Does a diagnosis of age-related macular degeneration (AMD) mean you can’t live a rich, fulfilling life? Not necessarily, according to the experts.
“The initial diagnosis can be scary,” said Purnima S. Patel, MD, associate professor of ophthalmology at Emory University who also works at the Atlanta VA Medical Center and serves as a clinical spokesperson for the American Academy of Ophthalmology. “People hear about the in-eye injections that are standard therapy and think, ‘there’s no way I can do this.’ They should know that their ophthalmologist can help them adapt to their situation and make the most of their vision. Plus, those injections aren’t nearly as gruesome as everyone fears.”
Start Screening for Macular Degeneration Early
As its name suggests, AMD is a product of aging. The most common form of AMD, dry AMD, happens when parts of the eye’s macula (part of the retina) get thinner with age. Tiny clumps of protein called drusen grow and central vision is slowly lost. The less common, but more serious, wet AMD happens when abnormal blood vessels grow under the retina and leak blood or other fluids that cause scarring on the macula. Vision loss is faster with wet AMD than with dry AMD.
The most common symptoms of AMD are vision distortions: straight lines that look wavy or bent, “splotchy” looking central vision, or being able to see some things but not others. Side, or peripheral, vision is not affected by AMD.
“Patients may have these symptoms and not even know it,” Dr. Patel said. “That is why we encourage adults to visit an ophthalmologist for a baseline screening at around age 40, when eye conditions start to manifest. By age 65, people should be screened annually.”
Dr. Patel added that annual screenings are particularly important for people with high risk factors, including a family history of AMD, light skin, smoking, being overweight, and having high blood pressure, high cholesterol or heart disease.
“The best prognosis for maintaining or recovering your vision is based on the strength of your vision at the time of diagnosis,” she said. “An ophthalmologist can stay attuned to any nuanced changes.”
Macular Degeneration Treatments: What to Expect
According to Dr. Patel, there is no cure for dry AMD. However, she typically recommends that patients with this common form of AMD take a vitamin formulation known as AREDS-2. Clinical studies of AREDS show that the formulation may delay progression of advanced AMD and help maintain vision longer in patients with intermediate AMD or AMD in one eye.
She also recommends an eye-healthy diet including lots of leafy greens, not smoking, and wearing UV eye protection, even on cloudy days—advice applicable to those with both dry and wet AMD.
“Ophthalmologists may send patients home with an Amsler grid,” she added. “It lets patients monitor each eye to help detect those subtle vision changes that aren’t always obvious because they come about so slowly.”
Treatments for wet AMD have evolved significantly over the past 10 years, according to Dr. Patel. Today, the standard therapy involves monthly injections of anti-VEGF drugs, which help reduce the number of abnormal blood vessels in the retina and slow blood vessel leakage.
“These injections aren’t a cure, but they can control and stabilize vision loss,” she said. “Your ophthalmologist will apply a sterilization solution to prevent infection as well as numbing drops before inserting a very slender needle into the eye. The whole process is a lot less painful than most people fear.”
Dr. Patel added that some patients report a gritty or sandy feeling in the eye following injections, but most people can go about their daily activities immediately after treatment as long as they avoid getting their eye dirty—so no swimming or lawn mowing, for example.
Living with Macular Degeneration
According to Dr. Patel, most people with macular degeneration live full lives, with minimal impact on activities of daily living.
“Because the central vision is affected, activities like reading and watching TV can be challenging,” she said. “However, since peripheral vision isn’t affected, people can still get around.”
She encourages those with MD to ask their ophthalmologist about assistive devices such as magnifiers and other tools and electronics designed specifically for those with low vision.
“I take care of people with macular degeneration every day and I’m in awe of the amount of resilience they have and the way they continue to thrive with the various treatment options and tools at our disposal,” concluded Dr. Patel.