Age-Related Macular Degeneration

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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.

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.

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

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

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

Wet form

Blood vessels grow from underneath your macula. These blood vessels leak blood and fluid into your retina. Yourvision is distorted so that straight lines look wavy. You may also have blind spots and loss of central vision. These bloodvessels 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.

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.

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.

• 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

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.

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.

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.

No one knows exactly what causes dry macular degeneration. But research indicates it may be related to a combination of heredity and environmental factors, including smoking and diet. The condition develops as the eye ages.

Who Is at Risk for AMD?

You are more likely to develop AMD if you:

• eat a diet high in saturated fat (found in foods like meat, butter, and cheese)
• are overweight
• smoke cigarettes
• are over 50 years old
• have hypertension (high blood pressure)
• have a family history of AMD

Having heart disease is another risk factor for AMD, as is having high cholesterol levels. Caucasians (white people) also have an elevated risk of getting AMD.

Tips for Home Safety
Caring for Seniors with Macular Degeneration

Reducing Risk of FallsSafety is an important issue, and a number of adaptations in the home can help.

• If possible, it is best to live on a single-level home without stairs.
• Thresholds should be flush with the floor.
• If stairs are unavoidable, they should have handrails on both sides.
• Marking steps with tape or painting them in contrasting colors can make them more visible.
• Floors should be kept clear of low furniture, movable rugs, and clutter.
• Grip bars on the walls of bathrooms near the toilet and shower are recommended.
• A shower with a low barrier is generally safer than having to step over the side of a bathtub.
• Use non-skid, brightly colored mats and a contrasting color toilet seat.
• Night lights are generally helpful.

Lighting Tips

• Lighting is important; bright, warm LED lighting can be helpful. “Warm” lighting does not refer to the temperature, but rather the color. Warm lighting tends to emphasize the reds and greens, while “cool” lighting emphasizes blue. Light bulbs are usually marked “warm” or “cool.”
• Moveable lights like “architect’s lamps” can help illuminate specific tasks.
• People who experience glare may benefit from using amber colored glasses lenses.

Kitchen SafetyIn addition to the lighting suggestions mentioned above, the following tips would be helpful to employ in the kitchen:

• Dials can be marked with bright tape or “glue bumps” to indicate specific settings, such as the 400 degree position on the oven.
• Sharp implements can be marked with tape to help identify the handle.
• For some people, high temperature cooking and sharp objects should be avoided.
• Microwaves can be safer than ovens and stovetops.
• Label medications in large print and have bright lighting and/or magnification available to read them, or a helper can put daily medications in a pill organizer box.

Reading Aids

• Optical devices including high-power reading glasses, hand-held or stand-based magnifiers, and closed-circuit TVs can help with reading.
• If central vision is significantly impaired, viewing objects with the eyes turned to the side (eccentric viewing), can help find a “sweet spot” on the retina that is not affected by AMD and can provide the best vision.
• Small telescopes can be built into glasses to view objects at a distance.
• Miniature telescopes can also be implanted into the eye (known as Implantable Miniature telescopes (IMTs)), and can be helpful for certain patients (an eye doctor can help determine which patients might benefit), although, as with all surgeries, there are some risks associated with the surgery required to implant the telescope.

Other devices that can be helpful include:

• Large screens for TV and computer. The font size, magnification, color balance, brightness and contrast on the screen should be adjusted to maximize vision.
• Computer keyboards with large letters are available.
• Voice recognition software on computers and cell phones can convert the spoken word to text. It can also read text aloud.
• Many audio books are now available on specific websites.
• For patients who like print newspapers, large print versions of some newspapers are available.