Age-Related Macular Degeneration: What You Need to Know If You’re Over 50

Did you know that age-related macular degeneration (AMD) is the most common cause of vision loss among people over age 50? And with very few symptoms in the earliest stages, it’s important to be aware of how it’s diagnosed, how it progresses, and what you can do to protect your eyesight.

By

Sally Wadyka

| Reviewed by

Quinn Wang, MD

Age-related macular degeneration (AMD) is the most common cause of vision loss in people over age 50. This progressive condition affects 11 million Americans. AMD can seriously impact your ability to drive, read and see faces clearly and can even lead to irreversible blindness.

 

While there is no cure for AMD—and no treatment that can reverse any vision loss due to the disease—there are steps you can take to slow down the disease progression and help protect your eyesight.  

What is age-related macular degeneration?

The macula is in the center of your retina, the clear layer of light-sensing tissue that lines the back of your eye. The macular area of your retina is responsible for your central vision and color vision. In other words, your macula gives you the ability to see things in fine detail both up close and far away. The retinal tissue that surrounds the macula is responsible for your peripheral vision. 

 

In people with age-related macular degeneration, the cells of the macula, called photoreceptors, are damaged by deposits of protein called drusen. The drusen are essentially waste products from the retina that accumulate in cell layers underneath the retina (specifically, they accumulate between the retinal pigment epithelium (RPE) layer and Bruch’s membrane.) Macular damage results in death of photoreceptors and RPE cells, which ultimately leads to severe scarring called geographic atrophy (GA.) This impairs central vision, and the resulting blurriness, wavy distortions, and/or blind spots make it especially hard to perform visually-demanding tasks such as reading.

Different types of age-related macular degeneration

Age-related macular degeneration is classified into two types: Dry AMD (aka atrophic AMD) and Wet AMD (aka neovascular AMD). 

  • Dry AMD is the more common type and is classified in three stages—early, intermediate, and late. About 80 percent of people with age-related macular degeneration have dry AMD. This condition progresses slowly, usually over several years. 
  • Wet AMD is a severe late-stage form of dry AMD. It is much less common than dry AMD, progresses rapidly, and can lead to dramatic vision loss. In wet AMD, abnormal blood vessels grow under and through the retina to cause harmful bleeding and tugging. The presence of new, abnormal blood vessels is why wet AMD is also known as neovascular AMD. 

Who’s at risk for age-related macular degeneration?

AMD becomes more common with age. People over age 55 have a higher risk of the disease than younger adults. Other factors that increase your risk of age-related macular degeneration include:

  • Smoking
  • Being Caucasian
  • Having heart disease, high cholesterol or high blood pressure
  • Being overweight
  • Eating a poor diet
  • Having a family history of AMD

Age-related macular degeneration symptoms 

The symptoms you experience depend on the type of AMD and also the stage of the disease.

  • Early stage dry AMD usually has no signs or symptoms
  • Intermediate dry AMD may cause slightly blurred vision or trouble seeing in low light
  • Late stage dry or wet AMD can cause central vision loss. You may also start to notice that straight lines look wavy. This symptom is a warning sign for late AMD. If you experience this visual disturbance, see your eyecare professional right away.

Can AMD be prevented?

Although you can’t control all of the risk factors for age-related macular degeneration, there are ways to lower your risk of vision loss. You can support your sight by:

  • Not smoking; smoking is the number one modifiable risk factor for AMD
  • Getting regular exercise
  • Controlling your cholesterol and blood pressure
  • Eating an eye-healthy diet that’s rich in dark, leafy greens, colorful fruits and vegetables and fatty fish like salmon

Diagnosing AMD 

During a comprehensive eye exam, your provider uses medicated drops to dilate your pupils. This allows them to see your entire retina and assess any changes to your retina or macula. An alternative to pupillary dilation is to obtain a wide-field fundus photo (i.e. using a machine called an Optos,) which captures even peripheral retinal pathology. 

 

Your eyecare provider will also have you look at an Amsler grid (and give you one to look at on your own daily). This paper-based tool is a square that contains a grid pattern. You hold it about 12 to 15 inches away from your face and look at the dot in the center of the grid, first with one eye and then the other. If any of the lines in the grid look wavy or blurred (or are missing), you should contact your eyecare provider right away.

 

Your provider will also do other tests (such as retinal optical coherence tomography or OCT) that provide detailed images of the macula, retina and the blood vessels beneath it.

Age-related macular degeneration treatments 

There is currently no cure for dry AMD. The best treatment is to help prevent progression of the disease by having regular eye exams.

 

Research shows that certain nutrients can help slow vision loss. Two landmark studies (AREDS and AREDS 2), sponsored by the National Eye Institute, looked at the effect of various vitamins on over 8,000 people aged 50 to 85. The research found that a specific combination of vitamins and minerals reduced risk and slowed progression of certain types of AMD.

 

Typically, the effective amounts are higher than you could get from diet alone—or even from a multivitamin. If you are at risk of AMD, you may want to talk to your eyecare provider about taking an AREDS formula supplement. The AREDS 2 formulation usually contain:

  • Vitamin C (500 mg)
  • Vitamin E (400 IU)
  • Lutein (10 mg)
  • Zeaxanthin (2 mg)
  • Zinc (80 mg)
  • Copper (2 mg)


For wet AMD, there are a variety of treatments that can help prevent further vision loss. However, the most common treatment is Anti-VEGF injections. 


Anti-VEGF medications: Your doctor injects these medications directly into the eye every four to eight weeks. Your eye doctor may give you a ​​topical numbing drop and an injection of lidocaine under the conjunctiva so that you don’t feel pain. This medication helps stop bleeding and leaking from the abnormal blood vessels under the retina. Anti-VEGF injections are the most common treatment for wet AMD and are highly effective if repeated at recommended intervals. 


Treatments for AMD are continuing to evolve. Learn more about new treatments on the horizon for wet AMD and dry AMD from this recent review, published at AAO.org

What’s the outlook for someone with AMD?

Even if you have age-related macular degeneration in both eyes, the condition—and related vision loss—may progress more quickly in one eye. That’s why it’s important to keep taking care of your eye health. Lifestyle changes, like diet and exercise, may help you save more of your eyesight.

 

If AMD is already affecting your eyesight, talk to your eyecare professional about tools—like low vision devices and vision rehab—that can help you live better with vision loss.

 

Sources:

American Optometric Association

American Academy of Ophthalmology

https://www.aao.org/eye-health/diseases/amd-macular-degeneration

https://www.aao.org/eye-health/diseases/vitamins-amd

National Eye Institute

American Macular Degeneration Foundation


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Taking good care of your eyes and your overall health can go a long way toward preventing age-related eye conditions. Eating an eye-healthy diet that includes lots of antioxidant-rich fruits and vegetables slows down the formation of cataracts and reduces your risk of macular degeneration. Getting plenty of exercise and maintaining a healthy weight can prevent diseases like diabetes and high blood pressure--both of which affect vision and eye health. And while you may not be able to prevent the presbyopia (and need for reading glasses) that comes with getting older, your eyecare professional can make sure you get the correct vision correction to see clearly.

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The sun’s rays contain damaging ultraviolet (UV) light. The same UV rays that burn your skin and lead to skin cancer also affect your eyes. Staring directly into strong sunlight can damage the retina. And repeated sun exposure over time can lead to cataracts, benign growths on the eyes and even eye cancer. Protect your eyes anytime you’re in the sun by wearing sunglasses that block both UVA and UVB rays.

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Some people claim that by correcting your vision with prescription glasses or contacts, you’re weakening your eyes—which then leads to worse vision. Their “proof” is that after wearing your corrective prescription for a while, your vision appears blurrier when you’re not wearing it. But that’s likely because you’re now used to seeing the world in clear, crisp detail—and in contrast, your uncorrected vision appears fuzzier. Getting the proper vision correction for your eyes is essential for your eye health. Don’t try to tough it out if you can’t see clearly. Visit your eyecare professional for an in-person or virtual vision screening.


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Not having a bright enough light may make it harder to clearly see the words on the page, but it won’t damage your eyes or permanently impact your vision. Because you’re straining to see, you might get a headache or other symptoms of eyestrain. If you want to read in bed without illuminating the entire bedroom, get a reading light that provides just enough brightness to see your book clearly. 


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LASIK surgery corrects your distance vision only, so people who are nearsighted benefit most from it. But LASIK doesn’t affect the lens of the eye, the part that helps you focus up close. As you get older, changes to the lens impact your ability to see close up. So even if you have LASIK in your 20s or 30s, you’ll most likely still need reading glasses by the time you hit your 40s or 50s.

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Having your face right up next to the bright screen may give you a headache or even cause some temporary eyestrain or fatigue, but it won’t damage your vision. Children are more prone to this behavior than adults—which may be because children can focus close up better than adults can. But if your child can only see the television clearly when sitting close (and has to hold other things close to see them clearly), they may be nearsighted. Taking your child to an eyecare professional for a vision exam will help determine if they need glasses to see clearly.

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Most eyecare professionals recommend removing—and thoroughly cleaning—your contacts every night. Even if you use extend-wear lenses that are approved for use a week or month at a time, it’s always safer to give your eyes a nightly break. Your contacts are more likely to accumulate bacteria when you leave them in 24/7, and that can lead to eye infections. Sleeping in your contacts also prevents essential oxygen from getting to your corneas. If you must sleep in your contacts, make it a once-in-a-while event and ask your eyecare provider about contacts that are specially formulated to let more oxygen through. 


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Carrots (along with other vegetables like sweet potatoes and dark leafy greens) contain high amounts of beta-carotene, which the body converts to vitamin A. Vitamin A is essential for eye health, and a deficiency of the nutrient is the leading cause of childhood blindness in developing countries. In the U.S., vitamin A deficiency is rare, and few people get so little it could impact their eyesight. Also, there’s no evidence that beta-carotene affects the sharpness of your vision or can prevent near or farsightedness. So while getting lots of beta-carotene in your diet may help keep your eyes healthy, no amount of carrots is going to actually improve your vision and allow you to toss out your glasses or contacts. 


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The jury is still out on how effective blue light glasses are for eyestrain. One recent study found they made no difference in eyestrain symptoms during a two-hour-long computer task. But some experts feel they may help alleviate eyestrain and fatigue during prolonged, cumulative screen time. Either way, blue glasses alone won’t solve the problem of too much screen time. The best way to reduce eyestrain is to limit screen time and take frequent breaks when you do need to spend several hours at your computer.

True
False

The jury is still out on how effective blue light glasses are for eyestrain. One recent study found they made no difference in eyestrain symptoms during a two-hour-long computer task. But some experts feel they may help alleviate eyestrain and fatigue during prolonged, cumulative screen time. Either way, blue glasses alone won’t solve the problem of too much screen time. The best way to reduce eyestrain is to limit screen time and take frequent breaks when you do need to spend several hours at your computer. 


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