Understanding Age-Related Macular Degeneration: Symptoms and Solutions

One of the things synonymous with old age is reduced strength in the bones and joints, reduced facial elasticity, reduced energy, and a lot more decline, including probable vision decline or loss. While this may seem ‘normal,’ or ‘expected,’ it is not normal.

Loosing vision as a result of old age is what is referred to as age-related macular degeneration, or otherwise shorted as AMD. AMD symptoms vary from person to person and while it is yet to have a cure, understanding this degeneration can help you better navigate your central vision or loss of it, thereof.

What is Age-Related Macular Degeneration (AMD)?

Starting from the definition, AMD (age-related macular degeneration) is a disease of the macula, which is the part of the eye that provides sharp, clear, central vision.

As individuals age, the macula can slowly degenerate, resulting in progressive vision loss and AMD is one of the leading causes of this form of severe vision loss in older adults, particularly with people aged 55 and over. In the case that AMD does not lead to complete blindness, it can make everyday activities such as reading, driving, or recognizing faces difficult because it affects the central vision.

Regarding its forms, AMD occurs in both dry and wet forms, with dry AMD generally being the most common and slowest progressing. Wet AMD is less common but is ultimately capable of causing rapid vision loss as a result of the growth of abnormal blood vessels in the eye.

Note that age-related macular degeneration (AMD) is an eye disease that can blur your central vision. It is a leading cause of vision loss for older adults, but it doesn’t cause complete blindness.

Types and Stages of AMD

As earlier discussed, AMD is divided into two forms: dry AMD and wet AMD, which have unique features and different rates of progression.

Dry AMD

Dry AMD, the most common form, makes up roughly 90 percent of cases. It evolves in three distinct but progressive phases; early, intermediate, and late dry AMD.

In the early phase, small yellow deposits known as drusen build up beneath the macula, though they don’t usually cause vision problems you can see.

As the disease advances (intermediate AMD), drusen increases in size, and vision might start to be blurry or distorted. Some people may have trouble seeing in low-light conditions at this stage.

In the advanced stage, the macula gradually deteriorates and geographic atrophy (the degeneration of light-sensitive cells) can develop, resulting in severe vision loss and challenges in handling everyday activities.

Wet AMD

Though less common, wet AMD is more aggressive and can lead to rapid vision loss. It happens when abnormal blood vessels beneath the retina start leaking fluid or leak blood, damaging the macula. Vascular endothelial growth factor (VEGF) signaling stimulates the formation of new blood vessels, resulting in cancerous blood vessel development.

This can cause scarring and rapid loss of central vision. It must be treated right away with anti-VEGF injections, photodynamic therapy, or laser therapy to prevent its progression (this wet AMD type).

Both types do affect central vision, but side vision is usually little affected. Regular eye exams, including tests such as optical coherence tomography (OCT) and fluorescein angiography, can detect AMD in its early stages, making it vital to control the severity and progression of the disease.

Early warning signs and symptoms of AMD

The classic symptoms to warn of age-related macular degeneration (AMD) vary by phase. Early on in its course, AMD may not produce overt symptoms, but as the disease advances, various signs may present themselves.

Blurriness or fuzziness

This is one of the initial signs that can occur as dry AMD advances. You may find reading or identifying faces becomes more difficult.

Seeing straight lines as wavy

This is called metamorphopsia and it is a common symptom of advanced AMD stage, which is especially true for wet AMD. It occurs when abnormal blood vessels or leakage of fluid warps vision.

Dark or empty spaces in your central vision

A typical sign of advanced AMD, you might notice a dark hole in the center of your field of vision, making it hard to focus on the things directly in front of you.

Difficulty seeing in low light

People with AMD may have difficulties with their night vision, making it harder (especially) to drive at night or even read in low-light conditions.

Some people have distorted vision

This is where things appear smaller or larger or have a distorted shape.

Note: Be mindful of any shifts in your sight and make sure to inform your eye doctor, pronto. Regular eye exams are important for identifying AMD early on, so treatment can be initiated to slow the disease and prevent severe vision loss.

Causes and risk factors for developing AMD

Age-related macular degeneration (AMD) is a heterogeneous eye disease that arises from a multifactorial syndrome that causes damage to the macula, which we refer to as the rod photoreceptors responsible for central vision. While the underlying reason AMD develops has not yet been fully understood, several major risk factors have.

Age is one of the main triggers — the risk increases sharply after age 55. A history of it in the family also factors in; that those with a genetic susceptibility to macular degeneration are more prone to develop it. Smoking has been closely associated with AMD, as it decreases blood flow to the retina and elevates oxidative stress. A diet high in saturated fat and low in nutrients beneficial to the eyes — including vitamin E, beta carotene, and antioxidants — may also contribute to increased risk.

In macular degeneration, changes to the macula slowly destroy light-sensitive cells and cause vision changes.

In dry macular degeneration, these changes occur slowly; in wet macular degeneration, abnormal blood vessels develop under the retina and leak fluid or blood. Vascular endothelial growth factor (VEGF) is the driving force behind this growth, which drives rapid vision loss to severe stages. There are also treatments targeting these abnormal new blood vessels — such as anti-VEGF drugs, laser treatment, and photodynamic therapy — to slow damage.

Other risk factors

High blood pressure, obesity, and long-term exposure to UV light without proper eye protection. Baseline and periodic eye examinations including optical coherence tomography (OCT) and fluorescein angiography are recommended for early detection of AMD and monitoring of the disease progression. Nutritional supplementation (eating nutrients) and dark leafy greens are also beneficial for maintaining vision and slowing progression in intermediate dry AMD. So, a nutrient-dense diet and not smoking are the main lifestyle changes you can make to give yourself a lower risk of central vision loss from AMD.

Diagnosing AMD: tests and procedures to know

Early diagnosis of age-related macular degeneration (AMD) is critical to preventing severe vision loss and managing the progression of this eye disease. A complete diagnosis usually requires a full eye exam and particular imaging tests to evaluate the health of the retina known as the macula, the part of the eye mainly responsible for central or fine vision.

Dilated eye exam

One standard procedure is a dilated eye exam, in which drops are administered to widen the pupil so the doctor can look for signs of dry AMD or wet AMD, such as abnormal blood vessel growth or deposits of drusen.

Optical coherence tomography

Optical coherence tomography (OCT) is an additional key study that employs light waves to provide high-quality images filling the macula, indicating early morphological changes when the macula degenerates slowly in dry forms of AMD or fluid persistence in bulk stages.

Amsler grid

Another tool is the Amsler grid, a simple test in which patients examine a grid of straight lines. If lines seem wavy, distorted or missing, it could signal AMD. Fluorescein angiography, in which a special dye is injected into the bloodstream so that it highlights abnormal blood vessels or leakage of the retina — a feature of wet AMD.

Diagnosing visual acuity and potential visual changes are imperative for protecting your remaining vision and continuing with everyday tasks impacted by AMD, according to the National Eye Institute. For patients already diagnosed, it is important to have regular follow-ups to measure the effectiveness of treatments be it wet AMD treatments that may include laser therapy or lifestyle modifications such as adapting your diet to include high levels of nutrients in order to slow the progression of AMD.

Current treatment options for managing AMD

Although age-related macular degeneration (AMD) has no cure, there are multiple interventions to slow its progression and maintain vision. The type of treatment varies based on if you have dry AMD or wet AMD, as the two diseases need different outlines.

For dry AMD, where the macula gradually breaks down, treatment aims to slow progression and support eye health. A healthy lifestyle, including a diet rich in nutrients such as lutein, zeaxanthin and omega-3 fatty acids, may help. A specific nutritional supplement with vitamins C and E, zinc, and copper, according to the AREDS2 study, has also been found to reduce the risk of advanced macular degeneration. These measures can also mitigate blank spots or optical distortions as the disease advances.

For wet AMD, in which abnormal blood vessels grow under the retina in a spot called the macula, the treatment is more aggressive. The optimal treatment option is anti-VEGF injections, which target the vascular endothelial growth factor that causes the abnormal growth of vessels and fluid leakage. These injections reduce swelling, halt the growth of new vessels and slow severe vision loss.

In some cases, laser therapy or photodynamic therapy closes off leaky vessels to minimize retina damage. For monitoring the condition and making treatment decisions, advanced imaging techniques such as optical coherence tomography (OCT) are critical.

Lifestyle changes to slow AMD progression

Lifestyle changes are important to managing AMD in addition to medical treatments. Eating less saturated fat, quitting smoking, and wearing protective sunglasses to protect eyes from UV exposure can all help to reduce your higher risk. Also, eyeglasses and contact lenses are a means to adapt to daily difficulties during AMD like reading difficulty and object or face recognition.

As AMD continues to impact side and central vision, routine eye exams and timely detection are key to slowing progression, decreasing the formation of scar tissue, and saving your remaining vision. Together, these practices will help people with AMD get around this condition more successfully.

Stages of AMD: what to expect over time?

Age-related macular degeneration (AMD) has three stages, a continuum that comes with different degrees of central vision impairment and eye health degradation. Knowing and accepting that there are successive stages can prepare you to expect changes and take action to deal with the condition.

Stage I

During the early stage, macular degeneration happens quietly with little to no noticeable symptoms. Small yellow deposits known as drusen start to accumulate beneath the retina, but vision is usually not affected. These signs can be picked up on a regular eye test, including optical coherence tomography (OCT), and are best analyzed in patients at risk, such as those with a family history of AMD.

Stage II

The next phase brings slight alterations, like trouble seeing in dim light or blank spots in your field of vision. The macula gradually deteriorates even further, and more drusen collect. Though symptoms may not be severe, it’s vital that you begin preventive measures, such as utilizing nutritional supplements akin to those in the AREDS2 formula that can assist in slowing progression.

Stage III

AMD can cause severe vision loss in its late stages. At this stage, the condition splinters into two types: dry AMD and wet AMD. In dry AMD, loss of light-sensitive cells leads to gradual vision loss, whereas in wet AMD, abnormal blood vessels sprout under the macula and ooze, resulting in rapid vision loss and scar-tissue buildup. Straight lines can look warped, and people may be unable to see what’s directly in front of them, rendering everyday tasks such as reading and driving difficult.

Conclusion

Early detection and proactive care are critical as the disease advances, and there are treatments available. Regular eye checkups, a diet rich in nutrients (such as lutein, zeaxanthin, and omega-3 fatty acids), and therapies such as anti-VEGF injections for wet AMD can help maintain vision. While progressive advanced AMD can be difficult, adaptive devices and visual rehabilitation can help maintain independence and adapt to visual changes.

Sources

• https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/age-related-macular-degeneration
• https://eyewiki.org/Age-Related_Macular_Degeneration
• https://www.aao.org/eye-health/diseases/amd-macular-degeneration
• https://www.hopkinsmedicine.org/health/conditions-and-diseases/agerelated-macular-degeneration-amd
• https://my.clevelandclinic.org/health/diseases/15246-macular-degeneration
• https://www.webmd.com/eye-health/macular-degeneration/age-related-macular-degeneration-overview