When looking at a face, you may see the hair but not the central facial details like the eyes, nose, and mouth.

What Is AGE-RELATED MACULAR DEGENERATION?

AMD damages central vision, decreasing a person’s ability to see finer, central detail for things like reading and recognizing faces, whether near or in the distance. The peripheral or side vision remains normal. As an example, when looking at a face, they may see the hair but not the central facial details like the eyes, nose, and mouth.

Age-related macular degeneration (AMD) is a condition that occurs when the center part of the retina called the macula becomes damaged and doesn’t produce as clear an image as it does when healthy. As part of our comprehensive eye care practice, we offer the latest in AMD detection and treatments so our patients have the best chance of avoiding vision loss from this potentially blinding eye disease.

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The type of AMD an individual has will impact the degree of vision loss and treatment options.

DRY AMD

Dry AMD is the more common form with about 80% of AMD individuals having this type. When dry AMD occurs, parts of the macula thin out and tiny protein clusters called drusen begin to grow. Typically central vision loss occurs slowly. In advanced, dry AMD there is loss of the retinal layers. There is no known treatment for advanced dry AMD.

WET AMD

Wet AMD is less common but usually leads to more profound vision loss. Wet AMD occurs when new, abnormal blood vessels grow under the macula. The term “wet” is used because the blood vessels may leak blood or other fluids that deform and scar the macula. Vision is typically lost faster with wet AMD than with dry AMD.

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SYMPTOMS OF AMD

Individuals may not have any symptoms of AMD, or they may have difficulty seeing fine detail, notice blank spots in central vision, or experience a distortion to the way things look. Most individuals don’t realize they have AMD until vision becomes blurry. Regular visits to an ophthalmologist can diagnose the disease before it is advanced, looking for early signs of AMD even before there are visual changes. This is important because there are lifestyle changes that a patient can make that will impact the progression of the disease.

AMD FACTS

AMD is very common. It is a leading cause of vision loss in people over 50 years old. Smoking increases both the risk of developing AMD, and the speed at which it progresses.

In addition to a dilated eye exam, specific testing for AMD may include optical coherence tomography (OCT) and fluorescein angiography to look closely at the retina. An OCT scan is a painless procedure that uses a specialized camera to scan the retina and provides very detailed images of the 18 normal landmarks of the retina. Fluorescein angiography is used to visualize blood traveling through the blood vessels to the retina and back out again. In this evaluation, yellow dye (called fluorescein) is injected into an arm vein while a special camera takes photos of the retina, showing normal and abnormal retinal findings.

AMD RISK FACTORS

You are more likely to develop AMD if you:

Smoke cigarettes, Are over age 50, Have a family history of AMD, Are Caucasian (white), Are overweight, Have heart disease, Have high cholesterol levels, Have hypertension, Are overweight, Are hyperopic.

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AMD Treatments

Dry AMD

Right now, there is no way to reverse the dry form of AMD. However, people with moderate dry AMD might benefit from taking a certain combination of nutritional supplements. A large study found that certain individuals may slow the progression of their dry AMD by taking these vitamins and minerals daily:

Vitamin C (500 mg)
Vitamin E (400 IU)
Lutein (10 mg)
Zeaxanthin (2 mg)
Zinc (80 mg)
Copper (2 mg)

During an ophthalmologist office visit, find out if vitamins and minerals are recommended.

Laser - Laser treatment is not used to treat dry AMD.

Wet AMD

Medication - There is no oral medication to treat wet AMD.

Medications - Injected - To help treat wet AMD, there are medications called anti-VEGF drugs. Anti-VEGF treatment helps reduce the number of abnormal blood vessels in the retina. It also slows any leaking from blood vessels. This medicine is delivered to the eye through a very slender needle.

Laser - Laser surgery may occasionally be used to treat wet AMD. A small laser beam is aimed at the abnormal vessels to reduce the number of vessels and slow the bleeding and fluid leakage.

Alternative AMD Treatments

In 1994, ophthalmic literature first reported that those who regularly consumed dark, leafy greens had less AMD progression. While the vitamins in the age-related eye disease study (AREDS) have been shown to decrease the rate of progression of AMD in up to 25% of patients with intermediate AMD, they do not prevent the disease in those at risk to develop the disease. There is conflicting evidence for the type and dosage of micronutrients as the AREDS vitamin formula undergoes continued modifications. Age-related eye disease study vitamin benefit is limited to individuals with specific genetics, and there are serious side effects and unanswered questions associated with these formulations. Side effects include the increased risk of lung cancer in smokers who took the original formulation and the controversial finding of acceleration of the AMD disease process in 13% of patients with certain risk alleles who take the AREDS vitamins. (Seddon et al, 1994; Kassoff A, et al, 2001; Pinazo-Durán MD et al, 2014; Fritz H, 2011; Awh CC et al, 2013; Chew EY et al, 2014)

The AREDS 2 study illustrates the difficulty in treating AMD once it becomes advanced so attention needs to be directed at those with early disease and the first-degree relatives of patients who have a 23% chance of developing AMD over their lifetime. Smoking and secondhand smoke significantly increase the risk of developing advanced AMD and smoking cessation slows the progression. Regular exercise reduces the risk of developing advanced AMD. And recent studies show that adherence to the Mediterranean diet decreases the odds of developing AMD by one-third. (Chew EY et al, 2013; Shahid et al, 2012; Klein BEK et al, 2001; Fritsche LG et al, 2013; Khan JC et al, 2006; Silva R, 2016; Chiu et al, 2014, Amirul et al, 2014; Carneiro & Andrade, 2017)

What The Patient Can Do

Quit smoking.
Follow the Mediterranean diet.
Exercise at least three times a week.
Report to your physician a family history of a close relative with AMD.
Obtain regular eye exams because early-stage AMD may not have any obvious symptoms. An ophthalmologist — an eye MD physician specializing in medical and surgical eye care — can detect the early signs of eye disease through comprehensive eye exams and advise on how to lessen the impact. The American Academy of Ophthalmology recommends people over age 65 get exams every one to two years.
AMD causes vision to change over time and these changes may not be noticed until fairly advanced. An ophthalmologist may advise monitoring for any blurry or blank spots in the central vision by looking at an Amsler grid every day to catch any changes as soon as possible. Treating them as early as possible can help slow or stop further loss of sight. Amsler grids are available in our office.
Here is how to use the Amsler grid:

1) Use the Amsler grid every day by keeping it in a place where it will be seen (refrigerator door, bathroom mirror, etc.)

2) Using good lighting, look at the grid from about 12–15 inches away, wearing reading glasses/bifocals if normally worn.

3) Covering one eye, look directly at the dot in the center of the grid with the uncovered eye. Notice if any of the lines look bent or wavy or any part of the grid looks blurry, dim, or out of shape.

4) Repeat with the other eye uncovered.

5) Call the ophthalmologist right away if you notice that any lines or parts of the grid look wavy, bent, blurry, dim, or distorted.

With more advanced AMD, many favorite things can still be enjoyed with special low vision tools, including magnifying tools, handheld computers, and electronic items
A vision rehabilitation specialist can teach household skills and help locate many low vision support services and tools.

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References

Amirul I, Fakir M, Chong EW, Hodge AM, Guymer RH, Aung KZ, Makeyeva GA. 2014.

Dietary Patterns and Their Associations with Age-Related Macular Degeneration: The Melbourne Collaborative Cohort Study: The Melbourne Collaborative Cohort Study.

Ophthalmology, Vol.121(7), pp.1428-1434

Awh CC, Lane AM, Hawken S, Zanke B, Kim IK. 2013. CFH and ARMS2 Genetic Polymorphisms Predict Response to Antioxidants and Zinc in Patients with Age-Related Macular Degeneration. Ophthalmology, Vol.120(11), pp.2317-2323

Carneiro Â, Andrade JP. 2017. Nutritional and Lifestyle Interventions for Age-Related Macular Degeneration: A Review. Oxidative Medicine and Cellular Longevity, Vol.2017

Chew EY, Clemons TE, SanGiovanni JP, Danis R, Frederick FL. 2013. Lutein + Zeaxanthin and Omega-3 Fatty Acids for Age-Related Macular Degeneration: the Age-Related Eye Disease Study 2 (AREDS2) Randomized Clinical Trial. JAMA, Vol.309(19), pp.2005-15

Chew EY, Klein ML, Clemons TE, Agrón E, Ratnapriya R, Edwards AO, Fritsche L, et al. 2014. No Clinically Significant Association between CFH and ARMS2 Genotypes and Response to Nutritional Supplements: AREDS Report Number 38: AREDS Report Number 38. Ophthalmology, Vol.121(11), pp.2173-2180

Chiu C-J, Chang M-L, Zhang FF, Li T, Gensler G, Schleicher M, Taylor A. 2014.

The Relationship of Major American Dietary Patterns to Age-Related Macular Degeneration. American Journal of Ophthalmology, Vol.158(1), pp.118-127

Fritsche LG, Chen W, Schu M, Yaspan BL, Yu Y, Thorleifsson G, Zack DJ, et al. 2013. Seven new loci associated with age-related macular degeneration. Nature genetics, Vol.45(4), pp.433-9

Fritz H, Kennedy D, Fergusson D, Fernandes R, Doucette S, Cooley K, Seely A, et al. 2011. Vitamin A and Retinoid Derivatives for Lung Cancer: a Systematic Review and Meta-Analysis. PloS One, Vol.6(6), pp.e21107

Kassoff A, Chenoweth RG, Zilis JD, et al. 2001. A Randomized, Placebo-Controlled, Clinical Trial of High-Dose Supplementation With Vitamins C and E, Beta Carotene, and Zinc for Age-Related Macular Degeneration and Vision Loss: AREDS Report No. 8.

Archives of Ophthalmology, Vol.119(10), pp.1417-1436

Khan JC, Thurlby DA, Shahid H, Clayton DG, Yates JRW, Bradley M. Moore AT, Bird AC. 2006. Smoking and Age Related Macular Degeneration: the Number of Pack Years Cigarette Smoking is a Major Determinant of Risk for Both Geographic Atrophy and Choroidal Neovascularization. British Journal of Ophthalmology, Vol.90(1), p.75

Klein BEK, Klein R, Lee KE, Moore EL, Danforth L. 2001. Risk of Incident Age-related Eye Diseases in People with an Affected Sibling. American Journal of Epidemiology, Vol.154(3), pp.207-211

Pinazo-Durán MD, Gómez-Ulla F, Arias L, Araiz J, Casaroli-Marano R, Gallego-Pinazo R, et al. 2014. Do Nutritional Supplements Have a Role in Age Macular Degeneration Prevention? Journal of Ophthalmology, Vol.2014, pp.127-144

Seddon JM, Ajani UA, Sperduto RD, Hiller R, Blair N, Burton T. 1994. Dietary Carotenoids, Vitamins A, C, and E, and Advanced Age-Related Macular Degeneration. JAMA, Vol.272(18), pp.1413-1420

Shahid H, Khan JC, Cipriani V, Sepp T, Matharu BK, Bunce C, Harding SP, et al. 2012. Age-Related Macular Degeneration: the Importance of Family History as a Risk Factor. British Journal of Ophthalmology, Vol.96(3), p.427

Silva R. 2016. Fruit-Rich Mediterranean Diet with Antioxidants May Cut Age-Related Macular Degeneration Risk by More than a Third. PR Newswire, reporting on 120th annual meeting of the American Academy of Ophthalmology, Oct 16, 2016

Williams PT. 2009. Prospective Study of Incident Age-Related Macular Degeneration in Relation to Vigorous Physical Activity During a 7-year Follow-Up. Investigative Ophthalmology & Visual Science, Vol.50(1), pp.101-6