Age-related macular degeneration (AMD) is a common chronic eye disease and a leading cause of vision loss among people over 50. It causes damage to the macula, a small portion of the retina that allows us to see objects straight ahead with sharp detail, which results in a blurry, distorted and darkened spot in the center of the field of view. Over time, the blurred area may grow larger or blank spots in the central vision may develop. Also, objects may not appear to be as bright as they used to be. The loss of central vision can interfere significantly with simple everyday activities, such as the ability to recognize faces, drive, read, write, or do close work.

amd simulation

Below are the answers to the top frequently asked questions we receive about macular degeneration from people diagnosed with AMD, their families, caregivers and loved ones.

WHAT IS AMD?

Macular-Degeneration_simAge-related macular degeneration (AMD) impacts millions of people and is the leading cause of blindness in adults 50 and older in the U.S. It occurs when the macula (a small spot near the center of the retina that lets you see color and fine detail) becomes damaged which often leads to a blurry, distorted and darkened spot in the center of the field of view. Over time, the blurred area may grow larger or blank spots in the central vision can develop. Objects also may not appear to be as bright as they used to. This type of central detail vision loss affects reading, driving, watching TV, sewing, seeing the faces of family and friends, and any other task that requires focusing on small objects. Although smoking, race and family history are contributing risk factors, age is the most significant risk. The disease is most likely to occur after age 50, but it can occur earlier. AMD is a chronic condition with a high genetic prevalence. There are two main types of age-related macular degeneration: dry and wet.

HOW DO I KNOW IF I HAVE MACULAR DEGENERATION?

In its early stages, macular degeneration may not have symptoms and may be unrecognized until it progresses or affects both eyes. The first sign of macular degeneration is usually a dim, blurry spot in the middle of your vision. This spot may get bigger or darker over time.

Symptoms of macular degeneration include:

  • Dark, blurry areas in the center of vision
  • Diminished or changed color perception

Since early macular degeneration may not have symptoms, it is very important to have regular eye examinations to detect these signs as soon as possible. Early detection of age-related macular degeneration is very important because there are treatments that can delay or reduce the severity of the disease.

An Amsler Grid can also help you to monitor changes in your vision. Click here for a printable Amsler Grid.

WHO IS AT RISK?

Although smoking, race and family history are contributing risk factors, age is the most significant risk. The disease is most likely to occur after age 50, but it can occur earlier. And since we are living longer, thanks to incredible advances in medicine and overall health, the incidence of AMD has been steadily on the rise.

Other risk factors include:

  • Smoking. Studies show that smoking doubles the risk of AMD.
  • Race/Ethnicity. AMD is more prevalent among Caucasians and Asian Americans than African-Americans or Hispanics/Latinos.
  • Family history. Those with immediate family members who have AMD are at a higher risk of developing the disease.
  • Women appear to be at greater risk than men.
  • Cardiovascular diseases. High blood pressure, stroke, heart attack, and heart disease with chest pain increase the risk of macular degeneration.
  • Research studies suggest a link between obesity and the progression of early and intermediate stage AMD to advanced AMD.

Demographics:

  • Elderly and/or Disabled
  • Age: 50+
  • Predominately Medicare population
  • Geographic Location: National and International
  • High genetic prevalence (hereditary)
  • Race: Occurs most often in Caucasian and Asian populations
  • Socioeconomic status, gender, sexual orientation and language: AMD does not discriminate in these areas

ANATOMY OF THE EYE - WHAT IS THE MACULA?

The macula is a small spot located in the center of the retina, the light-sensitive tissue at the back of the eye. It is made up of millions of light-sensing cells that provide sharp, central vision. The retina instantly converts light or an image into electrical impulses and then sends these impulses, or nerve signals, to the brain where they are translated into the images we see. Damage to the macula often leads to a blurry, distorted and darkened spot in the center of the field of view.

macula

WHAT IS DRUSEN?

Drusen are deposits that lie beneath the retina in a layer called Bruch’s membrane. Drusen can be a marker for macular degeneration (especially in the 50+ age group) because there appears to be an increased risk for macular degeneration as the number of drusen increases. Fat also accumulates in Bruch’s membrane with age. This may also contribute to drusen formation. Drusen can be thought of as backed up waste products from various layers of the retina. Most people with drusen have no symptoms. However, the development of drusen may be a precursor to macular degeneration.

Drusen occurs in two forms:

  1. Hard, small – do not increase with age and do not predispose a person to macular degeneration
  2. Soft, large – associated with age, may predispose to macular degeneration

There is no clinically effective way to treat drusen. However, several clinical trials are underway to evaluate various methods including laser treatments and their effects on drusen reduction and on the progression of macular degeneration.

It is very important to be followed closely by an ophthalmologist if drusen are present. Only an ophthalmologist can monitor subtle changes in the retina and manage any complications that may arise.

WHAT IS DRY MACULAR DEGENERATION?

Dry AMD is the most common form of AMD and is characterized by the presence of yellow deposits, called drusen, in the macula. Vision loss is usually gradual,  in fact, in the early stages of dry AMD, changes in vision may be hard to notice. As the drusen increase and grow in size, straight lines may appear wavy or it may look like there are blank spots in the center of vision. Colors may also begin to look dim.

Dry AMD has three stages, all of which may occur in one or both eyes:

  1. Early AMD. People with early AMD have either several small drusen or a few medium-sized drusen. At this stage, there are typically no symptoms and no vision loss.
  2. Intermediate AMD. People with intermediate AMD have either many medium-sized drusen or one or more large drusen. Some people see a blurred spot in the center of their vision. More light may be needed for reading and other tasks.
  3. Advanced Dry AMD. In addition to drusen, people with advanced dry AMD experience geographic atrophy, which is a gradual breakdown of the light-sensitive cells and supporting tissue in the central retinal area. This breakdown causes a blurred spot in the center of your vision. Over time, the blurred spot may get bigger and darker, taking more of your central vision.

WHAT IS WET MACULAR DEGENERATION?

Wet AMD (or neovascular AMD) is characterized by the growth of abnormal blood vessels underneath the retina. These blood vessels leak blood or fluid into the retina causing that portion of the retina to swell. This swelling of the retina distorts vision and can cause a sudden decrease in central vision. An eye with wet AMD will usually lose its ability to see fine detail; although prompt treatment may slow or minimize vision loss.

About 10-15% of individuals with macular degeneration develop the wet form.

CAN DRY AMD TURN INTO WET AMD?

Dry AMD can advance and cause vision loss without turning into wet AMD but it can also suddenly turn into wet AMD, even during early stage AMD. Because of this, dry AMD should be monitored closely. It is possible to have the wet type in one eye and the dry type in the other.

WHICH IS MORE COMMON – DRY AMD OR WET AMD?

Dry AMD is much more common. More than 85% of all people with intermediate and advanced AMD combined have dry AMD. However, if only advanced AMD is considered, about two-thirds of patients have wet AMD. Since almost all vision loss comes from advanced AMD, wet AMD leads to significantly more vision loss than dry.

HOW IS MACULAR DEGENERATION DIAGNOSED?

Your eye doctor can detect macular degeneration in a comprehensive routine eye exam. The presence of drusen (tiny yellow deposits beneath the retina) is an early sign of macular degeneration which can be seen during an examination.

Other methods your doctor may use to detect macular degeneration include:

Amsler grid. The lines of the grid may look wavy or disappear if you have AMD. Click here for a printable Amsler Grid.

Fluorescein angiogram. This procedure detects leaking blood vessels and may be used to determine if an individual has wet AMD. During this procedure a fluorescent dye is injected into your arm which travels through your body, including your eyes. Photographs are taken as the dye passes through your retinal blood vessels and fluorescent patches reveal abnormal areas and leakage.

Optical coherence tomography (OCT). OCT use light waves to provide depth information and clear visualization of the various layers of the retina. This allows doctors to see things such as fluid and to determine exactly which layer of the retina is affected.

HOW IS MACULAR DEGENERATION TREATED?

There is currently no cure for macular degeneration, however, treatments exist that may slow the progression of the disease.

There is currently no treatment for early dry AMD. Continue to have regular eye exams and maintain a healthy, well balanced diet and lifestyle. Exercise, avoid smoking and eat lots of green leafy vegetables and fish.

Treatments for wet AMD:

AREDS2 Formula. For some people, taking AREDS2 vitamins is recommended.

Anti-VEGF injection treatments. Anti-VEFG drugs such as Eylea, Avastin and Lucentis, are injected into the eye to reduce the growth of abnormal blood cells. These injections are used to treat wet macular degeneration.

Photodynamic therapy. This technique uses a light-activated drug called a photosensitizer and a special laser to treat wet macular degeneration right at the center of the macula.

Laser surgery. This involves using a laser to destroy the abnormal blood vessels in your eyes. This is not a procedure that is not commonly used anymore.

Click here for more information about current treatments for AMD.

CAN MACULAR DEGENERATION BE PREVENTED?

Universal recommendations of prevention include:

  • Don’t smoke
  • Wear sunglasses and hats to prevent exposure to ultraviolet light
  • Maintain a healthy weight and a healthy diet containing antioxidants, lutein and zeaxanthin, green leafy vegetables and fish (Click here for more info about eye-healthy nutrients)
  • Exercise regularly
  • Maintain a healthy weight
  • Maintain normal blood pressure
  • Get regular eye exams and contact your doctor immediately if you notice changes in your vision

Although studies examining these interventions have produced conflicting results with regard to preventing or minimizing macular degeneration, studies showing the general health value of stopping smoking and eating a diet rich in antioxidants are well supported.

HOW CAN AGE-RELATED MACULAR DEGENERATION BE MANAGED?

  1. Regular eye examinations – It is very important that people with AMD monitor their vision daily since sudden vision changes may be a sign of wet AMD or new abnormal blood vessel growth or leaking.
  2. Self-monitoring of vision – A simple test, called an Amsler Grid, can reveal signs of macular degeneration such as blurry areas, wavy lines, or blank spots. Any changes should immediately be reported to the ophthalmologist. Click here for more info and to print an Amsler Grid.
  3. The use of low vision aids – Low vision aids can help with tasks that require detailed vision. It is also helpful to see a low vision specialist, a doctor specifically trained in low vision rehabilitation. Aids such as magnifiers, closed circuit television, reading machines, writing guides, large-faced appliances and clocks, large-print checks, and large print reading materials can help people continue to read and take care of themselves. Click here for some tips for living with low vision.

WILL REMOVING A CATARACT IMPROVE VISION?

There is no simple answer to this question. An ophthalmologist can advise you about your particular and unique condition. Click here to read an article about cataracts and AMD.

WHAT IS THE IMPACT OF MACULAR DEGENERATION?

In personal terms, vision is the most important of the five senses: it links us most intimately to the world. Vision allows one to see a new grandchild, read a letter from a friend, scan a computer screen or navigate through traffic. At the beginning stage, AMD alone does not result in complete loss of sight and most people continue to have some useful vision and are able to take care of themselves. As the disease advances, it is devastating, robbing people of their independence and has a negative impact on the ability to function well in everyday life. The economic impact of visual impairment and blindness to the individual, caregivers and other healthcare payers, including the value of time and quality of life in the U.S comes to approximately $51.4 billion annually.[1]

[1] The Economic Impact of Vision Problems, 2007 Prevent Blindness America

HOW MANY PEOPLE HAVE AMD?

There is a direct correlation between the increase in AMD and the growing aging population in the United States. Currently more than 15 million people in the U.S. are diagnosed with some form of the disease. Future statistical projections estimate that by the year 2020; approximately 20 million Americans will suffer from macular degeneration and other retina-related debilitating diseases.[1]

[1] National Eye Institute, NIH and American Society of Retina Specialists reports

IS THERE A CONNECTION BETWEEN STATINS AND AMD?

Statins (cholesterol-lowering medications) have been hypothesized to be potentially protective in AMD as they reduce LDL (low-density lipoprotein) and have anti-inflammatory properties. A recent phase I/II clinical trial conducted by researchers at Massachusetts Eye and Ear/Harvard Medical School and the University of Crete found evidence that treatment with high-dose atorvastatin (the generic name of the statin Lipitor) is associated with regression of lipid deposits and improvement in visual acuity1. However, this study only collected results from a sample size of 23 patients which is unfortunately too small of a sample size to draw valid clinical conclusions. Also, the findings reference a “subset” of patients which could be problematic since typically if enough subsets are made, generally something can be found.

Looking at the bigger picture, larger studies have conflicting results. The AREDS Study 2 Report Number 9 did not show a protective effect from statins. Of the 3,791 participants, approximately half were statin users, and there was no evidence of benefit from statins in terms of AMD stage2. A Cochrane review also reported lack of conclusive evidence that statins may slow progression of AMD3. However, another meta-analysis suggested a protective effect for early AMD and neovascular AMD but not for geographic atrophy4.

The study conducted by researchers at Massachusetts Eye and Ear/Harvard Medical School and the University of Crete did use a higher dose of statins, but a larger randomized trial is needed to draw definitive conclusions. With the current evidence available, many physicians believe it is premature to start prescribing statins for AMD treatment. Experts tell us that more data is needed, however, focusing on a low cholesterol healthy diet is always a good idea!

Although significant conclusive findings have not been made from this study, the results are encouraging and represent how critical it is to continue research into novel treatments. These types of studies continue to expand our knowledge and understanding of how existing drugs and treatments may lead to new discoveries which will benefit the millions of people currently suffering with macular degeneration.

 

1. Vavvas, et al. Regression of some high-risk features of age-related macular degeneration (AMD) in patients receiving intensive statin treatment. Published online February 09, 2016 http://dx.doi.org/10.1016/j.ebiom.2016.01.033 2. Al-Holou SN, et al. The association of statin use with age-related macular degeneration progression: the age-related eye disease study 2 report number 9. Ophthalmology 2015 Oct 1. pii: S0161-6420(15)00884. 3. Gehlbach P, Li T, Hatef E. Statins for age-related macular degeneration. Cochrane Database Syst Rev. 2012 Mar 14;3:CD006927. doi: 10.1002/14651858.CD006927.pub3. Review. Update in: Cochrane Database Syst Rev. 2015;2:CD006927. PubMed PMID: 22419318; PubMed Central PMCID: PMC3804324. 4. Le Ma, et al. The association between statin use and risk of age-related macular degeneration. Scientific Reports 5, Article number: 18280 (2015) doi:10.1038/srep18280

WHAT IS MVRF'S POLICY IN REGARDS TO RESEARCH ON HUMANS AND ANIMALS?

MVRF’s policy is similar to that of NIH. MVRF-funded investigators using animals or humans in their research have to have their projects and protocols approved by their institutional Animal Care Committee or Human Ethics Committee and have their procedures overseen by appropriate personnel with experience in these areas.

We uphold a cruelty-free philosophy.

WHAT IS A MACULAR HOLE?

A macular hole is a small gap that opens up at the center of the retina, in an area called the macula.

The retina is the light-sensitive film at the back of the eye. In the center is the macula – the part responsible for central and fine detail vision needed for tasks such as reading.

In the early stages, a macular hole can cause blurred and distorted vision. Straight lines may look wavy or bowed, and you may have trouble reading small print. After a while, you may see a small black patch or a “missing patch” in the center of your vision. You won’t feel any pain and the condition doesn’t lead to a total loss of sight. Surgery is usually needed to repair the hole. This is often successful, but you need to be aware of the possible complications of treatment. Your vision will never completely return to normal, but it’s usually improved by having surgery.

Click here for more information on macular holes.

WHAT IS A MACULAR PUCKER?

A macular pucker (also called an epiretinal membrane) is a layer of scar tissue that grows on the surface of the retina, particularly the macula, which is the part of your eye responsible for detailed, central vision.

The macula is the small area at the center of the eye’s retina that allows you to see fine details clearly. The retina is a layer of light-sensing cells lining the back of your eye. As light rays enter your eye, the retina converts the rays into signals, which are sent through the optic nerve to your brain where they are recognized as images. Damage to your macula causes blurred central vision, making it difficult to perform tasks such as reading small print or threading a needle.

As we grow older, the thick vitreous gel in the middle of our eyes begins to shrink and pull away from the macula. As the vitreous pulls away, scar tissue may develop on the macula. Sometimes the scar tissue can warp and contract, causing the retina to wrinkle or become swollen or distorted.

The macula normally lies flat against the back of the eye. When wrinkles, creases or swelling affect the macula, vision can become blurry and distorted and you may even have a blind spot in your central vision.

Click here for more information about macular puckers.

The information presented is neither medical advice nor suggestions regarding your condition. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment. Please discuss any medical questions or concerns with an ophthalmologist or retinal specialist.

For more information about age-related macular degeneration, we recommend visiting the National Eye Institute’s website, https://nei.nih.gov/.