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Age-Related Macular Degeneration

What is age-related macular degeneration?

Age-related macular degeneration (AMD) is a disease that affects a person’s central vision. AMD is the most common cause of severe loss of eyesight among people ages 60 and older. Only the center of vision is affected with this disease. People rarely go completely blind from it. However, AMD can make it difficult to read, drive, or do other daily activities that need fine, central vision.

AMD happens when the macula begins to break down. The macula is located in the center of the retina and provides us with sight in the center of our field of vision. With less of the macula working, central vision begins to get worse.

What causes age-related macular degeneration?

The 2 primary types of AMD have different causes:

  • Dry. This type of AMD is the most common. Its cause is unknown. This happens as the light sensitive cells in the macula slowly break down. It generally happens in both eyes. It is thought that the age-related thickening of the tissue under the retina contributes to dry AMD.
  • Wet. This type of AMD is less common. It accounts for most severe loss of eyesight caused by AMD. Wet AMD happens when new blood vessels behind the retina start to grow beneath the retina. They leak fluid and blood and can create a large blind spot in the center of the visual field.

Who is at risk for macular degeneration?

Possible risk factors for AMD are:

  • Being female
  • Ages 60 and older
  • Smoking
  • Family history
  • Uncontrolled high blood pressure or hypertension
  • Cardiovascular disease
  • Obesity
  • High blood cholesterol levels

What are the symptoms of age-related macular degeneration?

The following are the most common symptoms of AMD. However, each individual may experience symptoms differently. Symptoms may include:

  • Blurry or fuzzy vision
  • Difficulty recognizing familiar faces
  • Straight lines appear wavy
  • A dark, empty area or blind spot appears in the center of vision
  • Rapid loss of central vision, which is necessary for driving, reading, recognizing faces, and performing close-up work

The presence of drusen, tiny yellow deposits in the retina, is one of the most common early signs of AMD. It may mean the eye is at risk for developing more severe AMD. These will be visible to your healthcare provider during an eye exam.

The symptoms of AMD may look like other eye conditions. Talk with an eye care professional for diagnosis.

How is age-related macular degeneration diagnosed?

In addition to a complete medical history and eye exam, your eye healthcare provider may do the following tests to diagnose AMD:

  • Visual acuity test. The common eye chart test, which measures vision ability at various distances.
  • Pupil dilation. The pupil is widened with eye drops to allow a close-up exam of the eye’s retina.
  • Amsler grid. Used to detect wet AMD, this test uses a checkerboard-like grid to determine if the straight lines in the pattern appear wavy or missing to the patient. Both indications may signal the possibility of AMD.
  • Fluorescein angiography. Used to detect wet AMD, this diagnostic test involves a special dye injected into a vein in the arm. Pictures are then taken as the dye passes through the blood vessels in the retina, helping the healthcare provider evaluate if the blood vessels are leaking and whether or not the leaking can be treated.

How is age-related macular degeneration treated?

Specific treatment for AMD will be determined by your healthcare provider based on:

  • Your age, overall health, and medical history
  • Extent of the disease
  • Your tolerance for specific medicines, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

Treatment for wet AMD usually involves injections of medicines into the eye to stop the growth of the abnormal blood vessels. These injections are typically painless. It may also include one type of laser surgery in which a high energy beam of light is aimed directly onto the leaking blood vessels to deter further leaking, although this is usually not necessary.

Currently, there is no treatment for dry AMD. This does not, however, indicate that sight will automatically be lost. This is particularly true if the AMD affects only one eye. Central vision may eventually be lost or reduced. Generally, the rate of loss is slow. There are nutritional treatment choices that may slow the progression of the disease.

What are the complications of age-related macular degeneration?

AMD can result in severe loss of central vision, but rarely blindness. It can, however, make it difficult to read, drive, or perform other daily activities that need fine, central vision.

Living with macular degeneration

If you have already had some loss of vision, ask your provider for information on services for people with low vision and devices that may help you with your everyday tasks.

When should I call my healthcare provider?

If your symptoms get worse or you have new symptoms, notify your healthcare provider.

Key points about age-related macular degeneration

  • Age-related macular degeneration is a disease that affects a person’s central vision
  • AMD can result in severe loss of central vision, but people rarely go blind from it
  • Risk factors for AMD include being ages 60 and older, being a woman, smoking, high blood pressure, cardiovascular disease, obesity, and high cholesterol
  • Although there is no cure for AMD, there are treatment choices that may prevent or slow the progression of the disease

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Medical Reviewers:

  • Griggs, Paul B., MD
  • Taylor, Wanda, RN, Ph.D.