related macular degeneration does NOT cause eye pain and does NOT affect your eyes' appearance. If you notice pain or changes in how your eyes look after your AMD diagnosis, this may be a sign of another underlying condition. Seek prompt medical attention.
Who is at Risk of AMD?
People older than 60 years of age are at greater risk, along with people who smoke or have smoked in the past, and those spending too much time in the sun without UV protection. High blood pressure, physical inactivity, and obesity are also detrimental risk factors.
Because of the less pigment in blue and green eyes, people with light-colored eyes are prone to AMD more than dark-eyed people. Also, Caucasians are more likely to develop age-related macular degeneration, compared to Hispanics or African Americans.
Patients with existing age-related macular degeneration in one eye are likely to develop it in their other eye as well later in life.
These profiles are not exclusive. People outside of these risk groups may also get AMD, even though they are statistically less prone to it!
Is Age-Related Macular Degeneration Genetic?
Genetics can play a role in the development of age-related macular degeneration. If you have a family history of the condition, you may be at a higher risk. However, lifestyle factors also influence your risk. So it's crucial to focus on overall eye health regardless of your family history of AMD.
Differences Between Wet and Dry Age-Related Macular Degeneration
Wet AMD (also known as neovascular AMD) involves the growth of abnormal blood vessels under the macula. This abnormality results in leakage of fluid and blood, which can cause rapid and severe vision loss if left unattended.
Dry AMD appears as a gradual deterioration of cells in the macula and the formation of small deposits (drusen), resulting in a slower progression of vision loss over time.
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How is Age-Related Macular Degeneration Diagnosed?
Diagnosing AMD is crucial for on-time intervention and effective management. Your eye doctor will conduct a series of tests to assess the health of your eyes and determine if AMD is present.
Take a closer look at the diagnostic process for age-related macular degeneration:
Comprehensive Eye Exam
Your eye doctor will start by reviewing your medical history. Then they will perform a thorough examination of your eyes. This includes checking your visual acuity, examining the structures of your eye with a slit lamp, and assessing your retina health.
Dilated Eye Exam
During the dilated eye exam, your eye doctor will use special eye drops to dilate your pupils. That's allowing them to get a clear view of your retina and macula. They will then examine these areas for any signs of AMD, such as drusen (yellow deposits under the central part of the retina) or pigmentary changes in the macula.
Optical Coherence Tomography (OCT)
The next step in the diagnosing process is an OCT scan. OCT is a non-invasive imaging test providing cross-sectional images of the retina. It allows your eye doctor to assess the thickness and integrity of the macula, as well as detect any fluid accumulation or structural changes associated with AMD.
Fluorescein Angiography
In some cases, your ophthalmologist may recommend a fluorescein angiography to evaluate the blood flow in your retina. The test involves injecting a safe dye into your arm through an intravenous line and taking rapid-fire photographs as the dye circulates through your blood vessels in the eye. It helps identify abnormal blood vessel growth (neovascular AMD) and leakage.
Early detection of AMD allows for timely intervention, which can help slow down its progression and preserve your vision. You have to attend regular eye exams as you get older, to monitor your eye health and detect any changes early on.
Age-Related Macular Degeneration Treatment
Age-related macular degeneration is highly individualized. It depends on the type and stage of the disease, overall health, and patient preferences. We advise you to work closely with your eye care specialist to develop a treatment plan, tailored to your AMD needs.
There are several treatment approaches for age-related macular degeneration:
Anti-VEGF Therapy
Anti-VEGF is the most common treatment for wet AMD.
Vascular endothelial growth factor (VEGF) is a protein promoting the growth of abnormal blood vessels in the retina. Anti-VEGF drugs, such as ranibizumab (Lucentis), aflibercept (Eylea), and bevacizumab (Avastin), and new generations of medicaments Beovu (Brolucizumab), Vabysmo (Faricimab-svoa) are injected directly into the eye. They tend to block the action of VEGF and inhibit the growth of these vessels. Anti-VEGF therapy can reduce swelling, leakage, and the risk of severe vision loss in patients with wet age-related macular degeneration.
Photodynamic Therapy (PDT)
PDT is a rare second-line treatment option for wet AMD.
Although it's less commonly used than anti-VEGF therapy, some doctors still recommend it as a treatment option. Photodynamic Therapy involves injecting a light-sensitive drug called verteporfin into the bloodstream. It is then activated by a laser to destroy abnormal blood vessels in the retina. PDT is often used in combination with other therapies or when anti-VEGF treatment is not effective.
Laser Therapy
In some rare cases of AMD, especially certain types of dry AMD, laser therapy is an option.
It can seal off leaking blood vessels or destroy abnormal tissue in the retina. Laser treatment is less commonly used today due to the development of more effective therapies like anti-VEGF injections.
Pegcetacoplan Intravitreal Injection Therapy
There are emerging therapies for slowing down geographic macular atrophy in the cases of dry macular degeneration like the FDA-approved SYFOVRE (Pegcetacoplan) intravitreal injection. The medication is applied monthly or every other month.
AREDS Nutritional Supplements
Studies have shown certain vitamins and minerals, such as vitamin C, vitamin E, zinc, copper, and lutein/zeaxanthin, may slow down the progression of early-stage AMD. These nutrients are often included in specific formulations known as AREDS (Age-Related Eye Disease Study) supplements, which are available over the counter.
Consult with your eye doctor before starting any supplements. They should be appropriate for your condition.
Low Vision Aids
For individuals with advanced AMD who experience significant vision loss despite treatment, low vision aids maximize remaining vision and improve quality of life. Those are magnifiers, telescopes, and special lighting devices.
While treatment may slow down the progression of AMD, the effectiveness may vary from person to person. Early diagnosis, regular monitoring, and proactive management are key to optimizing outcomes.
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Age-Related Macular Degeneration Prevention
While there is no surefire way to prevent AMD, certain lifestyle choices and habits can reduce your risk or delay its onset.
The age-related macular degeneration preventive measures to take include:
Healthy diet
Quit smoking
Maintain a healthy weight
Protect your eyes from UV light
Monitor your eye health
Eat a balanced diet of fruits, vegetables, and omega-3 fatty acids. Foods high in antioxidants, such as leafy greens, berries, and fish, may help protect the eyes from oxidative damage.
Smoking is also a significant risk factor for age-related macular degeneration and can accelerate its progression. If you quit smoking, you lower your risk and improve your eye health altogether.
Obesity and high body mass index (BMI) have also been linked to a high risk of AMD. Aim to maintain a healthy weight through regular exercise and a nutritious diet.
You should also wear sunglasses that block harmful UV rays whenever you're outdoors, even on cloudy days, as prolonged exposure to UV light affects eye health. Last but not least, attend regular eye exams.
Remember to consult with your eye doctor for individual advice and recommendations based on your risk factors and needs.
Statistics and Resources:
Checked by Atanas Bogoev, MD.