Macular Degeneration

Macular degeneration is a common eye disease that affects central vision, making it difficult to see things directly in front of you. While it can cause significant vision loss, it does not lead to complete blindness, and treatments are available to help manage the condition.

Table of contents

• What is macular degeneration?
• Types of macular degeneration
• Stages of the disease
• Symptoms
• Risk factors
• How macular degeneration is diagnosed
• Treatment options
• Prevention and lifestyle changes
• Living with macular degeneration

What is macular degeneration?

Macular degeneration is an eye disease that affects your ability to see things directly in front of you. It happens when the macula, the central part of the retina at the back of your eye, becomes damaged. The retina is the light-sensitive tissue that controls your vision. The macula is specifically responsible for sharp, straight-ahead vision that you need for activities like reading, driving, recognizing faces, and seeing details.^[1][2]

People with macular degeneration lose their central vision, which means they can’t see things directly in front of them clearly. However, they do not go completely blind. Their peripheral vision, which is the ability to see things off to the sides, remains intact.^[1][2]

• Macula
• Retina

The condition is most common in people over the age of 50, which is why it is often called age-related macular degeneration or AMD. In the United States, macular degeneration is a leading cause of vision loss in people who are 60 and older.^[1][5]

Almost 20 million U.S. adults have some form of macular degeneration. Globally, around 200 million people are thought to be living with this condition, and that number is expected to reach 288 million by 2040.^[1][5][6]

Types of macular degeneration

There are two main types of macular degeneration: dry and wet. Each type affects the macula differently and progresses at different rates.^[1][2]

Dry macular degeneration

Dry macular degeneration, also called atrophic macular degeneration, is the most common form. Nearly 90% of people with macular degeneration have this type. It develops when tiny yellow protein deposits called drusen form under your macula. As these deposits build up, they cause the macula to dry out and become thinner.^[1][2]

Vision loss with dry macular degeneration tends to happen gradually over several years. Most people do not completely lose their central vision. However, in some cases, the dry form can change into the wet form.^[1][2]

Wet macular degeneration

Wet macular degeneration, also called exudative or advanced neovascular macular degeneration, occurs when abnormal blood vessels develop under your retina and macula. These blood vessels leak blood and fluid. The term “exudative” refers to how the fluids ooze out.^[1][2]

When fluid builds up, a bulge forms in your macula, which can cause you to see dark spots in your center of vision. About 10% of people with macular degeneration have the wet form. This type is more severe and can quickly lead to total loss of central vision if left untreated. The good news is that treatment options are available for wet macular degeneration.^[1][2]

Stages of the disease

Dry macular degeneration develops through three stages: early, intermediate, and late. Symptoms like vision loss often aren’t evident until the late stage, but your eye care provider can see signs of the disease when doing an exam.^[1][2]

In the early stage, your macula changes, but your vision usually isn’t affected. You may not notice any problems at all. In the intermediate stage, some people still have no symptoms, while others may notice mild blurriness in their central vision or trouble seeing in low lighting. In the late stage of dry macular degeneration, central vision fails. This is also called geographic atrophy.^[1][2]

Wet macular degeneration is already considered an advanced or late stage of the disease. Any stage of dry macular degeneration can turn into wet macular degeneration, but wet macular degeneration is always considered late stage.^[2]

Symptoms

The symptoms of macular degeneration depend on which stage and type you have. Early dry macular degeneration usually doesn’t cause any symptoms. That’s why it’s so important to get regular eye exams, especially as you get older.^[2]

In intermediate dry macular degeneration, some people may notice mild blurriness in their central vision or have more trouble seeing in low lighting. Others still have no symptoms at this stage.^[2]

In late macular degeneration, whether dry or wet, many people notice that straight lines start to look wavy or crooked. This is an important warning sign. You may also notice a blurry area near the center of your vision. Over time, this blurry area may get bigger, or you may see blank spots. Colors may seem less bright than before, and you may have more trouble seeing in dim lighting.^[2][3]

Because macular degeneration affects only central vision, your peripheral vision remains intact. This means you can still see things off to the sides. You won’t go completely blind from this condition.^[1][2]

If you notice that straight lines start to look wavy, see your eye doctor right away. This can be a warning sign of late macular degeneration that needs immediate attention.^[2]

Risk factors

Your risk for macular degeneration increases as you get older. People age 55 and older are more likely to develop the condition. The risk of developing advanced macular degeneration increases from 2% for those ages 50 to 59, to nearly 30% for those over the age of 75.^[2][5]

Besides age, several other factors can increase your risk of developing macular degeneration:^[1][2]

• Having a family history of macular degeneration
• Being overweight
• Smoking
• Having high blood pressure
• Eating a diet high in saturated fats
• Being white or Caucasian

Macular degeneration can be an inherited eye disease, but it also develops in people with no family history of the condition. Getting older is a key factor in age-related macular degeneration. Non-age-related macular degeneration may be associated with diabetes, head injuries, infections, or a diet lacking in required nutrients.^[1]

If you’re at risk for macular degeneration because of your age, family history, or other factors, it’s important to get regular eye exams. Ask your doctor how often you need to get your eyes checked. Early macular degeneration doesn’t have any symptoms, so don’t wait for your vision to change.^[2]

How macular degeneration is diagnosed

An eye care professional can diagnose macular degeneration by reviewing your medical and family history and doing a complete eye exam. The exam typically includes putting drops in your eyes to dilate them, which allows the doctor to examine the back of your eye with a special tool.^[3][8]

During the exam, your eye doctor looks for yellow deposits called drusen under the retina. People with macular degeneration often have many of these deposits. The doctor may also look for a mottled appearance caused by these deposits.^[3][8]

Your doctor may use an Amsler grid, which is a simple test to check for changes in the center of your visual field. If you have macular degeneration, some of the straight lines in the grid may look faded, broken, or distorted.^[8][9]

Additional tests may include:^[8]

• Fluorescein angiography: Your doctor injects a dye into a vein in your arm. The dye travels to and highlights the blood vessels in your eye. A special camera takes pictures as the dye travels through the blood vessels, which can show changes in your retina or blood vessels.
• Indocyanine green angiography: This test is similar to fluorescein angiography and uses an injected dye. It may be used alongside fluorescein angiography.

Treatment options

Treatment for macular degeneration depends on the type and stage of the disease. Currently, there is no cure for macular degeneration, and no treatment can restore vision that has already been lost. However, treatments can help slow the progression of the disease and preserve remaining vision.^[2][10]

Treatment for dry macular degeneration

There is currently no approved medical treatment for early or intermediate dry macular degeneration, but research is ongoing around the world.^[11]

People with intermediate-stage dry macular degeneration may benefit from taking a special mix of dietary supplements to decrease their risk of losing central vision. In clinical trials, an over-the-counter combination of vitamins and minerals called the AREDS2 formula showed benefit in preventing progression of intermediate dry macular degeneration to late-stage disease. AREDS2 may also slow development of wet macular degeneration. This supplement includes vitamins C and E, zinc, copper, lutein, and zeaxanthin. Always talk to your doctor before taking any formula.^[9]

For late-stage dry macular degeneration (geographic atrophy), two drugs have been approved for use in the United States: Syfovre and Izervay. Both are administered through eye injections either monthly or every other month. These medications aim to reduce inflammation in the eye and slow the progression of geographic atrophy. It’s important to note that the aim of both drugs is to slow the speed of deterioration, not to restore vision. In the United Kingdom, Syfovre has been declined for approval, and Izervay is currently being considered.^[9][11]

Treatment for wet macular degeneration

Several treatment options are available for wet macular degeneration, and treatment should be given quickly, before there is permanent scarring to the macula.^[11]

Anti-VEGF injections are the most common treatment for wet macular degeneration. VEGF stands for vascular endothelial growth factor. These medications block abnormal blood vessel growth under the retina, slowing or stopping fluid leakage that can damage the macula. Several anti-VEGF drugs are available, including Avastin, Beovu, Eylea, Lucentis, Susvimo, and Vabysmo. These are injected directly into the eye.^[1][9]

Less commonly used treatments include:^[9]

• Photodynamic therapy: This combines injections with laser treatment.
• Laser coagulation: A laser is used to destroy abnormal blood vessels.

Low vision aids

For patients with advanced macular degeneration, low vision aids such as magnifiers or specialized glasses can improve daily functioning. Vision therapy may also help maximize the use of remaining vision. These adaptive devices and techniques can significantly improve your level of independence and quality of life.^[11][14]

Prevention and lifestyle changes

While you can’t completely prevent macular degeneration, especially if you have genetic risk factors, there are steps you can take to reduce your risk or slow the progression of the disease.^[2]

The most important lifestyle changes include:^[1][16][18]

• Stop smoking: Smoking is one of the leading risk factors for macular degeneration. Quitting can slow the condition’s advancement and reduce additional damage to your vision.
• Eat a healthy diet: A diet rich in leafy green vegetables, colorful fruits, and foods high in omega-3 fatty acids (like fatty fish and nuts) can support retinal function and slow the progression of macular degeneration.
• Exercise regularly: Physical activity can help reduce your risk and may slow progression if you already have the disease.
• Control your blood pressure and cholesterol: Managing these conditions through medication or lifestyle changes can help protect your vision.
• Maintain a healthy weight: Being overweight increases your risk of developing macular degeneration.
• Wear protective eyewear: Sunglasses that block harmful UV rays shield your eyes from unnecessary stress. Consistently wearing protective lenses outdoors is a small but effective step toward protecting your vision.

Dietary antioxidant vitamins, minerals, and carotenoids do not appear to prevent the onset of macular degeneration, but dietary supplements may slow the progression in those who already have the disease.^[6]

Living with macular degeneration

Learning that you have macular degeneration can be worrisome for you and your family. However, most people with macular degeneration can retain good vision for their entire lives. Even those who lose their central vision almost always maintain their side, or peripheral vision.^[14]

The best way to adapt to vision loss is to learn new ways of doing things. There are many resources and strategies available to help you maintain your independence and quality of life.^[14]

Using your other senses

Most people with low vision are surprised to find out how much information they can obtain from their senses of hearing, touch, and peripheral vision. Tuning into your sense of hearing and learning to use touch more effectively can help with daily activities. For example, when cooking, you can slowly move your hand about a foot over a pan on the stove to check that it’s centered over the burner.^[14][15]

Practical tips for daily living

Many simple adaptations can make daily life easier:^[13][15][17]

• Improve lighting: Make the lighting in your home bright and even. Use task lighting to highlight what you’re working on. Place lighting so it shines directly on what you’re trying to do, without shadows or glare.
• Use contrast: Use big, bright, bold, and contrasting colors to make it easier to see items. For example, paint window and door frames a different color from the walls, use different colored chopping boards for different food types, or wrap brightly colored tape around the handles of utensils to make them easier to find.
• Try adaptive devices: Use talking equipment such as microwaves, watches, scales, and timers. Large-face clocks, watches, and mobile phones can be easier to see. Magnifying glasses can help with reading.
• Adjust your position: Try positioning things to make use of your peripheral vision areas of sharper sight. With practice, you may find you can improve your ability to do tasks using your side vision.
• Use voice assistants: A voice assistant can set alarms, tell you the weather, make grocery lists, turn on lights, and much more.

Vision rehabilitation

Visual rehabilitation can help you adjust and function better with your remaining vision, although it cannot restore vision that has been permanently lost. Talk to your doctor about what limitations you are experiencing due to your vision loss. Your doctor may refer you to a vision rehabilitation center, eye clinic, or other organization where a low-vision therapist can make personalized recommendations to help you adapt to daily living activities.^[14]

Remember, even if you cannot be treated for your macular condition, you will not lose all your sight. People with macular conditions often find things take longer than before, but by learning new techniques, they can manage very well.^[13]