Age-Related Macular Degeneration (AMD)
Have you noticed issues with your sharp, straight-ahead central vision? You may have a condition called age-related macular degeneration (AMD). For the millions of adults living with age-related macular degeneration (AMD), this is a reality. This condition is the nation’s leading cause of irreversible vision impairment among those over 50 years, with cases expected to grow to almost 22 million by 2050. It’s also one of the more familiar concerns treated at Retina Associates of Utah.
Age-Related Macular Degeneration (AMD) Explained
AMD is a degenerative disease that affects the retina – the thin, photosensitive tissue layer in the back of the eye. When light enters the eye, your retina gets to work by transforming the light into electrical signals, which then make the journey to the brain, using the optic nerve as their highway. AMD targets the retina’s central portion, the macula, which contains cells enabling your eye to perform multiple advanced central vision tasks. As you age, your macular tissue weakens and loses its functionality.
Age-Related Macular Degeneration Symptoms
AMD can develop quickly or slowly, and early on, there are likely no apparent symptoms. Generally, AMD doesn’t result in complete blindness, and peripheral vision isn't affected. But there may be central vision loss, such as issues with close-up tasks, like seeing faces or reading. You may experience such symptoms as blurriness, shadowy portions within your central vision, and visual distortions, like straight lines appearing wavy or crooked.
Types of Age-Related Macular Degeneration
1.) Dry Age-Related Macular Degeneration (AMD) – The most common type of AMD is dry AMD, also known as atrophic AMD. Part of normal aging, dry AMD is usually not harmful or painful. Vision loss generally develops slowly and gradually, affecting one or both eyes. But dry AMD may not impact vision at all, and you may not even be aware until a routine eye exam.
Dry AMD can make it difficult to see in the dark and make out contrasts. During your regular dilated eye exams, your ophthalmologist may detect deposits of drusen – small, yellow, cholesterol-like deposits that accumulate under the retina. Drusen are a normal part of aging, but should they grow in size and number, retinal specialists can use this to determine AMD progression. Drusen can only be detected through an eye examination, so patients who are diagnosed or at risk for developing AMD must regularly monitor their vision and alert their eye doctor about any changes as soon as possible.
2.) Wet Age-Related Macular Degeneration (AMD) – Wet AMD, also known as exudative AMD, is a more serious form that occurs in about 10% of patients with macular degeneration. The tell-tale indicator of this condition is aberrant, weed-like blood vessels growing beneath the retina – a process known as choroidal neovascularization (CNV). With CNV, these new blood vessels are fragile and break easily, resulting in fluid and blood spilling into the macular area as well as swelling. This can cause a wide range of symptoms, including blurred central vision, visual distortions, and vision loss.
Age-Related Macular Degeneration Risk Factors
When it comes to dry AMD, the main risk factor is being over the age of 50. But other conditions and lifestyle factors may raise your chances for dry AMD and its potential progression to the wet form, including:
- A family history of AMD
- Chronic conditions such as diabetes, high blood pressure, or high cholesterol
- Having light-colored irises
- Having a low-nutrient diet
- Long-term exposure to harmful UV rays (e.g., sunlight)
- Being Caucasian
Preventive and Treatment for Dry AMD
For most cases of dry AMD, there is no treatment option. The key form of treatment is preventive care to reduce the chances of developing AMD or slow its progression. These preventive measures include:
- Getting underlying conditions under control
- Eating a high-nutrient diet or taking supplements as directed by your doctor
- Staying physically active
- Avoiding or quitting smoking
- Achieving and maintaining a healthy body mass index (BMI)
- Shielding your eyes from UV ray exposure by wearning sunglasses
- Monitoring your vision daily for any changes
Most patients with dry AMD can maintain their vision for many years to come by taking preventive measures. For those who have the more advanced form of dry AMD – geographic atrophy – there is now an FDA-approved treatment known as Syfovre (pegcetacoplan injection). Syfovre helps to regulate the complement immune system, which can attack retinal cells and contribute to the progression of geographic atrophy.
Eating a healthy diet containing nutrient-rich foods has been shown to promote eye and vision health. Among these foods are:
- Oily fish, such as sardines or mackeral
- Dark leafy greens, like kale
- Citrus fruits, such as oranges
- Nuts and seeds, like walnuts and chia seeds.
Research also suggests multiple supplements benefit vision, including vitamins C and E, lutein, zeaxanthin, zinc, and copper. However, it’s crucial that you first discuss any nutritional changes with your doctor.
If you’ve been diagnosed with dry AMD, you should try to monitor your vision daily, as this allows you to detect any changes faster. You may find it helpful to use a simple device, an Amsler grid, in the comfort of your home. It’s a paper chart with horizontal and vertical lines forming a grid pattern, with a dot located in the grid’s center. If used regularly, it can help you identify any aberrations in your vision. Here are the directions:
- Wear your normal reading glasses.
- Ensure you’re using the grid in a well-lit room.
- Keep the grid held about 12-15 inches away from your face.
- Cover one eye and focus your uncovered eye on the center dot.
- Look to see if the lines on the grid appear straight or distorted, including any wavy lines, darkened or blurred areas, or blank spots.
- Repeat these steps with the other eye.
Did you observe any changes or distortions in your eyes? If yes, alert your ophthalmologist immediately.
To preserve your vision, schedule regular eye exams to detect the earliest signs of AMD. If you’re between 40 and 54, we advise you to visit our ophthalmologists at least every 2-4 years, depending on your health needs. If over 55, schedule an eye exam at least every 1-2 years.
Dry AMD can lead to a progressive condition known as geographic atrophy. In geographic atrophy, cells in the macula gradually degenerate; as time goes on, this cellular degeneration results in regions of retinal tissue loss. This can cause significant central vision impairment, making daily tasks such as reading and recognizing faces increasingly challenging. Early detection and ongoing management are crucial in addressing this sight-threatening condition.
Wet Age-Related Macular Degeneration: Treatment Options
Fortunately, if wet AMD is diagnosed in its earliest stages, patients have a higher likelihood of delaying and preserving any vision loss. Treatment options are determined by the symptoms’ severity.
- One of the most common treatment methods is anti-vascular endothelial growth factor medications. Patients will regularly have anti-VEGF medications injected into their affected eye(s) to stop unusual blood vessel growth. You can expect the affected eye to first be numbed, resulting in a relatively painless procedure with little, if any pain or discomfort. Patients usually do well, and if diagnosed early, your central vision may be preserved.
- Focal laser surgery, or photocoagulation, involves a high-energy laser that seals off abnormal blood vessels. This prevents further macular leaking and bleeding.
- Photodynamic therapy involves a light-activated drug injected into the bloodstream. The drug then travels to the ocular blood vessels. A laser is used on the eye to activate the drug, which then seals the abnormal blood vessels.
Turn to our Experienced Retina Specialists for AMD Treatment
At Retina Associates of Utah, our team of board-certified retina specialists and vitreoretinal surgeons have extensive educational training in the diagnosis, medical management, and surgical treatment of all retinal diseases, including dry and wet AMD. In addition to their clinical practice, our retina specialists continuously enhance their knowledge and expand the world of retina care by using the latest findings and most advanced techniques, as well as pursuing academic and clinical research.
Being actively involved in retinal research allows for the introduction of new and optimal disease treatments. Our physicians regularly lead and participate in groundbreaking clinical trials, including those for AMD. For example, as part of a major retinal clinical trial, RAU’s Dr. Robert Kwun performed Utah’s first surgical administration of an investigational gene therapy known as RGX-314 for wet AMD and other neovascular retinal conditions.