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AGE RELATED MACULAR DEGENERATION DIAGNOSIS AND TREATMENT

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Macular Degeneration Association AMD Center of Excellence

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Healthy eye compared to an eye with macular degeneration

What is AMD?

AMD is a common eye condition and a leading cause of vision loss among people age 50 and older. It causes damage to the macula, a small spot near the center of the retina and the part of the eye needed for sharp, central vision, which lets us see objects that are straight ahead.

AMD by itself does not lead to complete blindness, with no ability to see. However, the loss of central vision in AMD can interfere with simple everyday activities, such as the ability to see faces, drive, read, write, or do close work, such as cooking or fixing things around the house.

The Macula

The macula is made up of millions of light-sensing cells that provide sharp, central vision. It is the most sensitive part of the retina, which is located at the back of the eye. The retina turns light into electrical signals and then sends these electrical signals through the optic nerve to the brain, where they are translated into the images we see. When the macula is damaged, the center of your field of view may appear blurry, distorted, or dark.

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Dr. Selina McGee describes Macular Degeneration and the advance medical imaging technology her office uses to help catch the disease as early as possible.

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Who is at risk for AMD?

Age is a major risk factor for AMD. The disease is most likely to occur after age 60, but it can occur earlier. Other risk factors for AMD include:

Smoking. Research shows that smoking doubles the risk of AMD. 

Race. AMD is more common among Caucasians than among African-Americans or Hispanics/Latinos. 

Family history and genetics. People with a family history of AMD are at higher risk. At last count, researchers had identified nearly 20 genes that can affect the risk of developing AMD. Many more genetic risk factors are suspected. 

You may see offers for genetic testing for AMD. Because AMD is influenced by so many genes plus environmental factors such as smoking and nutrition, there are currently no genetic tests that can diagnose AMD, or predict with certainty who will develop it. The American Academy of Ophthalmology currently recommends against routine genetic testing for AMD, and insurance generally does not cover such testing.

Does lifestyle impact AMD?

Researchers have found links between AMD and some lifestyle choices, such as smoking. You might be able to reduce your risk of AMD or slow its progression by making these healthy choices:

Avoid smoking

Exercise regularly

Eat a healthy diet rich in green, leafy vegetables and fish (omega 3's)

What are the stages of AMD?

There are three stages of AMD defined in part by the size and number of drusen under the retina. It is possible to have AMD in one eye only, or to have one eye with a later stage of AMD than the other.

Early AMD . Early AMD is diagnosed by the presence of medium-sized drusen, which are about the width of an average human hair. People with early AMD typically do not have vision loss.

Intermediate AMD. People with intermediate AMD typically have large drusen, pigment changes in the retina, or both. Again, these changes can only be detected during an eye exam. Intermediate AMD may cause some vision loss, but most people will not experience any symptoms.
Late AMD. In addition to drusen, people with late AMD have vision loss from damage to the macula. There are two types of late AMD: 

 

  • In geographic atrophy (also called dry AMD), there is a gradual breakdown of the light-sensitive cells in the macula that convey visual information to the brain, and of the supporting tissue beneath the macula. These changes cause vision loss. 
  • In neovascular AMD (also called wet AMD), abnormal blood vessels grow underneath the retina. (“Neovascular” literally means “new vessels.”) These vessels can leak fluid and blood, which may lead to swelling and damage of the macula. The damage may be rapid and severe, unlike the more gradual course of geographic atrophy. It is possible to have both geographic atrophy and neovascular AMD in the same eye, and either condition can appear first.

 

AMD has few symptoms in the early stages, so it is important to have your eyes examined regularly. If you are at risk for AMD because of age, family history, lifestyle, or some combination of these factors, you should not wait to experience changes in vision before getting checked for AMD.

Not everyone with early AMD will develop late AMD. For people who have early AMD in one eye and no signs of AMD in the other eye, about 5% will develop advanced AMD after 10 years. For people who have early AMD in both eyes, about 14% will develop late AMD in at least one eye after 10 years. With prompt detection of AMD, there are steps you can take to further reduce your risk of vision loss from late AMD.

If you have late AMD in one eye only, you may not notice any changes in your overall vision. With the other eye seeing clearly, you may still be able to drive, read, and see fine details. However, having late AMD in one eye means you are at increased risk for late AMD in your other eye. If you notice distortion or blurred vision, even if it doesn’t have much effect on your daily life, consult an eye care professional.

Nutrition and AMD

Protection and prevention is the name of the game and here are some key areas to manage:

 Stop smoking

 Eat your green leafy vegetables

 Take eye nutrition supplements that include a balanced ratio of 10mg of Lutein and 2 mg Zeaxanthin