Age-Related Macular Degeneration

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What is Age-Related Macular Degeneration?

Age-related macular degeneration (ARMD or AMD) is common, affecting up to 20% of people over 60 years of age. AMD is the most common cause of irreversible vision loss in the United States. Severe vision loss from AMD can occur in up to 6% of 80 year olds.

There are two kinds of AMD: dry and wet. Both forms can lead to vision loss and patients can have either or both. More than 90% of patients diagnosed with AMD have the dry form, which is often associated with a slower course (over many years) characterized by drusen formation, retinal degeneration, and a gradual wearing away of the retina called atrophy. If these areas of retinal degeneration group together into larger areas, these areas are called geographic atrophy. Wet AMD is characterized by the development of abnormal blood vessels known as choroidal neovascular membranes (CNVM) that disrupt the retina and cause leakage of ¬fluid. This growth of abnormal blood vessels can result in vision loss due to build up in the retina (edema), bleeding in the retina, and scar tissue formation (fibrosis).

Examination and Diagnostic

Regular eye examinations are important to diagnose and manage AMD. While being evaluated by your eye doctor you may undergo multiple types of ocular imaging including photography, ocular coherence tomography (OCT), and fluorescein angiography (FA) to facilitate diagnosis and treatment.

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What can I expect if I have AMD?

AMD usually manifests after age 50. The disease is often bilateral (present in both eyes), and patients often have a significant family history of AMD. Most patients with early dry AMD with mild retinal changes will have no or minimal problems with their vision. Over time, dry AMD can cause slowing of reading speed, difficulty with adaptation to changing light conditions, and loss of contrast sensitivity. In its most advanced form, dry AMD can cause profound central vision loss, often with preserved peripheral (side) vision. Wet AMD is generally associated with more rapid visual loss over days to weeks compared to dry AMD. Patient may notice decreased vision or distorted vision.

Treatment of AMD

There is currently no cure for either dry or wet AMD. Smoking is toxic to the retina and can contribute to AMD progression. If you smoke stop smoking as soon as possible! Other ways to optimize your retinal health include eating a healthy diet with regular vegetables and ¬fruits, and maintaining a healthy body weight. The risk of vision loss from some forms of AMD can be reduced by taking a speci¬al combination of supplements. The Age-Related Eye Diseases Studies (AREDS & AREDS2), which were large clinical trials, demonstrated a decreased risk of visual loss from moderate dry AMD by taking a combination of the following:

  • 15 mg of Beta-carotene
  • 400IU of Vitamin E
  • 500 mg of Vitamin C
  • 80 mg of Zinc
  • 2 mg of copper
  • Lutein/Zeaxanthin

Of interest, this study did not show a bene¬fit from supplement use in patients without AMD or in patients with very early AMD.

An Amsler grid is a chart to use at home to monitor your vision. Use it daily for each eye as directed and if you notice changes in your vision, contact your ophthalmologist as soon as possible.

Click here to download an Amsler grid.

Incredible advances in our ability to treat wet AMD since the early 2000s have revolutionized patient outcomes. Before that time, a diagnosis of wet AMD carried a very poor prognosis with most eyes progressing to severe vision loss. Fortunately, medications now available can benefit over 90% of wet AMD patients. These medications primarily target VEGF (vascular endothelial growth factor), a molecule responsible for the abnormal blood vessels which cause damage in wet AMD. Repeated injections of anti-VEGF agents (Avastin, Lucentis & Eylea) have been firmly established as the optimal treatment for wet AMD. These powerful drugs are given as injections into the eye to suppress abnormal blood vessel growth and leakage. Because these injections are not a cure, but only a treatment, they have to be administered repeatedly (sometimes as often as monthly, indefinitely) in order to have their maximal vision-improving results. Extensive numbing of the eye makes this injection procedure virtually painless.

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