Macular degeneration is a common age-related eye disorder that can lead to reduced vision. Early symptoms can be subtle, which is why regular eye checkups are critical.
Macular degeneration, or age-related macular degeneration (AMD), is a degenerative eye disease. It occurs when a critical layer of cells beneath the macula breaks down and slowly disappears. The macula, a small region located right in the center of your retina, is essential for crisp, precise vision.
Damage to the macula can cause central vision loss. It doesn’t affect your peripheral vision — what you see on the side when you’re looking straight ahead.
Macular degeneration is common, affecting
There are two types:
- Dry macular degeneration: Dry macular degeneration involves the buildup of waste products and photoreceptor debris, called drusen, that form under the thinning macula. It’s common, affecting 85% to 90% of people with macular degeneration.
- Wet macular degeneration: Wet AMD is a less common type that occurs when new blood vessels form under the retina. The vessels can leak fluids and blood, disrupting the complex retinal anatomy, which may result in macular scarring.
The early warning signs of macular degeneration are not obvious. In fact, many people only notice issues when their vision becomes blurry. That’s why it’s important to regularly visit an eye doctor, who can diagnose the condition early.
The early warning signs of macular degeneration can be subtle or nonexistent.
Any early and intermediate macular degeneration symptoms always relate to dry macular degeneration. If it progresses, the symptoms can be linked to either dry or wet types.
Early symptoms
Early macular degeneration often causes no symptoms, which is why it’s difficult to catch it in its early stages without speaking with an eye doctor.
If early symptoms do occur, you may have difficulty seeing in low light. Your eyesight may appear far blurrier than before, whether seeing near or far. Additionally, colors may not seem as bright as before. This is all caused by a gradual loss of central vision.
However, these signs might be unnoticeable to some people. Visiting an eye doctor for regular screenings is the best way to know whether you have macular degeneration.
Intermediate symptoms
Intermediate macular degeneration might cause some vision loss or changes. But again, in many instances, there might be no noticeable symptoms.
Late symptoms
In the later stages, macular degeneration may cause symptoms such as:
- lines looking wavy or crooked
- blurriness in the center of your vision
- seeing blank spots
- increased difficulty seeing in low light
- colors appearing less bright
Severe changes may signal the development of wet macular degeneration. If this occurs, it will often cause a sudden and significant loss of central vision.
To diagnose macular degeneration, an eye doctor will typically start by asking about your medical history. This can help them consider your risk factors for developing the condition.
Your eye doctor can then use various tests, such as:
- Amsler grid test: The Amsler grid test is a square-shaped graph with a dot in the center. If you have macular degeneration, some of the lines may look wavy, curved, or absent.
- Dilating eye drops: These drops widen your pupils. Your eye doctor will then examine the inside of your eye using a special lens.
- Optical coherence tomography (OCT): With this test, your eye doctor will use a machine to scan your retina and macula.
- Fluorescein angiography: With this procedure, your eye doctor will intravenously inject fluorescein, an inert vegetable dye, into your arm. This dye highlights the blood vessels in the back of the eye, and time-lapse photography allows the doctor to identify anything unusual in the blood vessels.
What are the risk factors?
Some people may be more likely to develop macular degeneration. Risk factors can include:
- having a family history of macular degeneration
- having hypertension (high blood pressure)
- having high cholesterol
- being over age 50
- having overweight or obesity
- eating a diet high in saturated fats
- smoking cigarettes
While there’s no cure for macular degeneration, some therapies can help prevent or delay vision loss. The best option depends on the stage and type of macular degeneration.
Early macular degeneration
There’s no treatment for early macular degeneration. Instead, your eye doctor will monitor your eyes during regular exams and recommend lifestyle changes, such as:
- quitting smoking, if applicable
- eating a balanced and nutritious diet
- exercising regularly
- maintaining healthy blood pressure and cholesterol
- reducing eye exposure to UV light
Intermediate macular degeneration
Your eye doctor might recommend supplements that help prevent the progression to late macular degeneration.
Late dry macular degeneration
The Food and Drug Administration (FDA) approved two medications in 2023 to treat geographic atrophy, which is the advanced stage of dry macular degeneration. These drugs are pegcetacoplan (Syfovre) and avacincaptad pegol (Izervay).
Late wet macular degeneration
- Anti-vascular endothelial growth factor (VEGF) drugs: These are the main form of treatment for late wet macular degeneration. Healthcare professionals will inject anti-VEGF into the eye, typically numbing the person before the injection. The injection can help stop the proliferation of atypical vessels.
- Laser photocoagulation: This technique uses a laser to seal leaking blood vessels and, beneath the retina, obliterate the source of the atypical vessels. This treatment has many limitations, so it might not be suitable for everyone.
Photodynamic therapy (PDT) : The approach uses a light-sensitive dye to transform light into chemical energy. The process releases free radicals, thereby causing vascular occlusion and minimal injury to nearby tissue.- Photobiomodulation (PBM): This therapeutic approach uses specific wavelengths of light to stimulate cellular energy production and improve overall retinal health.
The last three treatment options are rarely used today.
Damage from macular degeneration is irreversible. If you’re diagnosed with early macular degeneration, it’s important to continue your regular eye checkups. This can help lower the risk of complications and possibly delay any disease progression.
Treatment will likely involve making certain lifestyle changes to help prevent or slow the progression of macular degeneration. Your doctor will help you understand which changes are most important.
For late macular degeneration, your eye doctor can determine if you’re a suitable candidate for current treatments.
If there is a delay in treatment, it can increase the risk of vision loss and blindness.
Early macular degeneration usually causes no noticeable symptoms. If they occur, you may have difficulty seeing in low-light situations. The only way to know if you have the condition is to visit an eye doctor.
Your eye doctor can diagnose macular degeneration using a variety of tests and tools. Damage from macular degeneration is not reversible, but good preventive care can help delay progression and reduce complications.