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Macular Degeneration

  • What Facts Should I Know about Macular Degeneration?
  • What Are Macular Degeneration Risk Factors?
  • Questions to Ask the Eye Doctor About Macular Degeneration
  • What Are Macular Degeneration Symptoms and Signs?
  • When to Seek Medical Care for Macular Degeneration
  • What Exams and Tests Do Doctors Use to Diagnose Macular Degeneration?
  • Are There Home Remedies for Macular Degeneration?
  • What Is the Treatment for Macular Degeneration?
  • What Is the Prognosis of Macular Degeneration?
  • What Are Macular Degeneration Complications?
  • Follow-up for Macular Degeneration
  • Are There Ways to Prevent Macular Degeneration?
  • Support Groups and Counseling for Macular Degeneration
  • Macular Degeneration Topic Guide
  • Doctor’s Notes on Macular Degeneration Symptoms

What Facts Should I Know about Macular Degeneration?

The diagnosis of macular degeneration is becoming increasingly more common due to patient awareness, physician access, and improvements in tools for detection. Additionally, because of the increase in our elderly population, there has been an increase in the percentage of the population at risk for this condition. Macular degeneration is a formidable challenge to patients, their doctors, and our society as the costs for delivering state-of-the-art care increase.

What is the medical definition of macular degeneration?

Macular degeneration, also called age-related macular degeneration (AMD or ARMD), affects the macula, which is the central portion of the retina of the eye. Our central vision (what you see directly in front of you rather than what you see at the side [or periphery] of your vision) is dependent on a healthy macula.

The retina is a layer of tissue inside the eye consisting of the receptors and nerves that sense and transmit light signals from the eye to the optic nerve. From there, the optic nerve sends the information to the brain for interpretation as our sense of vision. The macula is the very central portion of the retina and is responsible for the detailed vision that we use to read, thread a needle, sign a check, or recognize faces.

Age-related macular degeneration is the leading cause of blindness in people older than 50 years in the United States affecting more than 2 million people. Because overall life expectancy continues to increase, age-related macular degeneration has become a major public-health concern.

What are the types of macular degeneration?

There are two types of age-related macular degeneration:

  • Dry form: This type results from the gradual breakdown of cells in the macula, which can result in a gradual blurring of central vision. Small, round, yellow-white spots called drusen accumulate under the macula in the dry type. Drusen can be seen by your doctor using standard eye exam equipment. Drusen can become visible at any age, but are much more common in people over the age of 55. Many people with drusen alone have excellent vision and no symptoms. A small percentage of people, however, will go on to develop an advanced form of dry AMD known as geographic atrophy (GA), in which the macular tissue gradually thins. When this occurs, there can be vision loss ranging from mild to profound.
  • Wet (exudative or neovascular) form: In the wet form of AMD, abnormal blood vessels grow under the macula. These blood vessels may leak fluid or blood, distorting or diminishing central vision. Wet AMD usually starts in one eye and may affect the other eye later. In contrast to the dry type, vision loss may be rapid.
    • Wet macular degeneration affects only 10%-15% of people who have AMD but accounts for the majority of people who have significant visual loss.

Juvenile macular degenerations (for example, Stargardt disease) are uncommon inherited macular diseases of childhood that are not discussed here.

What does macular degeneration look like?

Age-related macular degeneration. Retinal photograph. Dry type with drusen (spots) and atrophy of retinal pigment epithelium, right eye. Courtesy of Dr. James Puklin and Dr. Dean Elliot.

What Are Macular Degeneration Risk Factors?

Many forms of AMD are hereditary (genetically inherited), but because symptoms may not appear until later years, obtaining an accurate family history may be difficult.

Additionally, the following risk factors are also associated with AMD:

  • Age: The likelihood of developing macular degeneration increases with age.
  • Smoking is a risk factor for both forms of macular degeneration, and smokers with AMD suffer more severe vision loss than nonsmokers with AMD.
  • Cardiovascular disease, high cholesterol, hypertension, and metabolic syndrome are also associated with AMD.
  • Race: Macular degeneration is more common in whites but occurs in all races.
  • Pigmentation: Macular degeneration is more common in people with lightly pigmented skin and light blue eyes.
  • Gender: Women get AMD more commonly than men.

Questions to Ask the Eye Doctor About Macular Degeneration

  • What can I do to decrease my chances of losing vision?
  • What symptoms should I watch for?
  • What lifestyle changes should I make?
  • What treatment options are available for my condition?
  • What low-vision aids are available to help me with my remaining vision?
Questions to Ask the Primary Care Provider (Family Practice Doctor, Internist, Geriatrician)
  • How can I improve my overall cardiovascular health?
  • How can I get help with smoking cessation?
QUESTION

What Are Macular Degeneration Symptoms and Signs?

Symptoms of AMD include the following:

  • Blurred or decreased central vision
  • Blind spots (scotomas), partial loss of vision
  • Distorted vision (metamorphopsia): Straight lines may appear wavy or bent.
  • Inability to see in dim light
  • Objects appearing suddenly smaller when viewed with one eye than with the other
  • AMD is not associated with redness of the eyes or pain.

Signs of AMD include the following:

There are no outwardly visible signs of AMD in the eye. An eye doctor will be able to see signs of AMD by examining the retina with special equipment. The signs may include irregular pigmentation, yellowish deposits, and fluid and/or blood in or under the retina, as discussed below.

When to Seek Medical Care for Macular Degeneration

In general, people older than 45 years should have a complete eye examination with an eye doctor (ophthalmologist or optometrist) every one to two years to screen for AMD, as well as other eye conditions (such as cataracts and glaucoma) that become more common with age. People with a known family history of AMD should be checked yearly.

Once a person is diagnosed with AMD, more frequent follow-up examinations may be needed. Additionally, the eye doctor will ask patients with AMD to monitor their vision at home using a tool known as an Amsler grid. If changes in vision are detected using the grid, patients should promptly notify their ophthalmologist.

Timely treatment of early wet age-related macular degeneration can often prevent further vision loss.

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What Exams and Tests Do Doctors Use to Diagnose Macular Degeneration?

An eye doctor will begin with a complete eye examination, which will include asking about any changes in vision and any family history of eye disease.

Initial tests include measurement of the sharpness of vision (visual acuity) and an examination of the retina. During the examination of the retina, the ophthalmologist looks for specific signs of macular degeneration.

  • Drusen and irregularities in the pigmentation of the retina are the hallmark signs of dry AMD. Drusen come in different sizes. Large drusen are associated with higher risk of vision loss than smaller drusen.
  • Thinning (atrophy) of the pigmented layer of the retina is seen in advanced dry AMD (geographic atrophy). Often it is helpful to take a photograph to document the findings and refer back to the image at follow-up visits to detect any subtle progression of the condition.
  • The eye doctor will also look for signs of wet AMD, which can include the presence of exudates (fluid), blood, or an elevation in the retina that hints at the presence of abnormal blood vessels forming behind the retina. Additional imaging is often used to study the changes in more detail. OCT (optical coherence tomography) is used to detect and better localize drusen and fluid in and behind the macula.
  • Fluorescein angiography (FA) is used to measure the size and extent of abnormal blood vessels. In this study, a dye (fluorescein) is injected into the arm. Then a series of photographs are taken of the retina as the dye passes through the retinal vessels. This test can help guide treatment of wet AMD.
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Are There Home Remedies for Macular Degeneration?

There are no home remedies available currently for AMD, however, there are steps one can take at home to minimize progression of AMD:

  • Supplements: In a landmark national study conducted by the National Eye Institute, people with moderate and advanced age-related macular degeneration were shown to significantly benefit by taking a dietary supplement containing certain vitamins and minerals. The supplement is known as the AREDS2 formula and is available over the counter. It slowed progression of disease in many cases. Unfortunately (and somewhat surprisingly), the same supplement did not prove to be of benefit in preventing progression in those who had mild AMD, nor did it have any significant effect on the development of AMD in people who started out with no disease. The definition of mild, moderate, and advanced disease was based on the retinal findings (for example, size of drusen) and other factors. An eye doctor will tell you if AREDS2 vitamins would be of any benefit.
    • The AREDS2 supplement currently recommended contains:
      • 500 milligrams of vitamin C
      • 400 international units of vitamin E
      • 80 milligrams of zinc as zinc oxide
      • 2 milligrams of copper as cupric oxide
      • 10 mg lutein and 2 mg zeaxanthin
  • No beta-carotene (vitamin A)
  • Diet: Though the AREDS2 supplements were not found to be helpful for all AMD patients, several studies have shown a clear association between the severity of AMD and diet. Diets high in vegetables, fruits, and omega-3-rich foods and low in sugar are associated with less progression and severity of AMD.
  • Smoking cessation is important for everyone with AMD. Smoking accelerates the progression of vision loss in AMD. In addition, smoking can worsen other eye conditions, including dry eye cataracts, diabetic retinopathy, and glaucoma.
  • Exercise: Regular exercise can help maintain good cardiovascular health, which is important as many studies have demonstrated an association between poor cardiovascular health and more advanced forms of AMD.
  • Your eye doctor will instruct you to monitor your vision at home with an Amsler grid.
    • To use the Amsler grid:
      • If you use corrective lenses (bifocals, contact lenses) for reading, wear them for the test.
      • Hold the grid 12 to 15 inches away in good light.
      • Cover one eye.
      • While looking directly at the center dot with the uncovered eye, note whether all lines of the grid around the dot appear straight.
      • Note any areas in which the lines appear wavy, distorted, bent, blurry, or dark.
      • Repeat this procedure with the other eye.
      • If any area of the grid appears wavy, distorted, bent, blurry or dark, contact your ophthalmologist. This could be a sign of worsening AMD, and prompt evaluation is important as earlier treatment has higher chance of success.

What Is the Treatment for Macular Degeneration?

  • As mentioned above, the AREDS2 vitamin/mineral supplements may help slow down the progression of moderate to advanced AMD. Your eye doctor will determine if you are a candidate.
  • For dry AMD, including geographic atrophy, there are no standard treatments currently available, however, research is under way and many promising experimental treatments are currently being evaluated.
  • For the wet form of AMD, there are treatment options. Your eye doctor will refer you to a retina specialist (an ophthalmologist who has done additional specialized training in treatment of retinal diseases). A class of medications known as anti-VEGF (anti-vascular endothelial growth factor) can help shrink or even eliminate the abnormal blood vessels that form under the macula in wet AMD. These include ranibizumab (Lucentis), bevacizumab (Avastin), and aflibercept (Eylea). They are injected into the eye directly, and often several injections are necessary over the course of months or years. Anti-VEGF therapy has had a high success rate in stabilizing or reversing the abnormal vessels, and many patients experience improved vision, as well.

Laser treatment: Laser treatment to the affected areas used to be a common therapy; however, the success rate was mixed. Photodynamic therapy is another type of laser treatment in which a lower-energy laser is used after pretreating with an intravenous medication (verteporfin [Visudyne]). With the success rate current anti-VEGF therapy, laser therapy is used less often today.

  • In all cases, the success rate of therapy is dependent on timing. The earlier the condition is treated, the higher the likelihood of success. This is why regular checkups with an eye doctor to detect AMD and close monitoring of vision with the Amsler once AMD is found are very important.

If a large amount of blood accumulates in or under the retina, there may be a role for eye surgery to remove the blood, and in some cases, the abnormal blood vessels themselves. Surgical options include pars plana vitrectomy (surgical removal of the vitreous gel in the eye), retinotomy (a small incision in the retina to access the trapped blood), or placement of a gas bubble, sometimes in combination with administration of anti-VEGF and blood-thinning medications (for example, tPA). A retina surgeon will determine which procedure might be indicated, depending on size and location of the vessels and blood, among other factors.

SLIDESHOW

What Is the Prognosis of Macular Degeneration?

Prognosis is highly variable. The prognosis is generally worse for those with a strong family history of AMD and those who develop either geographic atrophy or wet AMD.

What Are Macular Degeneration Complications?

In wet AMD, abnormal vessels can ooze blood under, in, or in front of the retina. The presence of the blood itself can cause further damage to the retina, thus necessitating prompt treatment when appropriate. Some patients develop double vision if the abnormal vessels distort or drag the macula, resulting in a shift of the image seen in one eye. Legal blindness (vision of 20/200 or worse with glasses) develops in a minority of AMD patients. When it occurs in both eyes, however, it, of course, has a huge impact on one’s lifestyle.

Follow-up for Macular Degeneration

Because some people with the dry form of macular degeneration may develop the wet form, those with the dry form should monitor their vision daily or at least weekly with the Amsler grid and notify their ophthalmologist of any changes in their vision.

Your eye doctor will ask you to return for repeat examinations. The frequency of these visits will depend on your risk factors. Pictures (photographs and OCT imaging) are often taken to keep track of the macular changes. Patients who have undergone treatment for the wet form of the disease should continue to monitor their vision for signs of recurrence.

Are There Ways to Prevent Macular Degeneration?

Unfortunately, there are no known ways to prevent AMD at this time; however, there are many steps one can take to decrease the severity of the disease.

  • Regular eye examinations to detect AMD in its earliest stages are important. And follow-up visits together with home monitoring of the vision with the Amsler grid is especially important in people who have been diagnosed with AMD.
  • If you smoke, stop. Smoking is associated with worse vision loss in AMD. Smoking is also associated with worsening of other eye conditions such as cataracts and glaucoma.
  • A balanced diet that includes plenty of vegetables and low amounts of sugar is associated with better eye health.
  • Protecting the eyes from the sun’s ultraviolet (UV) light with sunglasses that block UV rays may also help decrease the severity of AMD. Additionally, the UV-blocking sunglasses help protect against skin cancer on the eyelids’ skin.
  • Ask your eye doctor if you should be taking the Age-Related Eye Disease Study (AREDS2) vitamin supplements.
  • A recent study implied a correlation between aspirin use and AMD, however, since then many other studies have demonstrated no correlation, and the overall benefits outweighed the risks for those who were prescribed aspirin for cardiovascular health.

Support Groups and Counseling for Macular Degeneration

People with vision loss from AMD may benefit from low-vision aids such as handheld or stand magnifiers for reading and telescopes incorporated into specially designed glasses to see into the distance. In addition, talking watches, computers that use large type face, and many other specialty devices are available.

Various organizations and web sites provide additional information and resources relating to macular degeneration:

Macular degeneration is the leading cause of legal blindness. Read about symptoms, diagnosis, medications, statistics, prevention, and treatment information.

Optelec

Macular Degeneration

What is Macular Degeneration?

Macular Degeneration is a medical condition often associated with aging (also referred to as “age-related Macular Degeneration”) that results in a loss of vision in the centre of your visual field. Central vision helps us to see objects clearly and perform tasks such as reading and driving.

Macular Degeneration is a progressive disease thought to be caused by a combination of genetic and environmental factors. It can occur in ‘dry’ and ‘wet’ forms and is the major cause of visual impairment amongst adults from the age of 50.

Dry Macular Degeneration

Dry Macular Degeneration is caused when the light-sensitive cells in the central part of your vision slowly break down. The result is that you will experience gradually blurring vision (see the image above). It may start with one or two spots, which gradually expand into larger areas, causing loss of vision.

The dry form of Macular Degeneration can be divided into three distinct stages:

  1. Early Macular Degeneration: causes small yellow spots under your retina (the lightsensitive tissue lining the inner surface of your eye). In this stage you will rarely experience symptoms or loss of vision.
  2. Intermediate Macular Degeneration: the yellow spots under your retina grow larger and expand, causing blurred spots in the centre of your vision. In this stage you may need more light to read or perform other tasks.
  3. Advanced Macular Degeneration: in addition to yellow spots, the light-sensitive cells in your central retinal area break down, causing a large blurred spot in the centre of your vision. This blurred spot may grow larger and darker over time. In this stage, you will experience difficulty reading and recognizing faces, unless these are very close to your eyes.

Normal vision vs. Macular Degeneration in an early stage

Normal vision vs. Macular Degeneration in an advanced stage

Wet Macular Degeneration

Approximately 10-15% of people with Macular Degeneration experience the ‘wet’ form. It is caused by leaking of blood and fluid from your blood vessels, located behind your retina. These fluids cause the macula (the central part of your visual field) to be raised from its normal place, causing rapid damage to your vision. One of the earliest symptoms you may experience is that straight lines appear wavy.

What are the symptoms of Macular Degeneration

Symptoms of Macular Degeneration include:

  • blurred vision
  • shadows or missing areas of vision
  • distorted vision
  • trouble discerning colours
  • slow recovery of visual function after exposure to bright light
  • a loss in contrast sensitivity

What to expect from Macular Degeneration

Macular Degeneration damages the central vision of your eye, which is responsible for approximately 35% of your visual field. You may experience difficulty recognizing faces, reading and driving. Your peripheral vision is not damaged by Macular Degeneration, so you can still lead an independent life.

Helpful Tips

Even if your eye care professional says, “Nothing more can be done for your vision,” ask how vision rehabilitation can help you make the most of your remaining vision through orientation and mobility training, and use of vision aids. Additional tips:

  • Get regular comprehensive eye examinations from your doctor
  • Eat a healthy diet high in green leafy vegetables, fish, fruit, whole grains and foods with vitamin D
  • Don’t smoke
  • Exercise regularly
  • Use task-oriented lighting when preforming daily activities
  • See beyond your diagnosis – learn what Optelec vision aids can help!

More information about Macular Degeneration

There is extensive information available about Macular Degeneration. The information included is intended to inform you about the basics of this eye condition, and is not intended as a replacement for information from your physician or eye specialist. Information regarding assistive devices that can help you if you have been diagnosed with Macular Degeneration is included. Our recommendations can be found under Tools and Resources.

Living with Macular Degeneration

Hearing that your sight is affected by Macular Degeneration may change your world, but be comforted by the knowledge that you are not alone. There are many people in your situation, some that have also just been diagnosed and some that have been living with Macular Degeneration for years. Below are two Optelec customers who have shared their story on how they coped with Macular Degeneration and today are able to lead a productive and independent lifestyle.

Testimonial

As an avid fan of reading, Adeline used to grow tired of watching the television every day for her news and entertainment. She yearned to spend her days in her Connecticut home reading a good book and delving into the newspaper instead. Her Macular Degeneration made reading extremely difficult until she was introduced to the Optelec ClearView+ through her local Authorized Dealer. Now she can’t imagine how anyone with low vision gets along without it.

“I feel normal because I can read the newspaper, I can read a book, I can read documents, I can read my checkbook balances. I can read the active ingredients in my medicine bottle without any difficulty. I think this machine is a godsend. Otherwise I would not know what is going on in my community, in my state or nation. It does get tiresome to watch TV. I like to read so it has been a great pleasure to me.”

Adeline now participates actively in her reading group and highly recommends the ClearView+ to anyone living with low vision.

Adeline D, Connecticut

Testimonial

You don’t have to be old to develop Macular Degeneration. Amy Bower, PhD, found that out when she was 24 and attending graduate school at the University of Rhode Island. At that point in time, Bower was already committed to a career in oceanography. “At first I lost my night vision, but soon I started losing my central vision as well,” says Bower, now 41. While continuing her studies, she initially relied on a variety of vision aids, including eyeglasses with built-in magnifiers. But even as she began her position as a research scientist in physical oceanography at the Woods Hole Oceanographic Institution, Bower’s vision deteriorated.

She turned to the Optelec ClearView+ desktop video magnifier – a new product at the time. She now has one for work and one for use at home. “My work involves reading, analyzing graphics and publishing in professional journals,” says Bower, who is now tenured and is the senior female scientist in physical oceanography, a field concerned with the ocean’s role in climate as well as the physics of ocean currents. Her work also includes travel for weeks at a time to places like the Indian Ocean, Mediterranean Sea and the North Atlantic.

“We have lab benches and desks on board, and I take my ClearView unit along,” says Bower, whose intelligence and commitment to her chosen field has earned the respect of her colleagues. Could she accomplish her work without the ClearView unit? “I suppose I could hire readers, but a lot of what I do involves reading graphics, which you have to analyze yourself,” she notes. “Besides, I value my independence.”

Amy Bower, Massachusetts

Many people with Macular Degeneration continue to do the activities they always did. You may learn to use your peripheral vision more efficiently and will learn to rely on your other senses to help you through the day.

There is currently no cure for Macular Degeneration. For Dry Macular Degeneration there are certain treatments that can help slow down the progression. Discuss this with your eye care professional to see what your options are.

If you experience vision loss as a result of Macular Degeneration, there are low vision devices that can assist you with those tasks that you have difficulty with. These devices will assist you with various visual tasks and will help you in continuing to lead an independent and full life.

Tools and Resources for Macular Degeneration

There is extensive literature available on Macular Degeneration. The Internet provides a wealth of information and most countries have one or more associations or support groups for people affected by Macula Degeneration. Our recommendations:

Macula Vision Research Foundation & SupportSight Seminars

  • Website
  • Facebook
  • Twitter @MVRFoundation
  • Phone: 866 462-2852
  • Learn more about Optelec’s NEW Partnership by clicking HERE!

Macular Degeneration Association

  • Website
  • Facebook
  • Twitter @MacularHope
  • Phone: 941 870-4399

Macular Degeneration Partnership

  • Website
  • Phone: 310 623-4466

Association for Macular Diseases

American Macular Degeneration Foundation

Prevent Blindness America

  • Website
  • Facebook
  • Twitter @PBA_savingsight
  • Phone: 800 331-2020

Foundation Fighting Blindness

  • Website
  • Facebook
  • Twitter: @fightblindness
  • Phone: 800 683-5551

There are many devices that can assist you in a variety of daily tasks if you have Macular Degeneration. Below is a short summary of some of these devices. For more information we suggest you browse through our product assortment or use our easy Help Me Choose assistant below to search and filter based on your wishes.

Products that may be useful if you have Macular Degeneration:

ClearView C Full HD Speech

Is reading too tiresome for you? Are you looking for a stylish magnifier that reads your printed documents aloud?

Item No.: CVC-HD-OCR-24-G3-US-A-13M

ClearView C 24″ Full HD Flex (This product is not available anymore)

Are you looking for a stylish High Definition magnifier that takes up less space on your desk?

Item No.: CVCHD24FLEX

Optelec Compact 7 HD

The Optelec Compact 7 HD is a truly portable 7-inch widescreen electronic video magnifier.

Item No.: COMP7HD

Optelec Traveller HD

Would you like to read in multiple locations? Are you looking for a more natural and fluent reading experience?

Help me choose

Don’t know what visual aid suits your eye condition the best? We help you to find the right product.

Information about how Macular Degeneration affects your sight. Browse the Optelec website to learn more about low vision aids.