Macular Degeneration / AMD

One of the most common causes of vision loss in older adults is age-related macular degeneration (AMD). AMD occurs when the macular cells deteriorate and cease to function properly. The macula is the central area of the retina that controls our central vision; it’s used for fine-detail activities such as reading, facial recognition, and driving. As macular degeneration progresses, it can make objects in your central vision appear blurry or distorted. Eventually, patients may lose the ability to see details, which can impair normal daily activities. AMD is categorized into two different types: wet and dry AMD.

Fortunately, because macular conditions like AMD impact only the macula, the rest of the retina typically remains unaffected, keeping peripheral vision intact. As such, AMD rarely results in total vision loss.

What is dry age-related macular degeneration?

In dry AMD, the macular cells gradually reduce in number and become less sensitive. Vision loss tends to occur slowly over time, with cases ranging from mild to severe.

AMD typically begins with the development of drusen, which are yellow deposits that build up under the macula. As the disease progresses, geographic atrophy or areas of cellular loss develop which causes more significant loss of central vision.

What is wet age-related macular degeneration?

Wet AMD is when new, abnormal blood vessels grow under the retina.  These vessels may leak blood or fluid causing scarring of the macula. Unlike dry AMD which happens over time, the onset of wet AMD can happen suddenly and result in a severe decline in vision. If left untreated, wet AMD can cause permanent loss of central vision.

AMD Risk Factors

There are several risk factors that can increase a patient’s chance of developing macular degeneration. These risk factors include:

  • Age and female gender
  • Genetics
  • Tobacco use
  • Obesity
  • High-fat diet
  • High cholesterol
  • High blood pressure
  • Cardiovascular diseases, such as atherosclerosis

When should I be seen by an eye care professional?

  • Dilated eye exams are recommended annually to detect AMD and other retinal diseases. Early diagnosis is essential in saving vision.
  • Symptoms of dry AMD include gradual onset of central blurriness (especially while reading), inability to recognize faces, a need for bright illumination when reading, and loss of color vision.
  • If you notice rapid onset of central loss of vision in one eye associated with distortion or blind spots, you should be seen within a week of onset as this could indicate the beginning of wet AMD.

a screen shot of a cage

  • Daily monitoring of your vision with an Amsler grid as seen above is a good method of early detection.  Image A is a normal grid while Image B demonstrates distortion and blind spots indicative of wet AMD which should prompt an immediate visit to your eye care professional. Many patients with dry AMD will have baseline mild distortion but if there are rapid changes, the possibility of conversion to wet AMD should be considered.

Can AMD be prevented?

Because macular degeneration is so closely linked to aging, preventive measures normally involve a healthy diet, regular exercise, weight management, no tobacco use, and protecting your eyes from the sun’s harmful UV rays. Additionally, the Age-Related Eye Disease Study 2 (AREDS 2) found that the progression of AMD may be slowed by taking these vitamins and minerals daily:

  • Vitamin C, 500 mg
  • Vitamin E, 400 IU
  • Lutein, 10mg
  • Zeaxanthin, 2mg
  • Zinc, 80mg
  • Copper, 2mg

Your eye doctor will tell you if these vitamins are recommended for your AMD, as not all stages of the disease will benefit.

AMD Treatment

Treatment for dry AMD historically consisted of preventive measures and vitamin usage alone. However in 2023, a class of medications called complement inhibitors, including Syfovre and Izervay, were approved by the US Food and Drug Administration (FDA) to slow the progression of geographic atrophy – an advanced complication of late-stage dry AMD which can eventually lead to central loss of vision. This treatment will not improve vision and involves repeated injections delivered into the eye through a thin needle.

More recently, a treatment called photobiomodulation (PBM), a noninvasive treatment involving the use of multiple wavelengths of light to stimulate retinal mitochondria, was shown in a small study to improve the vision by >6 letters in over 60% of patients over two years.

Treatment for wet AMD usually involves the use of anti-vascular endothelial growth factor (anti-VEGF) medications to stop leakage of abnormal and leaking blood vessels. These medicines are delivered into the eye through a thin needle. As a retinal specialist, Dr. Keithahn has years of experience with these medications and is uniquely trained and qualified to administer them and determine the optimal treatment plan. The goal is to provide sufficient treatment to stabilize the condition thereby preventing further visual loss while minimizing the frequency of injections and visits to the clinic. When wet AMD is detected early the current treatments give a reasonable chance to recover vision in many patients thus emphasizing the importance of early detection strategies.

What should I watch for?

Your doctor will schedule regular follow-up appointments to monitor your condition. In addition, monitor your vision with an Amsler grid daily so that any changes in vision will be recognized as early as possible. Instructions on how to use the grid will be provided. Any persistent changes—waviness or dimness of the lines-should be reported to your doctor immediately.

 

• Dry Age-Related Macular Degeneration (AMD) Video

• Medication Injections - Wet Age-Related Macular Degeneration (AMD) Video