What You Should Know About Age-Related Macular Degeneration
Your questions answered about this sight-stealing condition
En español | At first it may seem as though you simply need a brighter bulb in your reading light, if not a new eyeglasses prescription. Objects look blurry; straight lines appear wavy. But the easy fixes don’t help. Then, over time, what seemed like an annoying inconvenience becomes something much more, as dark splotches block the center of your vision. If this sounds familiar, you may be among the roughly 11 million people in the U.S. with some form of age-related macular degeneration, the leading cause of vision loss among Americans over 50.
Although there’s no cure for macular degeneration, there are things you can do to slow its progression.
Here’s what to know about the disease.
What it is
Age-related macular degeneration (AMD) is a common eye condition that causes damage to a small spot near the center of the retina called the macula, the part of the eye that helps you see things clearly. Peripheral (side) vision usually remains unaffected.
Types of AMD
Dry (nonexudative) age-related macular degeneration
By far the most common form of AMD (80 percent of people with it have this type), it usually progresses slowly, over a number of years. If only one eye is affected, you may not even notice the changes in your vision because your good eye tends to compensate for your weak one.
Wet (exudative or neovascular) age-related macular degeneration
About 10 percent of people with AMD develop this more advanced form. With wet AMD, abnormal blood vessels underneath the retina leak blood and fluid, causing permanent damage to the macula. Unlike dry AMD, which progresses gradually, this rarer type is more likely to cause a sudden and more profound change in your central vision. It accounts for about 90 percent of AMD-related severe vision loss.
This is what may be the most difficult thing about AMD: In the beginning there usually aren’t any symptoms. You can live with AMD for years before you start to experience signs such as blurriness, distortions or shadowy areas in your central vision. As it progresses, however, the condition can lead to a loss of vision in one or both eyes, with so-called blind spots blocking portions of your central vision.
That’s why it’s important to see your ophthalmologist for a comprehensive dilated eye exam every year beginning at age 60. During the exam your doctor will inspect the macula for what’s known as drusen, yellowish deposits about the width of a human hair, and also for pigment changes under the retina. Some small drusen are to be expected with age, but medium-size or larger ones are “a hallmark of the disease,” says Deeba Husain, a retina specialist at Massachusetts Eye and Ear and codirector of the Age-related Macular Degeneration Center of Excellence at Harvard Medical School. “As the disease advances, drusen can grow in number and become larger.”
There’s no known cause, but the biggest risk factors include age (AMD is most likely to occur after age 60), race (whites are more likely to get AMD than African Americans or Hispanics) and family history. “Age-related macular degeneration is a complex condition involving many genes and various environmental factors,” says T.Y. Alvin Liu, a retinal specialist at the Johns Hopkins Wilmer Eye Institute. “It’s a result of the body’s inability to adequately deal with the wear and tear over decades of metabolism.”
Effects on Daily Life
Some people with macular degeneration are able to continue driving, and many more are able to manage daily activities with the help of magnifiers and reading glasses with high-powered lenses. Something to keep in mind: AMD isn’t painful. And since it doesn’t affect peripheral (side) vision, it doesn’t cause total blindness, though the loss of eyesight can interfere with activities such as reading, driving or watching TV.
Unfortunately, there's no reversing or stopping macular degeneration, though there's evidence that certain things can slow down its damage to the eye. Researchers at the National Eye Institute found that taking certain high-dose vitamins and minerals — including vitamins C and E, zinc and copper — slowed progression of the disease in people who have intermediate AMD and those who have late-stage AMD in one eye. Talk with your eye doctor about whether such high-dose supplements make sense for you.
“Patients with dry AMD can lose vision from thinning of the retina, and unfortunately, there is currently no effective treatment for [that],” says Liu. “Eventually, the holy grail will be using stem cell therapy to replace areas of the thinned retina. As for wet AMD, there are many promising new medications or treatment strategies that could have a longer effect, as compared to the current standard of care, which typically involves frequent [eye] injections.”
No matter the stage or form of AMD, an essential part of any treatment plan is a healthy lifestyle, including exercising regularly and following a diet that incorporates plenty of fish and leafy green vegetables. A review of studies published in 2016 in the journal Nutrients showed that eating fish regularly can reduce your risk of developing AMD. What's more, a study published in 2018 in the Journal of the Academy of Nutrition and Dietetics found that eating vegetables rich in nitrates — such as beetroot, spinach, kale, collard greens and arugula — may help. But perhaps the most important lifestyle factor in preventing AMD is smoking, as it doubles your risk. “Smoking leads to absorption of harmful chemicals into the body, including oxidants that can cause damage to the retina,” Husain says.