Age-related macular degeneration is a disease that causes blurring of your 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 severe.
You may have either type in just one eye, but over time you may get it in the other eye too.
Macular 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, but they know several different things may play a part. You are more likely to have macular degeneration if:
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 centre of your field of vision. As the disease gets worse, you may have trouble with tasks like reading and driving.
The two forms differ in how quickly symptoms develop and how severe they are.
Often the first symptom of the wet form is that straight lines look wavy or curved. If you think you might have wet macular degeneration, see your doctor right away. In some cases, quick treatment may help you keep your central vision.
A doctor can usually detect macular degeneration by doing a regular eye examination 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. If you have macular degeneration, your doctor may see drusen. These are yellowish white waste deposits that can build up at the back of the eye.
The doctor may have you look at a chart with lines and a dot at the centre. This is called an Amsler grid. It can help detect changes in your central vision. If you have the wet form, the lines near the centre dot will look wavy or curved, or you may see a blank spot or hole in part of the grid.
If you have macular degeneration, your doctor will want to see you for regular follow-up examinations. You can also use an Amsler grid at home. Looking at it every day will help you keep track of any changes in your vision.
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.
A diet rich in antioxidant vitamins and minerals may help slow down vision loss in some people with moderate to severe macular degeneration.2 Talk to your doctor about whether this diet might help you.
If you have the wet form of macular degeneration, you may have one or more of the following treatments:
These treatments can't restore central vision, but they may slow down vision loss. If your doctor recommends photodynamic therapy, injections, or laser surgery, it is important to have it done right away.
There are many things you can do at home to make the most of your remaining vision. Using vision aids like magnifying glasses or brighter lighting in your house may help you see better. You may be able to get large-print books and newspapers or a computer screen that displays large print or pictures. 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 with vision loss.
It can be scary to find out that you have a vision problem that will get worse. It is common to have a range of emotions. But if you feel very sad or hopeless, talk to your doctor. Antidepressant medicines may help. Your doctor can also refer you to a counsellor who helps people adjust to living with low vision.
Frequently Asked Questions
Learning about age-related macular degeneration (AMD):
Living with AMD:
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In dry AMD, cells in the macula break down, resulting in vision problems. No one knows why some people get AMD but others do not. In the early stages of dry AMD, a type of debris called drusen, which comes from cells, builds up in the area under and around the macula. When viewed with ophthalmoscopy, which is a way of seeing inside the eye, drusen 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 development of numerous large drusen is associated with AMD.2
Wet AMD is caused by the growth of abnormal blood vessels under the macula. Experts are studying why this happens. The blood vessels break easily and leak blood and fluid under the macula. The excess blood and fluid, along with abnormal scar tissue that forms under the macula, distort and damage the macula.
Dry age-related macular degeneration (AMD) and wet age-related macular degeneration both cause vision loss and may produce similar symptoms:
The symptoms of wet and dry AMD differ in two important ways:
Rate of development.
With dry age-related macular degeneration (dry AMD), vision gradually becomes worse over the years. As the cells and blood vessels beneath the macula age, they begin to thin and break down. When these cells and blood vessels stop working, the nerve cells in the macula that detect light cannot function properly. As more and more of the nerve cells in the macula break down, vision loss very slowly gets worse. At present, there is no treatment to prevent this vision loss. But a diet rich in zinc and antioxidant vitamins may slow the progression of vision loss.
Vision loss from dry AMD is often slow and gradual, allowing you to make adjustments over time. A small percentage of people who have dry AMD develop the abnormal blood vessels that lead to wet AMD.
The impact AMD has on your life will depend on your lifestyle and on how bad your vision loss is. Even though AMD may affect central vision, it does not cause complete blindness. And most people keep good side (peripheral) vision. For information on adapting to reduced vision, see the Home Treatment section of this topic.
With wet age-related macular degeneration (wet AMD), vision can suddenly become worse. Wet AMD begins with the growth of abnormal blood vessels under the macula, which is the part of the eye that is responsible for central vision. 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.
When the nerve cell damage is contained in a small area, it causes a blank spot to develop in your field of vision. As this area expands, the blank spot also gets larger.
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 vision.
Treatment can sometimes delay or prevent further vision loss, but it cannot reverse vision loss that has already occurred. Normal use of the eyes (such as for reading or watching television) will not speed up vision loss or make the condition worse. Loss of vision from wet AMD may progress rapidly. This does not allow much time for those affected to adjust to the vision loss and find ways to live with it.
For information on adapting to reduced vision, see the Home Treatment section of this topic.
The major risk factors for age-related macular degeneration (AMD) include:
Other risk factors for developing AMD may include:2
Genes may play an important role in your risk for AMD. Researchers have found certain genes that seem to be linked to AMD.
Wet age-related macular degeneration (wet AMD) can damage your vision within days or even hours. This damage can be severe and permanent.
Call your doctor immediately if:
Your doctor will refer you to an eye doctor (ophthalmologist) if needed.
Call your doctor immediately if you see either of the following on an Amsler grid:
These are signs of the more serious form of the disease, wet AMD. If you have been diagnosed with dry age-related macular degeneration (dry AMD), check your vision in each eye using an Amsler grid every day or as often as your doctor recommends. Dry AMD does not usually develop into wet AMD, but be on the lookout for signs of wet AMD.
The slow vision loss caused by dry AMD does not demand urgent care. The fading of colours or dimming of vision may progress so slowly that it does not bother you, especially if it only affects one eye. But even gradual changes in vision may signal a larger problem.
Call your doctor to discuss whether you need an eye examination if:
In general, sudden changes in your vision that do not go away need immediate attention. Gradual or slow changes in vision tend to be less serious. If you have noticed gradual changes in your vision, talk to your doctor about whether you need an eye examination.
The Canadian Medical Association recommends that all people age 45 and older have a complete eye examination every 2 to 4 years to help find AMD early. The following table summarizes the recommendations for comprehensive eye examinations:1
|Age (years)||When to get a comprehensive eye examination|
|65 or older||Every 1–2 years|
|55–64||Every 1–3 years|
|40–54||Every 2–4 years|
|Younger than 40||5–10 years|
Watchful waiting means to take a wait-and-see approach.
Watchful waiting is not appropriate if you have rapid vision loss or sudden changes in your vision. If you have any rapid vision changes, see 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 mild, slow vision loss, such as that caused by dry age-related macular degeneration (dry AMD), watchful waiting is appropriate. There is no treatment for dry AMD. And you may never develop vision loss to the point that it disrupts your regular lifestyle.
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 examination. The doctor first will find out more about your symptoms, past eye problems, and other health conditions by asking you about your medical history.
Next, the doctor will test your central vision with a visual acuity test. During this test, you cover one eye and read letters on a wall chart 6.1 m (20 ft) away. Central vision gets worse over time in a person with AMD, and a visual acuity test can measure whether your vision has gotten worse since your last examination. The doctor may also test your visual field, which includes both your central vision and side (peripheral) vision.
Ophthalmoscopy allows the doctor to examine the inside of your eye (see a picture of macular degeneration). Using a beam of light and a magnifying lens to view the inside of your eye, the doctor will examine your retina and macula for signs of AMD. The presence of bright, yellowish white deposits called drusen is one of the early signs of AMD. If you have wet AMD, the doctor may be able to see blood in part of the retina or a white or gray scar near the macula.
An Amsler grid test can also detect wet AMD. An Amsler grid is a series of straight lines that run up and down and left to right. The grid has a dot at the centre. If you have wet AMD, the lines near the centre dot will appear wavy or curved instead of straight, or you may see a blank spot or hole on part of the grid.
For more information on vision testing, see the topic Vision Tests.
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 test can also locate leaky blood vessels under the macula and help your doctor determine whether they can be treated.
If you have AMD and some loss of vision, your doctor may perform a low-vision evaluation to help find ways for you to make the most of your remaining vision and keep your quality of life.
Anyone older than 50 is at risk for age-related macular degeneration. Doctors screen for the disease during regular eye examinations by looking for deposits called drusen and for other changes in the macula caused by AMD.
Regular use of an Amsler grid can detect the progression of dry AMD to wet AMD. People who have dry AMD and those who have an increased risk for developing AMD should use the Amsler grid.
There is no cure or treatment for dry age-related macular degeneration (dry AMD) at this time.
You may not have significant problems with your vision for many years. Vision loss happens very slowly and is usually not severe. It often affects only one eye, and you may be able to adjust for the vision loss with the unaffected eye. If you have dry AMD, follow your doctor's advice for having regular examinations and for watching the condition at home (such as using an Amsler grid), because dry AMD may sometimes develop into wet AMD.
Your doctor may advise vitamin supplements or a diet rich in zinc and antioxidant vitamins. These vitamins may help slow the progression of advanced AMD and delay vision loss if you already have AMD.
In a few cases, wet age-related macular degeneration (wet AMD), which is the more serious form of the disease, can be treated with photodynamic therapy (PDT), medicines that are injected into the eye, or thermal laser photocoagulation surgery.
Treatment cannot cure AMD, but it can slow its progression. Other types of treatments using radiation are being studied. But these treatments are considered experimental and are not part of standard treatment.
Some cases of wet AMD cannot be treated by either laser photocoagulation or PDT. And PDT can only be used for a minority of cases.8
Treatment cannot restore vision, but it 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 recurs, 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.
Do not smoke. For more information about quitting smoking, see the topic Quitting Smoking.
If you already have vision loss from AMD, your doctor may also conduct a low-vision evaluation. The evaluation will help you find ways to make the best use of your remaining vision. The evaluation also may include suggestions for counselling and training on dealing with reduced vision to help you keep your quality of life as much as possible.
Because AMD often leads to a significant loss of vision and, in most cases, there is no effective treatment, finding out that you have AMD can be very hard. Your doctor can refer you to counsellors who specialize in helping people adjust to living with low vision.
You cannot prevent age-related macular degeneration (AMD). But there are some steps you can take that may lower your risk of developing AMD.
You may help prevent wet AMD if you already have the dry form:
Check your vision in each eye with an Amsler grid every day or as often as your doctor recommends. Watch for vision loss by looking for changes in your ability to read, see the television clearly, or see people's faces at a distance. If you notice a change, discuss with your doctor whether you need to have an eye examination.
People with either type of age-related macular degeneration (AMD) in one or both eyes should check the vision in each eye 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. If wet AMD has started to develop or is progressing, early treatment may be able to delay further loss of your central vision.
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 keep your quality of life as much as possible:
Because AMD can lead to a significant loss of vision and, in most cases, because there is no effective treatment, finding out that you have AMD can be very difficult. You may feel angry if treatment cannot help you or feel anxious that loss of vision from AMD will make you less able to function on your own.
Although it is normal to feel unhappy about these changes, 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 counsellor who specializes in helping people adjust to living with limited vision.
Anti-VEGF medicines can slow the vision loss that is linked to wet age-related macular degeneration (AMD). These medicines block a protein that leads to the wet type of macular degeneration. This protein is called vascular endothelial growth factor (VEGF). VEGF causes new abnormal vessels to grow in the eye. The growth of these abnormal vessels leads to macular degeneration.
Anti-VEGF medicines appear to slow the growth of abnormal blood vessels that cause vision loss in wet AMD.4 Two examples of anti-VEGF medicines used to treat AMD are bevacizumab (Avastin) and ranibizumab (Lucentis). These medicines are injected into the eye.
Anti-VEGF medicines are also known as VEGF inhibitors.
Thermal laser photocoagulation surgery is used to treat wet age-related macular degeneration (wet AMD). But this surgery is an option for less than one-fourth of people who have wet AMD.8 Whether your AMD can be treated by laser photocoagulation surgery or other surgery depends on the location and development of abnormal blood vessels under the retina.
Surgery does not cure wet AMD, but it can sometimes slow down or prevent further loss of central vision. Without treatment, vision loss from wet AMD may progress until a person has no central vision left. Early surgery is vital to slowing down vision loss, which can be rapid.
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 treatment.3
The only surgical method for treating wet age-related macular degeneration (wet AMD) is laser surgery, or laser photocoagulation.
Laser surgery can result in some loss of central vision, because the laser cannot burn the abnormal blood vessels under the macula without also burning some of the normal nerve cells in the macula. But while your vision may be worse right after surgery, it may be less likely to continue to get worse than if you did not have the surgery.
AMD does not cause the same amount of vision loss in everyone who has the disease. It is often hard to know in advance whether laser surgery will do more harm than good.
Photodynamic therapy (PDT) is another treatment for age-related macular degeneration (AMD). Photodynamic therapy uses a light-sensitive dye that attaches to abnormal new blood vessels under the macula. PDT has been the most common treatment for the past 5 to 10 years but is gradually beginning to be replaced by anti-VEGF medicines. Most people need multiple treatments to get the full benefits of PDT.
Currently, no treatment has proved effective for dry AMD, so the search for other treatments continues. Not all cases of wet AMD can be treated with laser photocoagulation surgery or PDT. And only about 15 out of 100 people can be effectively treated with laser photocoagulation surgery. PDT can only be used for a minority of cases as well. 8
Experts are currently studying possible surgeries for AMD. These include:
Researchers are studying several possible treatments for AMD. These include:
The most recent treatment that has been developed for wet AMD are the anti-VEGF medicines. These medicines are injected into the eye and are becoming the standard of care today.
Laser treatment almost always causes some immediate, permanent central vision loss (a central blind spot), and it does not prevent future growth of abnormal blood vessels. Some experts think that photodynamic therapy (PDT) and radiation therapy could prove to be more effective and less destructive than laser surgery because they are more precise. These procedures may be better able to target the blood vessels without damaging the nerve cells in the retina and macula. But the effectiveness and long-term consequences of PDT are still being studied.
Many treatments for AMD are costly, need to be repeated, and may have limited effectiveness. Some treatments may even make your AMD worse or cause vision loss. Talk with your doctor to make sure that you understand the possible benefits, risks, and side effects of your treatment choices.
|AMD Alliance International|
|1929 Bayview Avenue|
|Toronto, ON M4G 3E8|
(416) 486-2500 ext. 7505
The goal of the AMD Alliance International is to educate and offer support to individuals and families around the world affected by AMD. AMD Alliance International conducts AMD research, provides educational materials to the public, and offers a toll-free helpline to the public.
|Canadian National Institute for the Blind|
|1929 Bayview Avenue|
|Toronto, ON M4G 3E8|
The Canadian National Institute for the Blind is a voluntary agency dedicated to helping improve the lives of the blind and visually impaired, preventing blindness, and promoting sight enhancement services. The organization offers a variety of publications and educational resources about vision loss and impairment, including pamphlets, newsletters, and a quarterly magazine.
|Canadian Ophthalmological Society|
|610-1525 Carling Avenue|
|Ottawa, ON K1Z 8R9|
The Canadian Ophthalmological Society is an association of eye doctors dedicated to helping the public take good care of their eyes and vision. This group provides educational information on eye conditions and diseases and eye safety.
|Macular Degeneration Foundation|
|P.O. Box 531313|
|Henderson, NV 89053|
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 Internet.
- Canadian Ophthalmological Society (2007). Canadian Ophthalmological Society evidence-based clinical practice guidelines for the periodic eye examination in adults in Canada. Canadian Journal of Ophthalmology, 42 :39–45.
- American Academy of Ophthalmology (2006). Age-Related Macular Degeneration (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Available online: http://www.aap.org/ppp.
- Arnold J (2006). Age-related macular degeneration, search date March 2005. Online version of Clinical Evidence (15).
- Drugs for some common eye disorders (2007). Treatment Guidelines From The Medical Letter, 5(53): 4–5.
- Cho E, et al. (2004). Prospective study of intake of fruits, vegetables, vitamins, and carotenoids and risk of age-related maculopathy. Archives of Ophthalmology, 122(6): 883–892.
- Brody BL, et al. (2005). Self-management of age-related macular degeneration at the 6-month follow-up. Archives of Ophthalmology. 123(1): 46–53.
- Seddon JM, et al. (2003). Progression of age-related macular degeneration: Association with body mass index, waist circumference, and waist-hip ratio. Archives of Ophthalmology, 121(6): 785–792.
- Martidis A, Tennant TS (2004). Age-related macular degeneration. In M Yanoff et al., eds., Ophthalmology, 2nd ed., pp 925–933. St. Louis: Mosby.
Other Works Consulted
- American Academy of Ophthalmology (2007). Vision Rehabilitation for Adults (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Also available online: http://www.aap.org/ppp.
|Primary Medical Reviewer||Kathleen Romito, MD - Family Medicine|
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Christopher J. Rudnisky, MD, MPH, FRCSC - Ophthalmology|
|Last Revised||December 29, 2009|
Last Revised: April 29, 2012
This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.