RESEARCH. HOPE. EDUCATION.
- What is Macular Degeneration?
- Screening & Diagnosis
- Treatments for Wet Macular Degeneration
- Healthy Eating for the Eyes
- Coping and Support
- Lifestyle and Home Remedies
What is Macular Degeneration?
Age-related macular degeneration (AMD) is the world’s leading causes of irreversible blindness in the United States.
The disease affects the macula located at the back of your eye which is the part of the retina that lets you see fine detail like images in front of you, facial features or letters on a page. AMD is not painful and can occur in one or both eyes. How quickly the disease progresses vary from person to person and from eye to eye. When the disease advances rapidly it may lead to sudden and severe vision loss.
Age is the greatest risk factor for AMD and people over 50 are at the greatest risk. Other risk factors include smoking, cardiovascular disease, high cholesterol, obesity and family history. Studies show that AMD may be hereditary. It’s recommended that anyone with a family history of AMD should have their eyes examined.
There are two types of AMD: wet and dry.
Age-Related Macular Degeneration at a Glance
Early Symptoms: None
Later Symptoms: Loss of the central vision, wavy objects and not able to recognize someone’s face.
Diagnosis: Dilated eye exam – Optical Coherence Tomography (OCT) – Fluorescein angiography
Treatment: Dietary supplements (vitamins and minerals), injections and laser treatment
About 85-90% of people with AMD have dry AMD. In dry AMD yellow-colored fatty deposits called “drusen” build up in the cells of the macula. As the size and number of these deposits increase so does your risk of developing wet AMD.
Symptoms may include blurry vision such as difficulty seeing sharp details both up close and from a distance. However, many people with dry AMD have no symptoms at all or do not notice any of these changes in their vision over time.
Most importantly, dry AMD puts you at an increased risk of progressing to wet AMD which can cause significant vision loss without treatment. Dry AMD can suddenly change to wet AMD without notice and you may not notice any changes or decline in your vision. Studies show that catching the progression from dry to wet AMD as soon as possible is critical to prevent irreversible vision loss.
About 10-15% of people with dry AMD progress to a more advanced form called wet AMD. In wet AMD abnormal blood vessels can suddenly leak fluid in the back of your eye without notice. The disease destroys the sharp pinpoint vision needed to see clearly which can cause permanent vision loss if left untreated. Wet AMD is also known as “neovascular” or “exudative” AMD.
When you have wet AMD your central vision becomes distorted. Symptoms include blurry vision, vision distortion where straight lines look wavy and a dark spot (or spots) in the center of your vision.
Wet AMD can severely impact quality of life and limit independence. It can make many of the activities you enjoy and rely on impossible like driving, reading, watching television and using a computer.
Rapid and severe vision loss can happen very quickly if treatment is delayed. Some people may not notice any changes in their vision until significant vision loss has occurred. Early detection of wet AMD allows your doctor to step in sooner so he or she can either quickly begin treatment or refer you to a retina specialist for treatment to help preserve your vision.
Screening & Diagnosis
Macular degeneration (AMD) can be diagnosed by your eye doctor during a comprehensive eye exam. There is currently no cure or treatment for dry AMD but there are steps you can take to reduce your risk of developing wet AMD. These include healthy lifestyle choices like not smoking, maintaining a healthy weight, eating green leafy vegetables and fish, regular exercise and taking AREDS2 formula-based vitamins daily. It’s also important to monitor your eyes with at-home testing between office visits.
There is home-monitoring technology available that is sensitive to changes in AMD. The ForeseeHome® AMD Monitoring Program is an easy-to-use early warning system for your eyes that can catch the progression from dry to wet AMD as soon as it happens which allows your doctor to step in sooner and initiate treatment if necessary. People preserved more of their vision when wet AMD was detected using ForeseeHome between office visits. ForeseeHome is FDA cleared, covered by Medicare and endorsed by the Macular Degeneration Association.
Unlike dry AMD, there are effective treatments for wet AMD. Studies have shown that these treatments are most effective when initiated early before any symptoms are noticed and vision loss has occurred. The disease will continue to progress until treatment begins. These treatments can stop or slow the progression of wet AMD but cannot permanently restore vision that has already been lost.
Treatments for Wet Macular Degeneration
Injections: One option to slow the progression of wet AMD is to inject specific drugs into the eye. With wet AMD, abnormally high levels of vascular endothelial growth factor (VEGF) are secreted in your eyes. VEGF is a protein that promotes the growth of new abnormal blood vessels. Anti-VEGF injection therapy blocks this growth.
Medications used to treat wet macular degeneration include:
- Bevacizumab (Avastin)
- Ranibizumab (Lucentis)
- Aflibercept (Eylea)
- Brolucizumab-dbll (Beovu)
If you are a candidate for this treatment, you may need monthly injections. Although an injection to the eye sounds quite frightening it is usually very well tolerated by patients with very few if any complications. Most patients describe the experience as being less painful and unpleasant than they anticipated.
Possible risks of eye injections include conjunctival hemorrhage, eye pain, floaters, increased eye pressure, infection and eye inflammation. Some of these medications may increase the risk of a stroke.
If you have fears about injections to the eye, it is especially important to discuss this with your doctor.
Healthy Eating for the Eyes
Ever since macular degeneration was identified as a disease of the retina there have been ongoing debates among ophthalmologists, optometrists and researchers regarding the role of nutrition in protecting against the disease and possibly slowing its progress.
According to a recent study published in the journal Ophthalmology, following a Mediterranean diet may help reduce the risk for AMD. The Mediterranean diet pattern is characterized by high consumption of plant-based foods and fish, moderate consumption of wine and low consumption of meat and dairy products.
The Age-Related Eye Disease Study 2 (AREDS 2) found that supplementation with antioxidants plus zinc decreased the likelihood of developing advanced age-related macular degeneration in some people. It also showed that for 13% of patients with a different genetic profile (2 high-risk CFH alleles and 0 ARMS2 risk alleles) the standard AREDS formula was detrimental and accelerated vision loss much faster.
Coping and Support
Not everyone with AMD develops late AMD or gets it in both eyes. But if you do, living with vision loss from AMD can be challenging.
Vision loss from macular degeneration can affect your ability to do things such as read, recognize faces and drive. These tips may help you cope with your changing vision:
- Ask your eye doctor to check your eyeglass prescription. If you wear contacts or glasses, be sure your prescription is up to date. If new glasses don’t help, ask for a referral to a low vision specialist.
- Use magnifiers. A variety of magnifying devices can help you with reading and other close-up work such as sewing. Such devices include hand-held magnifying lenses or magnifying lenses you wear like glasses.
You may also use a closed-circuit television system that uses a video camera to magnify reading material and project it on a video screen.
- Change your computer display and add audio systems. Adjust the font size in your computer’s settings and just your monitor to show more contrast. You may also add speech-output systems or other technologies to your computer.
- Use electronic reading aids and voice interface. Try large-print books, tablet computers and audio books. Some tablet and smartphone apps are designed to help people with low vision. Many of these devices now come with a voice recognition feature.
- Select special appliances made for low vision. Some clocks, radios, telephones and other appliances have extra-large numbers. You may find it easier to watch a television with a larger high-definition screen or you may want to sit closer to the screen.
- Use brighter lights in your home. Better lighting helps with reading and other daily activities and it may also reduce the risk of falling.
- Consider your transportation options. If you drive check with your doctor to see if it’s safe to continue doing so. Be extra cautious in certain situations such as driving at night, in heavy traffic or in bad weather. Use public transportation or ask a friend or family member to help especially with night driving. Make arrangements to use local van or shuttle services, volunteer driving networks or rideshares.
- Get support. Having macular degeneration can be difficult and you may need to make changes in your life. You may go through many emotions as you adjust. Consider talking to a counselor or joining a support group. Spend time with supportive family members and friends.
Lifestyle and Home Remedies
Even after receiving a diagnosis of wet macular degeneration, you can take steps that may help slow vision loss.
- Don’t smoke. If you smoke ask your doctor for help to quit.
- Choose a healthy diet. The antioxidant vitamins in fruits and vegetables contribute to eye health. Kale, spinach, broccoli, squash and other vegetables have high levels of antioxidants including lutein and zeaxanthin which may benefit people with macular degeneration. Foods containing high levels of zinc also may be of particular value in patients with macular degeneration. These include high-protein foods such as beef, pork and lamb. Nonmeat sources include milk, cheese, yogurt, whole-grain cereals and whole-wheat bread.
Another good choice is healthy unsaturated fats, such as olive oil. Research studies have shown that a diet high in omega-3 fatty acids such as those found in salmon, tuna and walnuts, may lower the risk of advanced macular degeneration. But the same benefit is not shown from taking omega-3 supplements such as fish oil capsules.
- Manage your other medical conditions. For example, if you have cardiovascular disease or high blood pressure take your medication and follow your doctor’s instructions for controlling the condition.
- Maintain a healthy weight and exercise regularly. If you need to lose weight, reduce the number of calories you eat and increase the amount of exercise you get each day.
- Have routine eye exams. Ask your eye doctor about the recommended schedule for follow-up exams. In between checkups, you can do a self-assessment of your vision using an Amsler grid or by using the ForeseeHome AMD Monitoring Program.
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Macular degeneration is caused when part of the retina deteriorates. The retina is the interior layer of the eye. The macula is the central portion of the retina and is responsible for detailed vision and central vision.