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One in three adults over 50 suffer from this vision-robbing condition. Protect yourself with these facts.
Age-related macular degeneration, or AMD, is the leading cause of severe vision loss in people age 50 and older. It attacks central vision and can rob people of the ability to recognize faces, drive, watch TV, see bright colors, and see fine detail necessary for reading, using a computer, and pursuing a wide range of hobbies such as sewing and woodworking.
“AMD does not usually affect peripheral vision,” says Eun S. Lee, O.D., an optometric physician with Regional Vision Consultants for America’s Best Contacts & Eyeglasses in Raritan, New Jersey.
“But because it affects the macula at the center of the eye’s light-sensing retina that allows us to see small, fine details, it can cause legal blindness,” Dr. Lee continues. “You may still be able to use side vision to detect light and motion around you.”
Early AMD typically has no symptoms. But a comprehensive eye exam can uncover early warning signs, giving you and your eye doctor time to take steps that can slow the progression of AMD and, in some cases, halt vision loss. Here’s what to know about this common eye condition.
What is AMD?
Age-related macular degeneration occurs when aging causes harm to the macula — the part of the retina responsible for straight-ahead vision and seeing details in sharp focus.
It can affect both eyes or just one, though having this disease in one eye increases your risk for developing it in the other eye. It affects people age 50 and older.
Everything from a family history of the disease to smoking to exposure to the sun’s ultraviolet rays can also play a role.
How common is AMD?
About 11 million Americans have AMD. As America’s population ages, that number could double to 22 million by 2050.
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Who’s at risk for AMD?
Many factors increase your risk for AMD — some are within your control, others are not. They include:
Age: Your risk goes up in your 50s and beyond. With every new decade, your risk for developing AMD increases by 18%, according to a recent German study of more than 15,000 midlife and older adults.
Family history: About 15% to 20% of people with AMD have a parent or sibling with this eye disease. However, many people without a known family history also develop AMD.
Race: White people face a higher risk for all stages of AMD than Black, Hispanic, and Asian adults. Researchers aren’t certain whether genetics, environment, lifestyle habits, or other factors explain the racial differences in risk.
Gender: Women face a higher risk for AMD simply because they live longer than men, according to the American Macular Degeneration Foundation.
Smoking: The most powerful, controllable risk factor for AMD is smoking. It may increase your odds for developing AMD twofold or even more. Smokers may also develop AMD five to 10 years sooner than nonsmokers. Smoking can also speed AMD’s progression and make treatments for wet AMD less effective.
Diet: People whose diets were rich in red and processed meats, refined carbohydrates, and saturated fat faced a threefold higher risk for developing late AMD over 18 years compared to those who ate more produce, lean protein, and good fats in a 2020 study published in the British Journal of Ophthalmology. Cell-protecting antioxidants in produce and good fats may help lower risk.
Body weight: Obesity increases AMD risk, perhaps by boosting cell-damaging inflammation and oxidative stress.
High blood pressure: Hypertension increased AMD risk by 15% in a 2019 study published in the Journal of Human Hypertension. The abnormal blood vessels in the eyes may cause an overgrowth of leaky blood vessels and further damage, the researchers noted. Heart disease and cardiovascular disease, which also affect blood vessels, may also raise AMD risk.
Exposure to the sun’s ultraviolet rays: UV light can damage the retina, accelerating aging and raising AMD risk.
What are the types and causes of AMD?
There are two types of AMD:
Dry AMD, also called atrophic AMD or nonexudative AMD, affects 85% to 90% of people with AMD, according to the American Macular Degeneration Foundation. It happens when your macula thins due to aging. The culprit: small, yellowish protein deposits under the macula called drusen.
While most people over age 50 have some of these protein deposits, having more drusen and drusen that are large and soft are associated with AMD. Vision loss and vision changes usually develop gradually, and people with dry AMD usually retain some central vision.
- Early: There are changes to the macula but no vision loss. Still, it’s important to take it seriously, Dr. Lee says, so that you can keep track of vision changes and adopt healthy lifestyle habits that could slow down the progression of early AMD.
- Intermediate: As damage progresses, central vision may look blurry or wavy.
- Late or advanced: Central vision is severely affected by late (also called advanced) AMD.
Wet AMD, also called advanced neovascular AMD or exudative AMD, occurs when abnormal blood vessels grow underneath the retina and macula. They leak blood and fluid that can build up under the macula, making it bulge or lift out of its normal position.
This interferes with central vision and can cause it to fail rapidly. An estimated 15% of people with AMD have this wet type. And in rare cases, dry AMD can become wet AMD.
If you have wet AMD in one eye with warning signs including large drusen, more than five drusen, clumping of pigment in the eye, and high blood pressure, the odds for developing it in your other eye can be as high as 87%. It’s as low as 7% without these risk factors.
The good news: Injections and laser treatments can halt new vision loss and help protect your “good eye” from damage.
What are the symptoms of AMD?
You may not notice any symptoms at all with early AMD, Dr. Lee says. In fact, AMD symptoms can also resemble symptoms of other eye problems, such as cataracts or needing a new eyeglass prescription.
Getting regular, comprehensive eye exams as recommended by your eye doctor is important for spotting AMD early to reduce your risk for vision loss, Dr. Lee says.
As the condition progresses, it can cause a variety of symptoms. They include:
- Your central straight-ahead vision may become blurry or objects in your direct line of sight may look fuzzy even when you’re wearing your glasses (if you do not have cataracts).
- You may have difficulty reading, seeing clearly at night or in low-light conditions, or have trouble recognizing familiar faces.
- Straight lines that appear to bend or look wavy could be a sign of more advanced dry AMD or of wet AMD.
- With wet AMD, you may also notice a dark area or blind spot in the center of your vision or, in more advanced AMD, lose central vision entirely. Side or peripheral vision is usually not affected by dry and wet AMD.
- You may also notice that your color vision isn’t as clear as it used to be.
How is AMD diagnosed?
Your eye doctor can find the earliest signs of AMD risk during a comprehensive eye exam. Knowing your medical history and family history may provide clues about your risk.
Tests administered during your eye exam let your doctor spot signs of early, intermediate, and advanced dry AMD and wet AMD. These include:
- A visual acuity test. This common eye chart test measures the sharpness of your eyesight at various distances.
- Amsler grid. This test uses a grid with a dot at the center. If any lines look wavy, distorted, or faded, or if any parts of the grid appear to be missing, these may be signs of AMD.
- Pupil dilation to examine the back of your eye. Your eye doctor will look for drusen — yellowish protein deposits under your retina. It is normal to have some drusen in your eyes after age 50, but if they are large and soft or increased in number or size, these are considered warning signs.
Your eye doctor may recommend other tests for AMD, including:
- Optical coherence tomography. This noninvasive imaging test uses images of your retina to pinpoint any areas that are becoming thinner or thicker or swollen due to fluid from leaking blood vessels.
- Optical coherence tomography angiography. This test uses reflected laser light to closely examine blood flow in the eyes. It’s noninvasive and painless.
- Fluorescein angiography. Your doctor may use this test to check for wet AMD. After a dye is injected into a vein in your arm, pictures of blood vessels in your retina are taken while the dye passes through. This shows whether blood vessels are leaking and can help your doctor evaluate treatment.
- Indocyanine green angiography. Similar to fluorescein angiography, this test can be used to identify the type of macular degeneration you have.
Can vision loss due to AMD be reversed?
For the most part, no. If you have wet AMD, injections to reduce damage caused by leaky blood vessels may improve vision somewhat. If you have central vision loss due to wet or dry AMD, low-vision devices can help you make use of the vision you still have so you can read, watch TV, and better see the faces of your friends and loved ones, Dr. Lee says.
These devices include special microscopic magnifiers mounted onto the center of eyeglasses for viewing objects very close up. Telescopic systems can be helpful for watching TV and reading street signs. They may be handheld or incorporated into eyeglass frames.
Your eye doctor can also help you access vision rehabilitation specialists who can help with strategies, equipment, and services so you can lead a full life with low vision.
How is dry AMD treated?
There is no treatment for dry AMD. But smart lifestyle steps may help slow progression, Dr. Lee says. Following a healthy diet, getting regular exercise, and quitting smoking may all help, according to the National Eye Institute. It’s important to keep up with regular eye exams as recommended by your eye doctor.
If you have early and intermediate AMD, research-tested dietary supplements called AREDS and AREDS2 may reduce your risk for developing late AMD, says Dr. Lee. In studies funded by the National Institutes of Health, taking AREDS for five years reduced risk of vision loss from AMD by 19% and reduced risk of progression from intermediate to advanced AMD by 25%. Taking the AREDS2 formula had similar results.
Wondering about the difference between AREDS and AREDS2? AREDS2 contains 500 milligrams of vitamin C, 400 international units of vitamin E, 2 milligrams of cupric oxide (copper), 80 milligrams of zinc, 10 milligrams of lutein, and 2 milligrams of zeaxanthin.
In contrast, the original AREDS formula contains beta-carotene instead of lutein and zeaxanthin. AREDS2 was developed and tested because beta-carotene supplements may raise cancer risk in smokers and former smokers.
“AREDS2 is a good choice for anyone with early and intermediate AMD,” Dr. Lee says. “It contains the antioxidants lutein and zeaxanthin, which are found in the retina of the eye. Reducing risk for AMD progression and vision loss is very important.”
If you already have late AMD in one eye, AREDS supplements may slow progression of AMD in your other eye. But the supplements have not proved beneficial in people with late AMD in both eyes.
What about wet AMD? Are there treatments?
Treatments for wet AMD focus on slowing or stopping vision loss caused by leaky blood vessels in the eyes. They include:
Anti-VEGF medications. Injected into the eyes, these drugs help to halt the leakage of blood and other fluids from blood vessels in the retina. They target a compound called vascular endothelial growth factor that promotes blood vessel growth and leaking.
Effects are short-lived, so people with wet AMD often need monthly injections, Dr. Lee says, though some may need injections only every two to three months with careful follow-up. Your doctor will numb and clean your eyes first, then inject the medication using a very small needle.
For most people with wet AMD, these drugs are the only treatment they need. In 2021, the U.S. Food and Drug Administration approved an eye implant called Susvimo that delivers anti-VEGF medication continuously without using injections. The device can be refilled with medication.
Photodynamic therapy (PDT). Sometimes used along with anti-VEGF drugs, PDT breaks down leaky blood vessels. The therapy involves receiving an injection of a light-sensitive drug called verteporfin in the arm. The drug is activated by cold laser light. Your doctor will numb your eye and put in a contact lens to guide the laser to the target: the extra blood vessels.
Can I check my vision at home if I have AMD?
In addition to regular eye exams, people with AMD can keep tabs on vision changes by using an Amsler grid at home, Dr. Lee says. The test can help people with dry AMD spot early changes that could mean they are progressing to advanced dry AMD or to wet AMD. To do this, print a copy of the grid (available at https://www.macular.org/amsler-chart) or ask your eye doctor for one.
Every day, do this quick check:
- Wearing your reading glasses, hold the grid in front of you so all the lines are in focus (usually about where you would hold a book or magazine).
- Cover one eye, then the other.
- While looking at the small black dot in the middle, note whether the grid lines are visible and straight.
Wavy lines, gray areas, black or white spots, or blurry spots may be warning signs of wet AMD.
“Take this test every day,” Dr. Lee says. “You can do it in the morning while your coffee perks. Put the grid on any flat surface, like your refrigerator or on the wall at eye level to make it easy.”
If you notice any new vision changes, mark them on the grid and contact your doctor right away.
Can AMD be prevented?
Adopting healthy habits can help lower your risk for AMD. These include:
Not smoking (or quitting if you are a current smoker). Smoking doubles your risk for AMD. Smoking seems to interfere with healthy blood flow in the eyes, causing oxidative stress damage to the retina.
Getting regular exercise. Combined with healthy eating, getting 10 hours of light exercise per week (such as housework or walking) or eight hours of moderate exercise (such as brisk walking) was associated with a fourfold lower risk of AMD in one study.
Keeping your blood pressure and cholesterol in a healthy range. High blood pressure, high cholesterol, and heart disease are all associated with increased AMD risk.
Maintaining a healthy weight. Obesity may increase risk. And in one large study, obesity raised the odds that AMD would progress to a more advanced stage by 32%.
Eat plenty of fruit, vegetables, and good fats. Antioxidant compounds, called carotenoids, may help protect your macula from damage that leads to AMD. You’ll find them in fruits and vegetables, especially leafy green veggies such as kale, spinach, collard greens, and lettuce.
Add foods rich in omega-3 fatty acids, such as salmon, sardines, and walnuts. These good fats are high in antioxidants. And limit added sugars and refined grains that can boost your blood sugar quickly. A “high glycemic diet” has been associated with a higher risk for developing AMD and for its progression.