Age Related Macular Degeneration (ARMD or AMD)

AMD is the leading cause of blindness in adults over the age of 60 in the United States. AMD affects the center portion of the retina called the macula, which is responsible for fine detail and central vision. The breakdown or damage to the macula caused by AMD can affect both distance and reading vision. When the macula is not functioning correctly, central vision can be blurred or dark.

There are two types of ARMD, wet and dry.

Dry AMD often results in a gradual decrease in vision.  It is categorized into three stages – early, intermediate, and advanced.  Early dry AMD starts when small drusen begin to form, which does not typically result in vision loss. As more drusen form and grow, becoming intermediate dry AMD, central vision may blur or become dim. In advanced dry AMD, the buildup of drusen causes retinal cell death (atrophy). This damage to the macula can cause a significant decrease in central vision.

Patients who are diagnosed with Wet AMD have already progressed through the stages of dry AMD. If the AMD converts from dry to wet, a sudden and sometimes severe loss of vision can occur.  In wet AMD, the abnormal blood vessels growing into, or within, the retina leak fluid and blood. The accumulation of fluid disrupts normal retinal function, leading to sudden changes in vision.  Scarring of the retina can occur in wet AMD and may cause irreversible loss of central vision.

Symptoms

  • Symptoms of dry and wet AMD vary in severity for each patient.  Typical symptoms of dry AMD include a very gradual onset of ablurred area or spot in the central vision and can worsen with time. In wet AMD, patients may also notice distortion where straight lines appear wavy, typically over the course of days to weeks. The presence of distortion can indicate the leakage of fluid from abnormal retinal blood vessels. It is important to see a retinal specialist if distortion is present, because the sooner treatment is initiated for wet AMD, the better the visual prognosis.

  • The use of an Amsler Grid is important for monitoring changes in vision for each eye.

  • If new symptoms or distortion are found, it is important to see a retinal specialist.  A dilated examination is necessary to diagnose and monitor AMD.  A combination of optical coherence tomography (OCT) and fluorescein angiography (FA)  may be performed to determine if wet AMD is present.

Risk Factors

While the cause of macular degeneration is unknown, certain risk factors have been shown to increase the likelihood of developing AMD.

  • Age-The incidence of AMD increases with age beyond 55.

  • Genetics-If there is family history of AMD, the chance of developing AMD increases. If you are diagnosed with AMD it is important for your children to have yearly examinations as they get older.

  • Smoking-Studies have shown individuals who smoke or smoked in the past have a higher risk of developing AMD compared to non-smokers.  Smokers are also at higher risk for more severe vision loss from AMD.

  • Diet-Studies have shown adherence to a Mediterranean diet decreases the risk of developing AMD.

  • Hypertension-High blood pressure and cardiovascular disease are associated with AMD.

Home Monitoring

New home monitoring systems can aid in the detection of conversion from dry AMD to wet AMD.

Treatment of Dry AMD

  • Currently there is no treatment for dry AMD. However, studies have demonstrated that nutritional supplements may slow the progression of the disease.

  • Nutritional Supplements

    • The Age-Related Eye Disease Study (AREDS) showed a specific combination of nutritional and vitamin supplements can slow the progression of AMD. These include:

      •  Vitamin C 500mg

      •  Vitamin E 400iu

      • Zinc oxide 825mg

      • Copper 2mg

      • Lutein 10mg and zeaxanthin 2mg

    • A retinal specialist may be able to provide you with a sample of AREDS2 supplements, which can also be purchased over the counter.

Treatment of Wet AMD

  • Treatment for Wet AMD has been revolutionized through the discovery of Anti-Vascular Endothelial Growth Factor (VEGF) inhibitors such as Avastin, Eylea, and Lucentis.  These medications are injected into the eye in an in-office procedure called an intravitreal injection.  The injection is painless and takes a few minutes. Follow-up care is important after receiving an intravitreal injection. Click here for post-injection instructions.

  • Laser therapy is rarely used to treat Wet AMD.

© 2018 Rocky Mountain Retina Association.