What Is Macular Degeneration?

Macular degeneration, often known as age-related macular degeneration (AMD), is a progressive eye disease that makes things blurry in the center of your vision. This condition occurs when there is damage to the macula—a part of the retina in the back of the eye that helps you see what is right in front of you.

Most people develop macular degeneration as they age. Other risk factors include having a family history of the condition and smoking tobacco. Macular degeneration is the most common form of vision loss in people older than 65. Research suggests that nearly 3 million Americans live with the condition each year.

Generally, macular degeneration progresses gradually. You may experience eye symptoms such as blurry vision and a lack of definition in the objects that you are looking at. It's important to note that your peripheral vision (or, what you can see from the sides of your eyes) is not affected. While there is usually no cure for the condition, treatment can help improve symptoms and slow the progression of the disease.

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What Is Dry Macular Degeneration (Dry AMD)?

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Types

There are two main types of macular degeneration: dry and wet. The key difference between them involves the underlying cause of the condition.

Dry Macular Degeneration

Dry macular degeneration can happen due to damage to and the gradual thinning of the macula. Generally, 70% to 90% of people with macular degeneration have this type. Dry macular degeneration also progresses slower than wet macular degeneration. This type can affect either one or both of your eyes. But, if you only experience symptoms in one eye at first, you are at an increased risk of developing the condition in the other eye as well.

Wet Macular Degeneration

When you have wet macular degeneration, vision loss tends to set on faster. This type is a more rare and severe subset of macular degeneration and occurs due to irregular blood vessel growth in your retina. The blood vessels can leak and cause scarring, which eventually damages the macula. Keep in mind: dry macular degeneration can turn into wet macular degeneration, which may occur when the disease advances very quickly.

Symptoms of Macular Degeneration

If you develop macular degeneration, you will primarily notice changes to your central vision, or the things that you can see right in front of you. This condition doesn’t affect peripheral vision or your ability to see in the dark (known as nocturnal vision). If you have this condition, the sharpness and clarity of what you’re looking at both close by and far away reduces. You may also experience the following vision changes:

• Blurry vision
• Trouble making out words on a page
• Difficulty driving
• Blank spaces in the center of your vision
• Objects appear wavy or crooked
• Colors look faded
• Lights may feel bright or distorted

Unlike some other forms of vision loss, macular degeneration doesn’t typically lead to complete blindness. However, it can lead to legal blindness, which occurs when you have a visual acuity of 20/200 or worse.

What Causes Macular Degeneration?

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Causes

The vision loss associated with macular degeneration is the result of damage to the macula. This is a part of the retina—the part of the eye that helps you process what you see. Researchers suggest that the development of small deposits in the macula (called drusen) can lead to dry macular degeneration. However, experts believe that wet macular degeneration happens as a result of scarring and blood leakage from abnormal blood vessel growth in the retina.

In both cases, cells in the macula get cut off from the necessary oxygen and nutrients that they need, eventually causing them to die and producing vision-related symptoms. It's important to note that researchers are still investigating exactly why macular degeneration occurs. While the above theories are accepted, more research is currently being done to understand the genetic and environmental factors that may trigger the condition to occur.

Risk Factors

Several risk factors can increase your chances of developing macular degeneration, including:

• Age over 65
• Smoking tobacco
• Having a family history of the condition
• High carbohydrate diet
• Sedentary lifestyle

Diagnosis

To detect macular degeneration, ophthalmologists (eye specialists) or optometrists (eye doctors) first evaluate your overall health status. They will look at your medical history, medications you’re taking, and any underlying health conditions you have. Once this process is completed, they can screen for other conditions that may be causing your symptoms. They can use one or more of the following exams to detect macular degeneration, among other vision concerns:

• Optometric exam: This is the standard test of vision and includes having you read letters far away or close by.
• Slit lamp exam: Your eye care provider gives you special drops to dilate your eyes, and then, with the help of a specialized microscope with a light (the slit lamp), they examine the retina and macula for signs of damage.
• Fluorescein angiography: If wet macular degeneration is suspected, your provider can use fluorescein angiography (a type of imaging test) to assess how severe your condition is. To help them visualize blood flow in the eye, they can inject a contrast dye into your arm and use a specialized camera to take a closer look at your blood vessels.
• Optical coherence tomography (OCT): OCT relies on the use of special light waves to carefully examine the retina. This non-invasive form of imaging lets eye care providers distinguish between cases of wet and dry macular degeneration and understand the severity of your condition.

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How Is Macular Degeneration Treated?

Stages of Macular Degeneration  

Dry macular degeneration goes through three stages. As you progress to each stage, your vision concerns will likely become more severe over time:

• Early: Early-stage macular degeneration is largely asymptomatic and doesn’t affect vision. However, medical exams can reveal signs of the condition.
• Intermediate: In the intermediate stage, you start to develop some symptoms.
• Advanced: If you have advanced macular degeneration, your vision may become significantly affected. You may have trouble seeing straight, have blurry eyes, and begin to slowly lose your ability to see in low-light conditions.

Treatments for Macular Degeneration

Macular degeneration is a chronic and progressive condition. Unfortunately, the loss of vision the condition causes is irreversible. While there’s no treatment that can cure macular degeneration, certain treatments and lifestyle changes can slow disease progression and help you preserve your remaining vision.

Supplements

Your eye care provider may recommend taking a blend of vitamins and minerals called AREDS-2. While you can find these supplements in most pharmacies without a prescription, talk to your provider before trying this method. AREDS-2 supplement is a blend of:

• Vitamin C
• Vitamin E
• Copper
• Zinc
• Beta-carotene
• Lutein
• Zeaxanthin

Prescription Medications

Medications can’t help with dry macular degeneration, but they can reduce symptoms if you have the wet type. A class of medications called anti-vascular endothelial growth factors (anti-VEGFs) can help slow disease progression. Your eye care provider can use one of the following medications, which they can administer via injection at their office or clinic:

• Beovu (brolucizumab)
• Lucentis (ranibizumab)
• Eylea (aflibercept)
• Avastin (bevacizumab)

Photodynamic Therapy

Photodynamic therapy, a type of laser therapy, is a treatment option for wet macular degeneration that commonly occurs in conjunction with anti-VEGF injections. This therapy involves the following steps:

1. Your provider will inject a medication into your arm
2. The drug will become activated by light
3. You will wear a special type of contact lenses to protect your eyes
4. A laser beam is placed on your eyes
5. The beam activates the drug in your macula and helps burn away the abnormal blood vessels that are causing symptoms

Syfovre Injection

Recently cleared for use by the US Food and Drug Administration (FDA), Syfovre (pefcetacoplan) is a therapy for advanced cases of macular degeneration. Your eye care provider can administer this injection directly into your eyes every 25 to 60 days. The purpose of this injection is to slow the progression of vision loss in your macula.

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Prevention

In order to prevent the onset of symptoms, your eye care provider can recommend the following lifestyle changes:

• Avoiding smoking
• Getting light to moderate physical exercise daily
• Eating a diet high in fruits, vegetables, lean proteins, nuts, and seeds
• Avoiding high carbohydrate foods
• Treating underlying medical conditions, such as high cholesterol or high blood pressure
• Wearing sunglasses to avoid damage to your eyes from ultraviolet (UV) rays

Related Conditions

Like other chronic (long-term) conditions, those with macular degeneration may be at an increased risk of developing other health conditions. According to research published in Investigative Ophthalmology & Visual Science, these conditions include:

• Type 1 diabetes
• Type 2 diabetes
• Heart disease and heart attack
• Hypothyroidism (underactive thyroid)
• Eye cataracts
• Glaucoma

Studies found that people with dry or wet macular degeneration experienced the above conditions at lower rates than those with either type of macular degeneration.

Living With Macular Degeneration  

Unfortunately, macular degeneration can’t be cured. Vision loss caused by the condition is irreversible and the disease is the leading cause of legal blindness in people over 65. However, preventative measures and treatments can slow down how fast your condition progresses. Your healthcare provider may recommend the following approaches to improve your quality of life as you live with your condition:

• Using magnifying lenses to help with reading or looking at pictures
• Trying audio-assistance devices, such as the Orcam, which is mounted on glasses and helps you recognize objects, faces, and words
• Changing the settings on screens to enlarge the size of text or images
• Increasing the brightness of screens or enabling dictation on them
• Reading large-print books or magazines
• Getting high-powered (high-lumen) lights for your office or home
• Wearing wraparound sunglasses to protect your eyes from UV rays
• Covering up shiny surfaces
• Asking for accommodations, such as modified work hours or brighter lights, at your workplace
• Relying on your loved ones or a mental health professional for emotional support and to manage the psychological effects of living with a chronic condition