Age-related macular degeneration is a disease that causes blurring of
central vision. The blurring happens because of damage
to the macula, a small area at the back of the
eye. The macula helps you see the fine detail in
things that your eyes are focusing on.
Macular degeneration makes
it harder to do things that require sharp central vision, like reading,
driving, and recognizing faces. It does not affect side vision, so it does not
lead to complete blindness.
There are two types of macular
degeneration—wet and dry. The dry form is by far the most common type. The wet
form is much less common, but it happens more quickly and is more
You may have either type in just one eye, but over time
you may get it in the other eye too.
degeneration is the result of damage to the nerve cells in the
macula. The process that leads to this damage is
different for each type.
Experts are still studying the causes of both forms.
The main symptom of macular
degeneration is dim or fuzzy central vision. Objects may look warped or smaller
than they really are. You may have a blank or blind spot in the center of your
field of vision. As the disease gets worse, you may have trouble with tasks
like reading and driving.
If you have the dry form, your vision will
probably become blurry slowly. You may have it for several years before it
affects your ability to read, drive, and do everyday activities.
Often the first symptom of the wet form is that straight
lines look wavy or curved. In the wet form, vision loss happens quickly and can be severe.
can usually detect macular degeneration by doing a regular eye exam and asking
questions about your past health. You may have some vision tests, including an
ophthalmoscopy. This test lets your doctor look at the inside of your eye and check for possible signs of this disease, such as drusen. These are yellowish white waste deposits that
can build up at the back of the eye.
At this time, there is no cure
for macular degeneration. But experts are exploring many new treatments that
hold hope for the future. Your doctor can keep you up to date on any changes in
treatment that might help you.
Eating food that contains lots of antioxidant
vitamins and minerals may help slow down vision loss in some people with
moderate to severe macular degeneration.1 Talk to your
doctor about whether this might help you.
These treatments may slow down vision loss from the wet form of macular degeneration:
many things you can do at home to make the most of your remaining vision. Try using
aids like magnifying glasses, brighter lighting, and large-print books. Having a good support
network is important too.
If you need more help, your doctor may
refer you to an
occupational therapist or rehabilitation specialist.
These professionals can help you get the tools and training you need to cope
with reduced vision. Local agencies may also offer services for people who have
It can be scary to find out that you have a vision
problem that may get worse. It is common to have a range of emotions. But if
you feel very sad or hopeless, talk to your doctor.
Learning about age-related macular degeneration (AMD):
Living with AMD:
Health Tools help you make wise health decisions or take action to improve your health.
Vision loss from
age-related macular degeneration is caused by
damage to the light-detecting nerve cells in the
macula. The cause of this damage to the nerve cells is
unknown. A person's genes and family history may play a role.
Age-related macular degeneration (AMD) can cause these symptoms:
The symptoms of wet and dry AMD differ in two important
age-related macular degeneration (dry AMD), the cells and blood vessels beneath the macula begin to thin and break down as they age.
these cells and blood vessels stop working, the nerve cells in the macula that
detect light can't work as well as they used to. As more and more of the nerve cells in
the macula break down, vision loss very slowly gets worse.
may have the disease for several years before it affects how you are able to read,
drive, and do everyday activities. If you have AMD in only one eye, you may not
notice minor vision changes, because your unaffected eye automatically makes up
for vision problems in your other eye.
A small percentage of people who have dry AMD eventually develop
Wet AMD begins with the growth of abnormal blood vessels under the macula. These blood vessels break easily. They
leak blood and fluid and cause scar tissue, all of which push against the
macula. They change the macula's shape and cause it to send distorted images to
your brain. Straight lines begin to appear wavy or curved, and objects may seem
oddly shaped or smaller.
Scar tissue also cuts off the macula
from the normal support cells that it needs in order to work. Nerve cells in
the macula begin to die, causing a loss of central vision.
If not treated, the scar beneath the macula may continue
to grow, affecting more and more of the nerve cells in the macula. Vision loss
gets worse as more of the macula becomes involved. The entire macula may be
destroyed by this process, resulting in a complete loss of central
Treatment can sometimes delay or prevent further vision
loss, but it cannot reverse vision loss that has already occurred.
With wet AMD,
vision loss can happen fast—within months or even weeks. This can make it hard to adjust to
the vision loss.
Even though AMD may affect
central vision, it doesn't cause complete blindness. And most people keep good side vision.
The main things that put you at risk (risk factors) for
age-related macular degeneration (AMD) include:
Other risk factors for developing AMD may include:1
Call your doctor immediately if:
Your doctor will refer you to an eye doctor
(ophthalmologist) if needed.
Call your doctor to
discuss whether you need an eye exam if:
Watchful waiting means to take a wait-and-see
Watchful waiting is not appropriate if you have rapid
vision loss or sudden changes in your vision. If you have any rapid vision
changes, go to your doctor as soon as possible. Immediate treatment may be able
to slow vision loss caused by wet AMD. Delaying treatment for wet AMD could
mean further loss of central vision.
If you have dry age-related macular degeneration (dry AMD),
watchful waiting is appropriate. You may
never develop vision loss to the point that it disrupts your regular
AMD can usually be
detected during a routine eye exam by your regular doctor or an eye care
professional (optometrist or
An ophthalmologist who
specializes in problems with the retina and macula can diagnose which type of
AMD you have. Also, laser surgery and medicine injections for wet AMD are done
by an ophthalmologist.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
A doctor can usually detect
age-related macular degeneration (AMD) with a regular
eye exam. The doctor first will find out more about your symptoms, past eye
problems, and other health conditions by asking you about your
The doctor will
central vision with a visual acuity test. During this
test, you cover one eye and read letters on a wall chart
20 ft (6.1 m) away. Central
vision gets worse over time in a person who has AMD, and a visual acuity test can
measure whether your vision has become worse since your last exam. The doctor
may also test your visual field, which includes both your central vision and
side (peripheral) vision.
Your doctor will look inside your eye using ophthalmoscopy. This test lets your doctor check for possible signs of this disease, such as drusen, which appear as yellowish white spots under the
retina. Although some small drusen can usually be
found in the macula as a normal result of aging, the presence of numerous
large drusen is associated with AMD.1
Amsler grid test can detect
wet AMD. If you have wet AMD,
lines on the grid appear wavy or curved instead of straight, or
you may see a blank spot or hole on part of the grid.
information on vision testing, see the topic
If your doctor thinks that
you may have wet AMD, you may also have a test called an
eye angiogram or an optical coherence tomography (OCT) to find out if abnormal blood vessels
are growing beneath the macula. The tests can also locate leaky blood vessels
under the macula and help your doctor find out if they can be
If you have AMD and some loss of vision, your doctor may
low-vision evaluation to help find ways for you to
make the most of your remaining vision and keep your quality of life.
The American Academy of Ophthalmology recommends that all
people ages 40 to 54 have a comprehensive eye exam every 2 to
4 years to help detect AMD early. The following table summarizes the
recommendations for comprehensive eye exams:2
There is no cure for age-related macular degeneration (AMD), but certain treatments may delay vision loss.
Your doctor can refer you to counselors who
specialize in helping people adjust to living with low vision.
Follow your doctor's advice for having
regular exams and for watching the condition at home (such as using an
Amsler grid), because dry AMD can sometimes develop into wet AMD.
Vitamins and diet changes may help slow vision loss. For more information, see Home Treatment.
Treatment for wet AMD can sometimes slow down or delay further damage to your
central vision. But in most cases, growth of fragile
new blood vessels in wet AMD starts again. And even repeated treatment is usually not
effective over the long term in preventing some loss of central vision.
Because wet AMD often causes rapid and severe loss of central vision, it
is important not to delay treatment if your doctor recommends it.
You can't prevent
age-related macular degeneration (AMD). But there are
some steps you can take that may lower your risk of getting it.
People who have an increased risk
for AMD should use the Amsler grid. Your doctor can give you one to use at home.
Although there's no treatment that can cure age-related macular degeneration (AMD), there are steps you can take that may keep it from getting worse. These steps may help prevent wet AMD if you already
have the dry form:
People with AMD should check the vision in both eyes using an
Amsler grid every day or as often as the doctor recommends. If any of the lines
on the grid change or begin to appear wavy and curved, or if you notice that
your vision is getting worse, call your doctor.
Reduced vision or
vision loss from AMD can affect your life in many ways. How much it will affect
you depends on your lifestyle and on how bad your vision loss is. Work
with your doctor to find ways to make the best use of your remaining vision.
There are things that you can do to adjust and to keep your quality of
life as much as possible.
normal to feel unhappy about your loss of vision. But if your feelings of sadness are
severe or do not improve, you may develop
depression, which requires treatment. If you need help
in dealing with your feelings about AMD, talk to your doctor and to your family
and friends. Your doctor can also refer you to a counselor who specializes in
helping people adjust to living with limited vision.
Anti-VEGF medicines, such as bevacizumab (Avastin) and ranibizumab (Lucentis), can slow the vision loss that is
linked to wet
age-related macular degeneration (wet AMD). These medicines are
injected into the eye.
doesn't cure wet
age-related macular degeneration (wet AMD), but it can sometimes slow down or prevent further loss
of central vision. Early surgery is vital to slowing
down vision loss, which can be rapid.
But laser surgery is an option for less than one-fourth of people
who have wet AMD.4 It is often hard to know in advance whether
the surgery will do more harm than good.
By the time many people are
diagnosed with wet AMD, it is often too late for surgery to provide much
benefit. Even with treatment, many people will still go on to lose more of
their central vision.
Currently, surgery is not used to treat
dry AMD. Laser surgery to remove deposits called
drusen may slow vision loss in people with dry AMD,
but experts think that it may increase the chance of developing wet AMD.
Researchers are currently doing studies to see if this is an effective
Studies are being done on possible other treatments for age-related macular degeneration (AMD), such as:
You can talk with your doctor about the progress of new potential treatments and also look into clinical trials.
This nonprofit group works to find cures, preventions, and improved treatments for age-related degenerative diseases. The website has information about Alzheimer's disease, macular degeneration, and glaucoma.
EyeCare America is a public service program of the
Foundation of the American Academy of Ophthalmology. This site aims to raise awareness about
eye diseases and eye care. It has information about eye conditions, treatments, and general eye health. You can check to see if you qualify for a free eye exam.
The Macular Degeneration Foundation provides extensive online
explanations about various aspects of macular degeneration. It also includes
information about new research and treatments. The organization publishes an
electronic newsletter called The Magnifier. Distributed
free by e-mail, it includes news regarding clinical trials, recent reports in
the media, and information about new resources available over the
The Macular Degeneration Partnership offers up-to-date information about
macular degeneration. The organization also supports research and coordinates
As part of the U.S. National Institutes of Health, the National Eye
Institute provides information on eye diseases and vision research.
Publications are available to the public at no charge. The Web site includes
links to various information resources.
American Academy of Ophthalmology (2008). Age-Related Macular Degeneration (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Available online:
American Academy of Ophthalmology (2010). Comprehensive Adult Medical Eye Evaluation (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Available online:
Lim LS, et al. (2012). Age-related macular degeneration. Lancet, 379(9827): 1728–1738.
Rosenfeld PJ, et al. (2009). Age-related macular degeneration. In M Yanoff et al., eds., Ophthalmology, 3rd ed., pp. 658–673. Edinburgh: Mosby Elsevier.
Arnold J, Heriot W (2007). AMD, search date March 2006. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
Other Works Consulted
American Academy of Ophthalmology (2007). Vision Rehabilitation for Adults (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Available online:
Despriet DG, et al. (2006). Complement factor H polymorphism, complement activators, and risk of age-related macular degeneration. JAMA, 296(3): 301–309.
Fletcher EC, et al. (2011). Retina and retinal disorders. In P
Riordan-Eva, JP Whitcher, eds., Vaughan and Asbury's General Ophthalmology, 18th ed., pp. 190–221. New York: McGraw-Hill.
Vedula SS, Krzystolik M (2008). Antiangiogenic therapy with anti-vascular endothelial growth factor modalities for neovascular age-related macular degeneration. Cochrane Database of Systematic Reviews (2).
November 12, 2012
Kathleen Romito, MD - Family Medicine
& Christopher J. Rudnisky, MD, MPH, FRCSC - Ophthalmology
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