Last updated date: 04-Mar-2023
Medically Reviewed By
Dr. Yahia H. Alsharif
Originally Written in English
Age-related Macular Degeneration| Diagnosis, Treatment & Prevention
Age-related macular degeneration (AMD) is a condition that affects the macula, a small area in the center of the retina in the eye. The retina is the part of the eye that converts light into electrical signals that are sent to the brain to create the images we see. The macula is responsible for central vision, which is needed for tasks such as reading, writing, and driving.
In AMD, the cells in the macula begin to deteriorate, which can cause a loss of central vision. There are two main types of AMD: dry AMD and wet AMD. Dry AMD is the more common form of the condition and is characterized by the gradual buildup of waste products in the macula. Wet AMD is less common but more severe, and occurs when new blood vessels grow under the macula and leak blood and fluid, which can cause rapid vision loss.
The exact cause of AMD is not known, but it is more common in people who are older and in those who have a family history of the condition. Other risk factors include smoking, high blood pressure, and exposure to sunlight. There is no cure for AMD, but treatments can slow its progression and help preserve vision.
AMD can cause difficulty in recognizing faces, reading, watching TV, driving and other activities that require fine vision.
What is Age-Related Macular Degeneration?
Age-related macular degeneration (AMD) is a progressive eye disease that affects the macula, the small central area of the retina responsible for sharp, detailed vision. The macula allows us to see fine details clearly, such as when reading, writing, or recognizing faces. AMD occurs when the cells in the macula deteriorate over time, leading to a loss of central vision. It is a leading cause of blindness among older adults, and there are two types of AMD: dry and wet. Dry AMD is the most common form and is caused by the gradual buildup of waste products in the macula, while wet AMD is caused by the growth of abnormal blood vessels under the macula that can leak blood and fluid, leading to rapid vision loss. There is no cure for AMD, but treatments can slow its progression and help preserve vision.
Anatomy of the Eye
- Choroid: The choroid is a blood vessel-filled layer that lines the back of the eye and is placed between the retina (the inner light-sensitive layer) and the sclera (the outer white eye wall).
- Ciliary Body: A muscle-containing structure placed behind the iris that focuses the lens.
- Cornea: The transparent front window of the eye that transmits and focuses (i.e., sharpness or clarity) light into the eye is known as the cornea. Laser surgery reshapes the cornea, altering the focus.
- Fovea: The center of the macula which provides the sharp vision.
- Iris: The colorful region of the eye that helps regulate the quantity of light entering the eye is known as the iris. When there is a lot of light, the iris shuts the pupil to allow less light in. When there is a lack of light, the iris dilates the pupil to let more light in.
- Lens: The lens directs light rays onto the retina. The lens is clear and replaceable if necessary. As we age, our lenses degrade, necessitating the use of reading glasses. Intraocular lenses are used to replace lenses that have become obscured due to cataracts.
- Macula: The macula is a region of the retina that includes light-sensitive cells. These light-sensitive cells in the macula allow us to perceive tiny details clearly in the center of our visual field. The degradation of the macula is a frequent problem that occurs as we age (age related macular degeneration or ARMD).
- Optic Nerve: The optic nerve is a bundle of over a million nerve fibers that transports visual information from the retina to the brain. (To see, we need light and our eyes must be connected to the brain.) Because it blends pictures, your brain truly controls what you perceive. The retina perceives pictures upside down, but the brain flips them around. This reversal of the pictures we perceive is similar to a mirror in a camera. Glaucoma is one of the most frequent eye disorders caused by damage to the optic nerve.
- Pupil: The pupil is the black central aperture in the center of the iris. The pupil dilates to compensate for the quantity of light available (smaller for bright light and larger for low light). This opening and closing of light into the eye is similar to the aperture of most 35 mm cameras, which let in more or less light depending on the circumstances.
- Retina: The retina is the nerve layer that lines the back of the eye. The retina detects light and generates electrical impulses that are sent to the brain via the optic nerve.
How the Eye Works?
Sight, sound, taste, hearing, and touch are the five senses. Sight, like the other senses, is intimately linked to many sections of our anatomy. The eye is linked to the brain and relies on it to interpret what we perceive.
The transmission of light affects how we see. Light enters the eye through the cornea and travels to the lens. The cornea and lens work together to concentrate light rays on the back of the eye (retina). The retinal cells absorb light and transform it into electrochemical signals, which are subsequently sent to the brain via the optic nerve.
The eye functions similarly to a camera. A camera's shutter can close or open based on the quantity of light required to expose the film in the camera's rear. The eye, like the shutter on a camera, works in the same manner. The iris and pupil regulate how much light enters the rear of the eye. When it gets really dark, our pupils dilate, allowing more light to enter. The lens of a camera may concentrate on things both far away and close up using mirrors and other mechanical devices.
The lens of the eye assists us in focusing but occasionally need assistance in order to concentrate clearly. Glasses, contact lenses, and artificial lenses all aid in improving our vision.
Epidemiology of Age-Related Macular Degeneration
Age-related macular degeneration (AMD) is a leading cause of blindness and visual impairment among older adults. It affects the macula, the part of the eye responsible for central vision, making it difficult to read, drive, and perform other daily activities.
- AMD is most common in people over the age of 60 and the risk increases with age.
- The prevalence of AMD is higher in developed countries and in individuals of white race.
- It is estimated that 1.75% of the world population age 50 and older have late-stage AMD.
- In the United States, it is estimated that 11 million people have AMD, with 1.8 million having the advanced form.
- The incidence of AMD is projected to increase as the population ages.
Types of Age-Related Macular Degeneration
There are two main types of Age-Related Macular Degeneration (AMD): dry AMD and wet AMD.
- Dry AMD: This is the most common form of the disease and occurs when the cells in the macula (the part of the eye responsible for sharp, central vision) begin to break down. Dry AMD causes a slow, gradual loss of central vision.
- Wet AMD: This is a more advanced form of the disease and occurs when new blood vessels begin to grow under the retina. These new blood vessels can leak fluid or blood, causing damage to the macula and rapid loss of central vision. Wet AMD is less common than dry AMD but is more severe.
It is also important to note that there are early and intermediate stages of AMD, which may not yet have symptoms and can only be detected with an eye exam.
What Cause Age-Related Macular Degeneration?
The exact cause of age-related macular degeneration (AMD) is not fully understood, but it is believed to be a combination of genetic and environmental factors. Some of the main contributing factors include:
- Age: The risk of AMD increases as people age, with most cases occurring in individuals over the age of 60.
- Genetics: Research has shown that certain genetic variations can increase an individual's risk of developing AMD.
- Smoking: Smokers are at a much higher risk of developing AMD compared to non-smokers.
- Sunlight exposure: Long-term exposure to sunlight may contribute to the development of AMD.
- Diet: A diet high in saturated fat and cholesterol and low in fruits and vegetables may increase the risk of AMD.
- High blood pressure: High blood pressure can increase the risk of developing AMD.
- Obesity: Being overweight or obese may also be a risk factor for developing AMD.
It's also worth noting that some studies have found a connection between cardiovascular disease and AMD, which suggests that damage to blood vessels in the eye may play a role in the development of the condition.
Clinical Presentation of Age-Related Macular Degeneration
The symptoms of Age-Related Macular Degeneration (AMD) can include:
- Blurred or distorted central vision
- Difficulty reading or doing other tasks that require fine vision
- Loss of color vision
- A dark or empty area in the center of your field of vision
- Needing more light to see
- Straight lines appearing wavy or distorted
Symptoms may appear gradually and may not be noticed in the early stages of the disease. It is important to have regular eye exams to detect AMD early.
Diagnosis of Age-Related Macular Degeneration
Age-Related Macular Degeneration (AMD) is typically diagnosed during a comprehensive eye exam. The following tests may be used to diagnose AMD and evaluate its severity:
- Visual acuity test: This test measures how well you can see letters or symbols from a distance.
- Dilated eye exam: This test allows the eye care professional to examine the inside of the eye, including the retina and macula, using eye drops to dilate, or widen, the pupils.
- Amsler grid test: This test uses a special grid to check for distortion or missing areas in your central vision.
- Fundus photography: This test uses special cameras to take detailed photographs of the inside of the eye, including the retina and macula.
- Optical coherence tomography (OCT): This test uses light waves to create detailed images of the retina, allowing the eye care professional to see any abnormal blood vessels or fluid buildup in the macula.
In case of dry AMD, the diagnosis is often made by examining the retina, noting the presence of drusen and other characteristics of the disease. While in wet AMD, diagnosis is confirmed by Fluorescein angiography, which is a test that involves injecting a special dye into your arm and taking photographs of your eye to show any abnormal blood vessels or leakage.
How Age-Related Macular Degeneration is Treated?
Age-related macular degeneration (AMD) is a condition that affects the central part of the retina, called the macula. There is no cure for AMD, but there are treatments that can slow down its progression and help preserve vision. These treatments include:
- Photodynamic therapy (PDT): A laser is used to destroy abnormal blood vessels that are growing under the macula.
- Anti-VEGF injections: Medications such as ranibizumab (Lucentis), bevacizumab (Avastin), and aflibercept (Eylea) are injected into the eye to block a protein called VEGF that promotes the growth of abnormal blood vessels.
- Low-vision aids: These devices, such as magnifiers and special glasses, can help patients with AMD make the most of their remaining vision.
- Nutritional supplements: The Age-Related Eye Disease Study (AREDS) found that a specific combination of vitamins and minerals, including vitamin C, vitamin E, beta-carotene, zinc, and copper, may reduce the risk of AMD progression.
It's important to note that these treatments are not effective for all patients, and the appropriate treatment will depend on the stage and type of AMD, as well as the patient's overall health and individual needs.
Prognosis of Age-Related Macular Degeneration
The prognosis for age-related macular degeneration (AMD) can vary depending on the type and stage of the condition.
In early stages of AMD, the condition may not cause significant vision loss and can be managed with regular eye exams and lifestyle changes. However, as the condition progresses, vision loss can become more severe and can make it difficult to perform daily activities such as reading, driving, and recognizing faces.
Dry AMD, which is the most common form of the condition, tends to progress more slowly than the wet form of the disease, and vision loss is generally more gradual. Wet AMD, which is caused by the growth of abnormal blood vessels under the macula, can lead to more rapid and severe vision loss.
While there is currently no cure for AMD, treatment options such as photodynamic therapy, anti-VEGF injections and low vision aids can help slow down its progression and preserve vision. Nutritional supplements, such as the Age-Related Eye Disease Study (AREDS) formula, may also help to reduce the risk of AMD progression.
It's important to note that regular eye exams are important for early detection and management of AMD. If you have concerns about your vision or any symptoms of AMD, you should consult an ophthalmologist (eye doctor) as soon as possible.
Complications of Age-Related Macular Degeneration
Age-related macular degeneration (AMD) can lead to several complications, including:
- Vision loss: As AMD progresses, it can cause central vision loss, making it difficult to see fine details and perform daily activities such as reading, writing, and recognizing faces. In advanced stages, the vision loss can be severe and can lead to legal blindness.
- Difficulty with activities of daily living: As vision loss becomes more severe, it can make it difficult for individuals with AMD to perform activities such as driving, cooking, and managing finances.
- Depression and social isolation: Vision loss can also lead to feelings of isolation, depression, and decreased quality of life.
- Increased risk of falls: Individuals with AMD may have difficulty with depth perception and peripheral vision, which can increase the risk of falls.
- Increased risk of other health conditions: AMD is associated with an increased risk of other health conditions such as cardiovascular disease and cognitive decline.
It is important to note that these complications can vary depending on the stage and type of AMD, as well as the individual's overall health and lifestyle. Regular eye exams and early treatment can help slow the progression of the disease and help preserve vision.
How to Prevent Age-Related Macular Degeneration?
There are several steps you can take to reduce your risk of developing age-related macular degeneration (AMD):
- Eat a healthy diet: Include plenty of fruits and vegetables, particularly leafy greens like spinach and kale, which are high in the antioxidants lutein and zeaxanthin.
- Don't smoke: Smoking is a major risk factor for AMD.
- Maintain a healthy weight: Being overweight or obese increases your risk of developing AMD.
- Exercise regularly: Regular physical activity can help lower your risk of developing AMD.
- Wear protective eyewear: Wear sunglasses that block UV rays when you're outside to protect your eyes from harmful UV radiation.
- Get regular eye exams: Regular eye exams can help detect AMD early, when treatment is most effective.
It's important to note that these are general recommendations, and you should consult with your eye doctor for specific guidance.
What Questions Should I Ask My Healthcare Provider?
If you have age-related macular degeneration, you may want to ask your healthcare provider:
- Why did I get AMD?
- What type of AMD do I have?
- What is the best treatment for the type of AMD I have?
- What lifestyle changes can I make to protect my vision?
- Are there any treatment risks or side effects?
- Is my family at risk for developing AMD? If so, what steps can they take to protect their vision?
- Should I watch for signs of complications?
Age-related macular degeneration (AMD) is a degenerative condition that affects the macula, a small area of the retina responsible for central vision. It is the leading cause of blindness in people over the age of 60.
There are two main types of AMD, dry and wet. The dry form is caused by the gradual accumulation of debris in the macula, while the wet form is caused by the growth of abnormal blood vessels beneath the macula. Both forms can cause damage to the retina, resulting in vision loss.
Risk factors for AMD include age, smoking, family history, obesity, and high blood pressure. There is no cure for AMD, but early detection and treatment can slow the progression of the disease and help preserve vision.
Preventing age-related macular degeneration involves maintaining a healthy lifestyle and regular eye exams. Eating a healthy diet that is rich in fruits and vegetables, especially leafy greens, not smoking, maintaining a healthy weight, exercising regularly, and wearing protective eyewear are all ways to reduce your risk of developing AMD.
Medically Reviewed By
Dr. Yahia H. Alsharif