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FAQ: Age-Related Macular Degeneration - AllAboutVision.com

What is macular degeneration?

Macular degeneration is a disease that occurs when the eye’s macula becomes damaged or breaks down, causing a gradual or sudden loss of central vision. The loss of central vision affects your ability to see what’s directly in front of you.

Is macular degeneration always caused by age?

Macular degeneration commonly affects adults aged 50 and over. This association with aging is why the condition is commonly referred to as age-related macular degeneration (AMD). 

Non-age-related factors are also linked to macular degeneration. Some of these include genetics, certain health problems and lifestyle or environmental factors. 

Though less common, macular degeneration may affect children and young adults. Stargardt’s disease is a form of juvenile macular degeneration that may cause vision loss earlier in life.

What are the different types of macular degeneration?

Age-related macular degeneration is classified as either dry or wet. The dry form is more common and affects about 80%-90% of AMD patients. It may result from drusen (yellow deposits of protein and fatty substances in the macula), the thinning of the macula or both.

Dry AMD may be further classified into three stages: early, intermediate and advanced. An advanced stage of dry AMD, known as geographic atrophy, may cause severe vision impairment.

In the wet type of AMD, new blood vessels form beneath the retina. Once developed, these vessels may leak blood and fluid into the back of the eye. This damages the macula, leading to central vision loss. 

Wet AMD is also a more advanced stage of AMD. Vision loss from this form is usually more severe.

Is it true that macular degeneration is becoming a bigger problem?

The number of people affected by AMD is expected to rise over the next couple of decades. Worldwide, more than 200 million people are living with age-related macular degeneration. It is predicted that by 2040, this number will grow to around 300 million. 

Several factors may play a role in the prevalence of AMD. As the aging population continues to grow, the number of those affected may increase since the risk for macular degeneration rises with age. Additional contributing factors may include: 

  • Exposure to UV rays 

  • Air pollution 

  • A typical Western diet 

  • Obesity

Who is most at risk for macular degeneration?

A variety of factors can increase a person’s risk for AMD. Some of these are controllable while others are not. You may be at a higher risk for AMD if you are 50 or older, smoke or have a family member with the disease. Medical conditions, like high blood pressure and high cholesterol, and being overweight are also notable risk factors for macular degeneration.

Ethnicity can also play a role in AMD development. Research reveals that people in the white population have a greater chance of getting the disease. Some studies have also shown that women may be more at risk for macular degeneration. 

What are the signs and symptoms of macular degeneration?

AMD may not show any signs or symptoms in the early stages, which makes getting regular eye exams essential to an early diagnosis. (Symptoms are what the patient experiences while signs are what the doctor sees.) Your doctor may detect signs of AMD before you notice any symptoms, so it’s important to get regular eye exams.

Some of the more common, early signs and symptoms of AMD include:

  • Drusen deposits in the retina

  • Blurred vision

  • Shadowy areas or blind spots 

  • Distorted vision (straight lines look curved or wavy)

  • Trouble reading, driving, recognizing faces and seeing fine details

One way to detect certain changes in your vision is to view an Amser grid. This is an eye chart of black lines that resembles graph paper. Click here to see how an Amser grid works.

What are some lesser-known signs and symptoms of macular degeneration?

AMD is often associated with the more common signs and symptoms listed above. But others might be less common or not as noticeable. Some of the lesser-known symptoms of macular degeneration include:

  • Delayed dark adaptation (your eyes take longer to adjust to the dark)

  • Seeing flashing lights in your central field of vision

  • Seeing dark spots on a white wall when you wake up in the morning

  • Experiencing visual hallucinations (Charles Bonnet syndrome)

Wet AMD is less common than the dry form. Your doctor may detect signs of this type of macular degeneration during an exam. Lesser-known signs of macular degeneration may include:

  • Geographic atrophy – Late stage of dry AMD, where cells in the macula break down and die off (atrophy)

  • Pigment epithelial detachment – Separation of the retinal pigment epithelial layer from the underlying structure (called Bruch’s membrane)

  • Localized submacular retinal detachment – Separation of the retina from the back of the eye due to fluid buildup beneath the retina

  • Submacular hemorrhage – Pooling of blood beneath the retina in the area of the macula

Is macular degeneration curable?

At present, there is no cure for macular degeneration. However, treatment may help slow or stop the progression of the disease. The earlier you’re diagnosed and begin treatment, the better your chances of keeping AMD from advancing.

What macular degeneration treatments are currently available?

There are several FDA-approved medical treatments for wet AMD. These largely include anti-VEGF eye injections such as Lucentis and Eylea, among others. Avastin (FDA-approved for certain cancers) is also used off-label to treat this condition. Anti-VEGF (vascular endothelial growth factor) drugs target the abnormal blood vessels that cause the wet form of AMD.

Photodynamic therapy and laser photocoagulation are other treatment options for wet AMD. However, these aren’t as widely used anymore due to the increased use of anti-VEGF injections.

Until recently, there were no medical treatments for dry AMD. However, two medications to treat geographic atrophy (the advanced stage of dry AMD) have now received FDA approval. These include Syfovre and Izervay, both of which are eye injections.

The implantable miniature telescope (IMT) is a small FDA-approved device surgically inserted into the eye. Replacing the eye’s natural lens, the IMT enlarges images onto the retina to reduce blind spots caused by AMD.

Two major clinical studies (AREDS and AREDS2) have shown certain nutrients may slow the progression of dry AMD. Some eye doctors may recommend specific nutritional supplements for those at risk for AMD or who have early signs and symptoms.

People who have significant vision problems caused by AMD often benefit from low vision devices. These vision aids can help them read, use a computer and perform other detailed tasks.

READ MORE: Treatments for age-related macular degeneration

Why do some people get macular degeneration and others don't?

Apart from age, genetics and certain lifestyle or environmental factors appear to influence the development of macular degeneration. This combination of factors places some people at a higher risk for disease. 

Factors that may increase the risk include smoking and eating a diet high in saturated fats. Certain health problems, like obesity, heart disease and high blood pressure, can also make some people more prone to developing AMD. Spending time in the sun without proper UV eye protection might also place some at a higher risk for the condition.

How much does family history influence the chances of getting macular degeneration?

Having a family history of macular degeneration could play a role in your chances of experiencing the disease. Macular degeneration may be hereditary, meaning you might be more likely to get it if you have a parent or sibling who has experienced AMD. It is estimated that of those with AMD, 15%-20% have an immediate family member who also has the disease.

Certain genetic changes or “mutations” are thought to increase the risk of AMD. However, exactly how these alterations lead to the condition is not well understood. Genetic changes associated with age-related macular degeneration may involve the following genes:

  • ARMS2 gene

  • HTRA1 gene

  • Complement system genes, including the complement factor H (CFH) gene

  • Genes that transport and metabolize high-density lipoproteins (HDL) 

  • Genes linked to other macular conditions

Is there any way to prevent macular degeneration?

Although there are no sure ways to prevent macular degeneration, you can take steps to help lower your risk. These include avoiding tobacco use and getting plenty of exercise. You can also consider eating a healthy diet, such as the Mediterranean diet. 

Researchers believe antioxidants such as vitamins (A, C and E), lutein, zeaxanthin, zinc and essential fatty acids may help prevent AMD. Your doctor can help you decide if you should take any nutritional supplements for your eyes.

Wearing sunglasses with 100% UV protection and a wide-brimmed hat when outdoors may also reduce your risk of AMD and other eye conditions.

One of the best ways to help prevent vision loss from macular degeneration is to visit your eye doctor for regular eye exams. During these visits, your doctor can check for signs of AMD and other eye conditions.

How can lifestyle changes impact the risk of developing macular degeneration?

Since lifestyle factors seem to play a role in AMD, adopting a healthier way of living may help lower your risk of the condition. Lifestyle changes to prevent macular degeneration can include:

  • Quitting smoking

  • Eating a healthy diet

  • Getting adequate exercise

  • Keeping your weight in a healthy range

  • Controlling high blood pressure and other conditions

  • Protecting your eyes from UV rays

It is also important to have your eyes examined on a regular basis. Your eye doctor can often detect the signs of macular degeneration before symptoms develop.

Are there any new treatments on the horizon for macular degeneration?

Research is ongoing to discover more effective or new treatments for macular degeneration. Some of these efforts include:

  • Port delivery system This treatment involves the auto-delivery of anti-VEGF drugs through a special implant placed in the eye. The goal is to reduce the need for frequent eye injections.

  • Stem cell therapy – Stem cell therapy involves replacing damaged retinal cells with healthy, new cells.

  • Gene therapy – Gene therapy uses techniques that prompt the eye to produce anti-VEGF medication on its own. The goal of this one-time treatment is to offer a longer-term result.

  • Oral medications Oral anti-VEGFs and oral antibiotics are being explored as an alternative to eye injections. Metformin (an oral diabetes medication) is also under study as a potential treatment option.

  • Eye drops Topical eye drops are being studied as a more convenient alternative to current AMD treatments.

In addition to new treatments for macular degeneration, efforts to develop longer-lasting anti-VEGF drugs are also underway.

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