Age-Related Macular Degeneration

What Is Age-Related Macular Degeneration?

Age-related macular degeneration (AMD) is an eye disease that may get worse over time. It’s the leading cause of severe, permanent vision loss in people over age 60.

It happens when the small central portion of your retina, called the macula, wears down. The retina is the light-sensing nerve tissue at the back of your eye.

Because the disease happens as you get older, it’s often called age-related macular degeneration. It usually doesn’t cause blindness but might cause severe vision problems.

Another form of macular degeneration, called Stargardt disease or juvenile macular degeneration, affects children and young adults.

Wet vs. Dry Macular Degeneration

There are two main types of age-related macular degeneration:

  • Dry form. People with this may have yellow deposits, called drusen, in their macula. A few small drusen may not cause changes in your vision. But as they get bigger and more numerous, they might dim or distort your vision, especially when you read. As the condition gets worse, the light-sensitive cells in your macula get thinner and eventually die. In the atrophic form, you may have blind spots in the center of your vision. As that gets worse, you might lose central vision.
  • Wet form. Blood vessels grow from underneath your macula. These blood vessels leak blood and fluid into your retina. Your vision is distorted so that straight lines look wavy. You may also have blind spots and loss of central vision. These blood vessels and their bleeding eventually form a scar, leading to permanent loss of central vision.

Most people with macular degeneration have the dry form, but the dry form can lead to the wet form. Only about 10% of people with macular degeneration get the wet form.

If you have macular degeneration, you’ll need to monitor your eyesight carefully and see your eye doctor regularly.

Symptoms of Macular Degeneration

Early on, you might not have any noticeable signs of macular degeneration. It might not be diagnosed until it gets worse or affects both eyes.

Symptoms of macular degeneration may include:

  • Worse or less clear vision. Your vision might be blurry, and it may be hard to read fine print or drive.
  • Dark, blurry areas in the center of your vision
  • Rarely, worse or different color perception

If you have any of these symptoms, go to an eye doctor as soon as possible.

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Causes of Macular Degeneration

Age-related macular degeneration is more common in older people. It’s the leading cause of severe vision loss in adults over 60.

Macular degeneration may have something to do with your genes. If someone in your family has it, your risk might be higher.

Smoking, having high blood pressure or high cholesterol, obesity, eating lots of saturated fat, being light-skinned, being female, and having a light eye color are also risk factors.

How Is Macular Degeneration Diagnosed?

A routine eye exam can spot age-related macular degeneration. One of the most common early signs is drusen -- tiny yellow spots under your retina -- or pigment clumping. Your doctor can see these when they examine your eyes.

Your doctor may also ask you to look at an Amsler grid, a pattern of straight lines that resembles a checkerboard. Some of the straight lines may appear wavy to you, or you may notice that some of the lines are missing. These can be signs of macular degeneration.

If your doctor finds age-related macular degeneration, you may have a procedure called angiography or one called OCT. In angiography, your doctor injects dye into a vein in your arm. They take photographs as the dye flows through the blood vessels in your retina. If there are new vessels or vessels leaking fluid or blood in your macula, the photos will show their exact location and type. OCT is able to see fluid or blood underneath your retina without dye.

It’s important to see your eye doctor regularly to find signs of macular degeneration early. Treatment can slow the condition or make it less severe.

What Treatments Are Available for Macular Degeneration?

There’s no cure for macular degeneration. Treatment may slow it down or keep you from losing too much of your vision. Your options might include:

  • Anti-angiogenesis drugs. These medications -- aflibercept (Eylea), bevacizumab (Avastin), pegaptanib (Macugen), and ranibizumab (Lucentis) -- block the creation of blood vessels and leaking from the vessels in your eye that cause wet macular degeneration. Many people who’ve taken these drugs got back vision that was lost. You might need to have this treatment multiple times.
  • Laser therapy. High-energy laser light can destroy abnormal blood vessels growing in your eye.
  • Photodynamic laser therapy. Your doctor injects a light-sensitive drug -- verteporfin (Visudyne) -- into your bloodstream, and it’s absorbed by the abnormal blood vessels. Your doctor then shines a laser into your eye to trigger the medication to damage those blood vessels.
  • Low vision aids. These are devices that have special lenses or electronic systems to create larger images of nearby things. They help people who have vision loss from macular degeneration make the most of their remaining vision.

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Researchers are studying new treatments for macular degeneration, but they are experimental. They include:

  • Submacular surgery. This removes abnormal blood vessels or blood.
  • Retinal translocation. A procedure to destroy abnormal blood vessels under the center of your macula, where your doctor can’t use a laser beam safely. In this procedure, your doctor rotates the center of your macula away from the abnormal blood vessels to a healthy area of your retina. This keeps you from having scar tissue and more damage to your retina. Then, your doctor uses a laser to treat the abnormal blood vessels.

 

Macular Degeneration Prevention

A large study found that some people with dry AMD could slow the disease by taking supplements of vitamins C and E, lutein, zeaxanthin, zinc, and copper. Ask your doctor whether these supplements would help you.

What Is the Outlook for People With Macular Degeneration?

People rarely lose all of their vision from age-related macular degeneration. Their central vision might be bad, but they’re still able to do many normal daily activities.

The dry form of age-related macular degeneration tends to get worse slowly, so you can keep most of your vision.

The wet form of macular degeneration is a leading cause of permanent vision loss. If it’s in both eyes, it can hurt your quality of life.

Wet macular degeneration can need repeated treatments. Test your vision regularly, and follow your doctor’s advice.

WebMD Medical Reference Reviewed by Alan Kozarsky, MD on October 26, 2019

Sources

SOURCES: 

National Eye Institute. 

American Academy of Ophthalmology.

National Institutes of Health: "NIH study provides clarity on supplements for protection against blinding eye disease."

American Academy of Ophthalmology: “What Is Stargardt Disease?” “How is AMD Diagnosed and Treated?”

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