Illness & Conditions - Health Conditions
Age-Related Macular Degeneration
What is age-related macular degeneration?
Age-related macular degeneration is a disease that causes blurring of your central vision . The blurring happens because of damage to the macula, a small area at the back of the eye . The macula helps you see the fine detail in things that your eyes are focusing on.
Macular degeneration makes it harder to do things that require sharp central vision, like reading, driving, and recognizing faces. It does not affect side vision, so it does not lead to complete blindness.
There are two types of macular degeneration—wet and dry. The dry form is by far the most common type. The wet form is much less common, but it happens more quickly and is more severe.
You may have either type in just one eye, but over time you may get it in the other eye too.
What causes macular degeneration?
Macular degeneration is the result of damage to the nerve cells in the macula. The process that leads to this damage is different for each type.
Experts are still studying the causes of both forms.
What are the symptoms?
The main symptom of macular degeneration is dim or fuzzy central vision. Objects may look warped or smaller than they really are. You may have a blank or blind spot in the center of your field of vision. As the disease gets worse, you may have trouble with tasks like reading and driving.
If you have the dry form, your vision will probably become blurry slowly. You may have it for several years before it affects your ability to read, drive, and do everyday activities.
Often the first symptom of the wet form is that straight lines look wavy or curved. In the wet form, vision loss happens quickly and can be severe.
How is macular degeneration diagnosed?
A doctor can usually detect macular degeneration by doing a regular eye exam and asking questions about your past health. You may have some vision tests, including an ophthalmoscopy. This test lets your doctor look at the inside of your eye and check for possible signs of this disease, such as drusen . These are yellowish white waste deposits that can build up at the back of the eye.
How is it treated?
At this time, there is no cure for macular degeneration. But experts are exploring many new treatments that hold hope for the future. Your doctor can keep you up to date on any changes in treatment that might help you.
Eating food that contains lots of antioxidant vitamins and minerals may help slow down vision loss in some people with moderate to severe macular degeneration. 1 Talk to your doctor about whether this might help you.
These treatments may slow down vision loss from the wet form of macular degeneration:
How can you cope with vision problems?
There are many things you can do at home to make the most of your remaining vision. Try using aids like magnifying glasses, brighter lighting, and large-print books. Having a good support network is important too.
If you need more help, your doctor may refer you to an occupational therapist or rehabilitation specialist. These professionals can help you get the tools and training you need to cope with reduced vision. Local agencies may also offer services for people who have vision loss.
It can be scary to find out that you have a vision problem that may get worse. It is common to have a range of emotions. But if you feel very sad or hopeless, talk to your doctor.
Frequently Asked Questions
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Vision loss from age-related macular degeneration is caused by damage to the light-detecting nerve cells in the macula . The cause of this damage to the nerve cells is unknown. A person's genes and family history may play a role.
Age-related macular degeneration (AMD) can cause these symptoms:
The symptoms of wet and dry AMD differ in two important ways:
With dry age-related macular degeneration (dry AMD), the cells and blood vessels beneath the macula begin to thin and break down as they age.
When these cells and blood vessels stop working, the nerve cells in the macula that detect light can't work as well as they used to. As more and more of the nerve cells in the macula break down, vision loss very slowly gets worse.
You may have the disease for several years before it affects how you are able to read, drive, and do everyday activities. If you have AMD in only one eye, you may not notice minor vision changes, because your unaffected eye automatically makes up for vision problems in your other eye.
A small percentage of people who have dry AMD eventually develop wet AMD.
Wet AMD begins with the growth of abnormal blood vessels under the macula. These blood vessels break easily. They leak blood and fluid and cause scar tissue, all of which push against the macula. They change the macula's shape and cause it to send distorted images to your brain. Straight lines begin to appear wavy or curved, and objects may seem oddly shaped or smaller.
Scar tissue also cuts off the macula from the normal support cells that it needs in order to work. Nerve cells in the macula begin to die, causing a loss of central vision.
If not treated, the scar beneath the macula may continue to grow, affecting more and more of the nerve cells in the macula. Vision loss gets worse as more of the macula becomes involved. The entire macula may be destroyed by this process, resulting in a complete loss of central vision.
Treatment can sometimes delay or prevent further vision loss, but it cannot reverse vision loss that has already occurred.
With wet AMD, vision loss can happen fast—within months or even weeks. This can make it hard to adjust to the vision loss.
Even though AMD may affect central vision, it doesn't cause complete blindness. And most people keep good side vision.
What Increases Your Risk
The main things that put you at risk (risk factors) for age-related macular degeneration (AMD) include:
Other risk factors for developing AMD may include: 1
When To Call a Doctor
Call your doctor immediately if:
Your doctor will refer you to an eye doctor (ophthalmologist) if needed.
Call your doctor to discuss whether you need an eye exam if:
Watchful waiting means to take a wait-and-see approach.
Watchful waiting is not appropriate if you have rapid vision loss or sudden changes in your vision. If you have any rapid vision changes, go to your doctor as soon as possible. Immediate treatment may be able to slow vision loss caused by wet AMD. Delaying treatment for wet AMD could mean further loss of central vision.
If you have dry age-related macular degeneration (dry AMD), watchful waiting is appropriate. You may never develop vision loss to the point that it disrupts your regular lifestyle.
Who to see
An ophthalmologist who specializes in problems with the retina and macula can diagnose which type of AMD you have. Also, laser surgery and medicine injections for wet AMD are done by an ophthalmologist.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
A doctor can usually detect age-related macular degeneration (AMD) with a regular eye exam. The doctor first will find out more about your symptoms, past eye problems, and other health conditions by asking you about your medical history.
Visual acuity test
The doctor will test your central vision with a visual acuity test. During this test, you cover one eye and read letters on a wall chart 20 ft (6.1 m) away. Central vision gets worse over time in a person who has AMD, and a visual acuity test can measure whether your vision has become worse since your last exam. The doctor may also test your visual field, which includes both your central vision and side (peripheral) vision.
Your doctor will look inside your eye using ophthalmoscopy. This test lets your doctor check for possible signs of this disease, such as drusen , which appear as yellowish white spots under the retina . Although some small drusen can usually be found in the macula as a normal result of aging, the presence of numerous large drusen is associated with AMD. 1
Amsler grid test
An Amsler grid test can detect wet AMD. If you have wet AMD, lines on the grid appear wavy or curved instead of straight, or you may see a blank spot or hole on part of the grid.
For more information on vision testing, see the topic Vision Tests.
If your doctor thinks that you may have wet AMD, you may also have a test called an eye angiogram or an optical coherence tomography (OCT) to find out if abnormal blood vessels are growing beneath the macula. The tests can also locate leaky blood vessels under the macula and help your doctor find out if they can be treated.
If you have AMD and some loss of vision, your doctor may do a low-vision evaluation to help find ways for you to make the most of your remaining vision and keep your quality of life.
The American Academy of Ophthalmology recommends that all people ages 40 to 54 have a comprehensive eye exam every 2 to 4 years to help detect AMD early. The following table summarizes the recommendations for comprehensive eye exams: 2
There is no cure for age-related macular degeneration (AMD), but certain treatments may delay vision loss.
Your doctor can refer you to counselors who specialize in helping people adjust to living with low vision.
Follow your doctor's advice for having regular exams and for watching the condition at home (such as using an Amsler grid ), because dry AMD can sometimes develop into wet AMD.
Vitamins and diet changes may help slow vision loss. For more information, see Home Treatment.
Treatment for wet AMD can sometimes slow down or delay further damage to your central vision . But in most cases, growth of fragile new blood vessels in wet AMD starts again. And even repeated treatment is usually not effective over the long term in preventing some loss of central vision.
Because wet AMD often causes rapid and severe loss of central vision, it is important not to delay treatment if your doctor recommends it.
You can't prevent age-related macular degeneration (AMD). But there are some steps you can take that may lower your risk of getting it.
People who have an increased risk for AMD should use the Amsler grid . Your doctor can give you one to use at home.
Although there's no treatment that can cure age-related macular degeneration (AMD), there are steps you can take that may keep it from getting worse. These steps may help prevent wet AMD if you already have the dry form:
People with AMD should check the vision in both eyes using an Amsler grid every day or as often as the doctor recommends. If any of the lines on the grid change or begin to appear wavy and curved, or if you notice that your vision is getting worse, call your doctor.
Living with reduced vision
Reduced vision or vision loss from AMD can affect your life in many ways. How much it will affect you depends on your lifestyle and on how bad your vision loss is. Work with your doctor to find ways to make the best use of your remaining vision. There are things that you can do to adjust and to keep your quality of life as much as possible.
It is normal to feel unhappy about your loss of vision. But if your feelings of sadness are severe or do not improve, you may develop depression , which requires treatment. If you need help in dealing with your feelings about AMD, talk to your doctor and to your family and friends. Your doctor can also refer you to a counselor who specializes in helping people adjust to living with limited vision.
Anti-VEGF medicines, such as bevacizumab (Avastin) and ranibizumab (Lucentis), can slow the vision loss that is linked to wet age-related macular degeneration (wet AMD). These medicines are injected into the eye.
Laser surgery doesn't cure wet age-related macular degeneration (wet AMD), but it can sometimes slow down or prevent further loss of central vision. Early surgery is vital to slowing down vision loss, which can be rapid.
But laser surgery is an option for less than one-fourth of people who have wet AMD. 4 It is often hard to know in advance whether the surgery will do more harm than good.
By the time many people are diagnosed with wet AMD, it is often too late for surgery to provide much benefit. Even with treatment, many people will still go on to lose more of their central vision.
Currently, surgery is not used to treat dry AMD. Laser surgery to remove deposits called drusen may slow vision loss in people with dry AMD, but experts think that it may increase the chance of developing wet AMD. Researchers are currently doing studies to see if this is an effective treatment. 5
Studies are being done on possible other treatments for age-related macular degeneration (AMD), such as:
You can talk with your doctor about the progress of new potential treatments and also look into clinical trials .
Other Places To Get Help
Last Revised: November 12, 2012
Author: Healthwise Staff
American Academy of Ophthalmology (2008). Age-Related Macular Degeneration (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Available online:
American Academy of Ophthalmology (2010). Comprehensive Adult Medical Eye Evaluation (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Available online:
Lim LS, et al. (2012). Age-related macular degeneration. Lancet, 379(9827): 1728–1738.
Rosenfeld PJ, et al. (2009). Age-related macular degeneration. In M Yanoff et al., eds., Ophthalmology, 3rd ed., pp. 658–673. Edinburgh: Mosby Elsevier.
Arnold J, Heriot W (2007). AMD, search date March 2006. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
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