Macular degeneration, commonly referred to as age-related macular degeneration (AMD), is a chronic eye condition that primarily affects the macula—the central part of the retina responsible for sharp, straight-ahead vision. This progressive disorder gradually diminishes central vision, making it difficult to read, drive, or recognize faces. While peripheral vision remains intact, the clarity and detail of what lies directly in front of you fade over time.

AMD is the leading cause of vision loss in people over 65, affecting nearly 3 million Americans. Although it cannot be cured, early detection and appropriate management can significantly slow its progression and help preserve visual function.

Types of AMD

There are two main types of AMD: dry and wet. Each progresses differently and requires distinct treatment approaches.

Dry AMD

Dry AMD is the most common form, accounting for 70% to 90% of cases. It occurs when the macula thins over time and accumulates drusen—tiny yellow deposits of protein and fat. This form progresses slowly, often without noticeable symptoms until the condition is advanced.

Dry AMD progresses through three stages:

  • Early stage: No vision loss but drusen are detectable during an eye exam.

  • Intermediate stage: Some vision problems like mild blurriness and difficulty with reading.

  • Advanced stage: Significant central vision loss and difficulty performing everyday tasks.

Wet AMD

Wet AMD is less common but more severe. It occurs when abnormal blood vessels grow under the retina and leak fluid or blood, causing damage to the macula. Vision loss can happen rapidly and may lead to severe central blindness if left untreated. Often, wet AMD develops from the advanced stages of dry AMD.

Symptoms

Symptoms of macular degeneration often go unnoticed in the early stages, especially in dry AMD. As the disease progresses, individuals may experience the following:

  • Blurred or fuzzy central vision

  • Difficulty recognizing faces

  • Trouble reading or driving

  • Straight lines appearing wavy or distorted

  • A dark or empty area in the center of vision

  • Difficulty adapting to low-light conditions

Unlike other eye conditions, AMD does not affect peripheral or side vision. Therefore, complete blindness is rare, but legal blindness may occur due to central vision loss.

Causes and Risk Factors

The exact causes of AMD remain unclear, but it is believed to result from a combination of genetic and environmental factors.

Causes

In dry AMD, the buildup of drusen impairs retinal cells, causing gradual deterioration of the macula. Wet AMD involves the abnormal growth of blood vessels beneath the retina, likely triggered by an overproduction of vascular endothelial growth factor (VEGF).

Risk Factors

Several risk factors may contribute to the development of AMD:

  • Age: The risk increases significantly after age 60

  • Family history: A genetic predisposition is common

  • Smoking: Increases the risk two to threefold

  • Obesity: Linked to faster progression of AMD

  • High blood pressure and cholesterol

  • Poor diet: Low in antioxidants and omega-3s

  • UV exposure: Excessive sun exposure over time

  • Sedentary lifestyle

Diagnosis

Regular eye exams are essential for early detection of AMD. A comprehensive diagnosis includes several tests:

  • Visual acuity test: Measures clarity of vision using a letter chart

  • Dilated eye exam: Allows a detailed view of the retina and macula

  • Amsler grid: A self-monitoring tool that helps detect changes in central vision

  • Optical coherence tomography (OCT): Provides detailed cross-sectional images of the retina

  • Fluorescein angiography: Uses dye to reveal abnormal blood vessel growth in wet AMD

Early detection plays a crucial role in preventing vision loss, especially for wet AMD.

Stages of AMD

As mentioned earlier, dry AMD advances through three stages:

  1. Early AMD: Characterized by the presence of medium-sized drusen without vision symptoms.

  2. Intermediate AMD: Large drusen and pigment changes in the retina begin to impact vision.

  3. Late AMD: Vision loss becomes noticeable. At this stage, it can be either dry (geographic atrophy) or wet (neovascular AMD).

Wet AMD is always considered late-stage and progresses more quickly than dry AMD.

Treatment Options

There is no definitive cure for AMD, but treatments aim to slow disease progression and manage symptoms.

Supplements (AREDS-2 Formula)

For dry AMD, especially in the intermediate or advanced stages, the Age-Related Eye Disease Study 2 (AREDS-2) formula is recommended. This supplement includes:

  • Vitamin C (500 mg)

  • Vitamin E (400 IU)

  • Zinc (80 mg)

  • Copper (2 mg)

  • Lutein (10 mg)

  • Zeaxanthin (2 mg)

These antioxidants help reduce the risk of progression to advanced AMD.

Anti-VEGF Injections

For wet AMD, anti-VEGF drugs prevent the formation of abnormal blood vessels. Common medications include:

  • Eylea (aflibercept)

  • Lucentis (ranibizumab)

  • Avastin (bevacizumab)

  • Beovu (brolucizumab)

These drugs are injected directly into the eye and are highly effective in slowing or halting vision loss.

Photodynamic Therapy

This involves injecting a light-sensitive drug into the bloodstream and activating it with a laser to destroy abnormal vessels in the retina. It's used in conjunction with anti-VEGF drugs.

Syfovre (pegcetacoplan)

Recently approved by the FDA, this injection is designed for geographic atrophy, a form of advanced dry AMD. It’s administered every 25 to 60 days to slow vision deterioration.

Prevention Strategies

While you can’t change genetic risk factors, several lifestyle changes can help reduce your risk or slow progression:

  • Don’t smoke: Smoking is the top modifiable risk factor

  • Eat a healthy diet: Include leafy greens, fruits, and omega-3-rich fish

  • Maintain a healthy weight: Exercise regularly and avoid obesity

  • Manage chronic conditions: Control blood pressure, diabetes, and cholesterol

  • Protect your eyes: Wear sunglasses with UV protection

  • Limit screen time: Rest your eyes frequently when using digital devices

Associated Conditions

Living with AMD increases the risk of other conditions:

  • Cataracts: AMD patients are more likely to develop lens clouding

  • Glaucoma: Increased intraocular pressure may occur alongside AMD

  • Diabetic retinopathy: In people with diabetes, AMD may exacerbate retinal damage

  • Depression and anxiety: Vision loss can impact mental well-being

Living With AMD

Adapting to life with AMD involves changes in daily habits and emotional coping. Strategies include:

  • Use visual aids: Magnifying glasses, high-contrast materials

  • Adjust digital settings: Enlarge text, increase brightness, use voice-activated tools

  • Home modifications: Add lighting, remove tripping hazards, label items

  • Stay connected: Support groups and therapy can help maintain mental health

  • Low vision rehabilitation: Specialists can teach adaptive techniques to enhance independence

Future Outlook

Ongoing research is exploring gene therapy, stem cell therapy, and retinal implants. Advances in imaging and AI diagnostics may soon allow earlier detection and more personalized treatments.

While AMD remains a challenging condition, awareness, early intervention, and supportive care can greatly improve quality of life for those affected.