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Age-Related Macular Degeneration

Background

Age-related macular degeneration (AMD) is a condition in which the macula (central portion of the retina) degenerates too rapidly. As people age, tissues break down naturally. In AMD, the rate of degeneration is accelerated and can result in significant and permanent vision loss. In fact, AMD is the largest cause of central vision loss in the United States in persons over the age of 65. Other common forms of macular degeneration occur in people with myopia (nearsightedness), congenital diseases of the retina, and retinal dystrophies.

There are two main forms of macular degeneration: dry AMD and wet AMD. All people with AMD start with the dry form, and only a small portion progress to the wet form, or bleeding form, of macular degeneration.

An example of vision loss in advanced macular degeneration.

An example of vision loss in advanced macular degeneration.

Retinal photograph showing the changes in wet macular degeneration. The central yellow deposits are drusen. Below the drusen is an arc-shaped area of sub-retinal blood.

Retinal photograph showing the changes in wet macular degeneration. The central yellow deposits are drusen. Below the drusen is an arc-shaped area of sub-retinal blood.

Dry AMD

  • Is slowly progressive
  • Does not usually impede useful and functional central vision
  • Requires periodic follow-up with a retinal specialist

Wet AMD

  • Progresses rapidly
  • Can lead to permanent, irreversible changes
  • Requires very close follow-up with a retinal specialist
  • Can be treated with eye injections

Treatment

Treatment depends on which form of macular degeneration a person has.

Dry AMD

People with dry macular degeneration are given the specific vitamin regimen used in the Age-Related Eye Disease Study (AREDS 1 and 2). In that study, certain vitamins were found to slow the progression of moderate-to-advanced dry AMD to the wet form. It is the only approved therapy for dry AMD at this time. There may be some benefit from the Lutein and Zeaxanthin found in the AREDS 2 formulation. All vitamin intake should be monitored and approved by your primary care physician.

Wet AMD

People with wet macular degeneration have several treatment options. Currently, the most successful therapy involves injecting medicine into the eye to stop the bleeding and leaking from blood vessels. This class of medicine blocks a chemical known as vascular endothelial growth factor (VEGF). Typically, these medications are injected monthly, until the leakage in the macula is resolved; then the medicine can be used less frequently. Ask your eye doctor about the different anti-VEGF medications available. Other treatment options include various lasers, which are used sparingly.

Most common symptoms

  • Central vision loss or distortion
  • Wavy lines in the vision
  • Gaps or holes in the central vision

Potential complications

  • Possibility of severe, rapid worsening of the central vision
  • Legal blindness

What do you do if you have macular degeneration?

  • See a retinal specialist for regular examinations of the retina.
  • Use home aids to help identify changes in your disease (Amsler grid).
  • Report any changes to your doctor immediately for diagnosis and treatment.
  • Take the vitamins your doctor has recommended.