Understanding Macular Degeneration (And How To Cope With It)

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Overview

Macular degeneration is the number one cause of vision loss in Americans over 50. (1) It’s commonly called age-related macular degeneration (ARMD, or AMD) in this age group.

Eleven million people in the United States have some form of macular degeneration. It is the leading cause of legal blindness (defined as visual acuity of 20/200) for adults over 40. (2)

What is Age-related Macular Degeneration?

Macular degeneration is a disease that affects the macula of your eye. The macula is the part of the retina that handles your straight-ahead, or central, vision. The retina is the part that communicates with your brain. When that communication is broken, vision is not possible.

There are two types of age-related macular degeneration—wet and dry.

Dry Macular Degeneration

Dry AMD is the most common, occurring in 85% to 90% (3) of macular degeneration cases. In this type, very small yellow deposits called drusen form in the macula of your eye. These drusen cause breakdowns in the macular tissue, leading to blind spots in your central vision.

The dry type can take years to produce symptoms. In 10% of cases, the dry type leads to wet macular degeneration. (2) However, the dry type can progress to central vision loss even without developing into wet AMD.

Wet Macular Degeneration

Wet AMD (also called neovascular AMD) is caused by abnormal blood vessels that develop under the retina, then leak into the macula. It can happen suddenly and progresses faster than the dry type. It is also more likely to cause complete loss of central vision.

Wet AMD is responsible for 90% of cases of legal blindness. (2)

What Are the Stages of Age-related Macular Degeneration? (5)

Early Stage

In early-stage AMD, most people don’t notice any symptoms. In this stage, imaging would show medium-sized drusen under your retina.

Intermediate Stage

By this stage, you may or may not notice a slight loss of vision. Imaging would show larger drusen than in the early stage. There may also be retinal pigment changes.

Late Stage

When the disease enters its late stage, you will be experiencing vision loss.

Are All Forms of Macular Degeneration Age-related?

No. There are three types of juvenile macular degeneration (JMD)—also called juvenile macular dystrophy (4)—that affect young people:

Stargardt’s Disease

This is the most common form of JMD. It begins before age 20, but first symptoms are noticed when patients are in their 30s. It leads to legal blindness.

Best’s Disease

Best’s is usually diagnosed between ages 3 and 15, but it can happen much later. It can affect one eye or both and eventually leads to 20/100 vision.

Juvenile Retinoschisis

This disease occurs almost exclusively in males. It causes central and peripheral vision loss. It is usually diagnosed between ages 10 and 20 but remains stable until age 50 to 60. It can progress to legal blindness.

What are the Causes and Risk Factors of Macular Degeneration? (6)

  • Age. For AMD, the older you get, the higher your risk.
  • Family history. There is a hereditary component to AMD and JMD.
  • Race. Caucasians are more likely to have macular degeneration.
  • Smoking. Smoking or exposure to second-hand smoke increases your risk significantly.
  • Obesity. Being obese may increase your chances of dry AMD progressing to the wet type.
  • Heart disease. You may be at higher risk if you have high blood pressure or heart conditions.

What are the Symptoms of Macular Degeneration? (6)

  • Distorted vision. Straight lines may seem wavy or bent.
  • Reduction in central vision in one eye or both.
  • The need for more light when doing close work or reading.
  • Trouble transitioning from bright light to low light, such as walking indoors on a sunny day.
  • Difficulty reading because of blurriness.
  • Reduction in perception of brightness of colors.
  • Difficulty recognizing faces.

Dry Macular Degeneration

With dry macular degeneration, symptoms typically come on gradually. Blurring and distortion of vision will eventually lead to blind spots. The symptoms can affect one eye or both, but both eyes is more common.

As the degeneration progresses, you will have difficulty reading and recognizing faces. Driving will become impossible.

Wet Macular Degeneration

With wet macular degeneration, symptoms are similar, but the cause is different. Abnormal blood vessels grow in the retina and leak into the macula. Wet AMD usually progresses more quickly than the dry type.

Early diagnosis is important with either type. It can help delay progression of disease.

How is AMD Diagnosed?

Your doctor will first take a complete medical history and family history. Family history is important because genetics is thought to be one of the major causes of macular degeneration.

He or she may do one or more of the following: (7)

  • Dilated eye exam. Your provider will dilate your eyes with drops and then look at the back of your eye with a special magnifying glass.
  • Amsler grid. (8) If you have developing macular degeneration, the straight lines on this grid will appear wavy or missing.
  • Fluorescein angiogram. Your provider will inject a colored dye into your arm, then take pictures of your eye as the dye passes through it. This allows him or her to see any blood vessels that may be leaking.
  • Optical coherence tomography. For this test, your provider will use a painless light beam to take images of your retina. It will show any retinal changes or leaking blood vessels underneath.

How Will My AMD Be Treated?

There is currently no treatment for dry macular degeneration. However, research supports nutritional changes that can slow progression of the disease (9).

When AMD has progressed to the wet form, following are the most common types of treatment (10):

  • Periodic intravitreal injections.
  • Photodynamic therapy.
  • Laser photocoagulation.
  • Macular translocation surgery.
  • Telescopic lens implant.

Can Anything Be Done to Prevent AMD?

At this time, prevention mainly involves lowering your risk factors.  If you have dry AMD, following are proactive steps you can take to lower your risk of progressing to the wet form and complete loss of central vision:

  • Get yearly eye exams. Early detection is important.
  • Get regular blood pressure checks. If needed, take medication as directed.
  • Don’t smoke. Smoking doubles your risk, according to the Cleveland Clinic. (11)
  • Maintain a weight as close to your ideal weight as possible.
  • Eat a diet rich in antioxidants and omega-3 fatty acids.
  • Research (12) shows that certain supplements (9) may be helpful in delaying AMD symptoms. Talk to your provider before taking any supplements.

Coping with Macular Degeneration  

Although there is no cure for macular degeneration, there is a lot you can do to make living with it easier.

  • Adjust the lighting in your home. Replace the light bulbs with brighter ones. Try replacing desk lamps with goose-necked floor lamps that can be moved closer to your work.
  • Replace clocks and electronics with models that have large digital readouts. Another  option is high-contrast designs such as black on white.
  • Try a digital magnifier. These come in sizes from handheld to desktop to floor models. Many of them have lights and variable magnification settings that you can increase as your vision loss progresses.
  • Customize your computer. Font and icon size can be enlarged. Monitor contrast can be adjusted. Newer computers allow you to control your computer settings and search by voice right out of the box. They will even read aloud to you.
  • Take advantage of audio alternatives. (13) If you can no longer see well enough to read, there are many other ways to take in information. These include books on tape, TED talks (14), podcasts, listening to TV documentaries, and many others.
  • Use e-readers and speech-to-text features. Tablets and e-readers have adjustable fonts. Modern cell phones allow you to use your voice to search, text, and e-mail. They also have electronic assistants that allow you to use your voice to operate the phone’s controls and settings.
  • Explore other low-vision assistive devices. (15) These include telescopic eyeglasses, light-filtering lenses, reading prisms, and closed-circuit television.
  • Research transportation options. (6­) As your AMD advances, your driving will be affected. Work with your doctor to decide when you can no longer drive safely.  Do some research ahead of time so you’ll know w­­hat options are available, such as buses, volunteer networks, ride-share programs, or shuttle services. Being prepared in advance will help you feel more confident and less anxious when that time comes.
  • Consider vision rehabilitation. (16) Look into low-vision rehab programs to learn practical ways to cope with your vision loss, such as learning to rely more on your peripheral vision. These programs are designed to help you learn new ways to perform daily tasks. They help to restore confidence and allow you to maintain your independence longer.
  • Spend time with supportive friends and family members. People with central vision loss are likely to feel depressed and socially isolated. (17)
  • Ask for help. Expect to have feelings of grief and loss. Seeing a counselor or social worker could help you manage those feelings.
  • Don’t give up hope. While it’s true that there is no cure for AMD yet, studies are currently underway that are showing promising results (18). You may be eligible to participate in a clinical trial that is researching a cure for AMD. Talk to your doctor if you are interested in finding out more about clinical trials. (19)

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