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Age-related Macular Degeneration


What is age-related macular degeneration?

Age-related macular degeneration, also called AMD or ARMD, is an eye disease that may occur with aging. ARMD is a disease that targets the macula (center part) of the retina (back of the eye). The macula contains the fovea, which helps you to see images in sharp detail. With ARMD, the macula becomes damaged, causing blurring or loss of vision in the center of your eyesight. These vision problems may progress slowly or quickly. ARMD has different stages and may affect one or both eyes.

What are the different stages of age-related macular degeneration?

  • Early ARMD: Early ARMD is when many small drusen (yellow deposits or spots) appear under the retina. The retina may have more color or less color than normal. With early ARMD, there is normally no change in your vision.
  • Intermediate ARMD: With intermediate ARMD, more drusen, that are larger in size, collect under your retina. There may also be areas of retina atrophy (wasting). The patches do not cause changes in the fovea at this stage. With intermediate ARMD, you may have blurry central vision and you may need more light when doing activities.
  • Late-stage ARMD: Late-stage ARMD causes a major decrease in your central vision and has a dry or wet form. The fovea is also atrophied with late-stage ARMD.
    • Dry ARMD: Dry ARMD is more common, and a less serious form of late-stage ARMD. Dry ARMD slowly causes changes in your vision. Dry ARMD can sometimes turn into the wet form of ARMD.
    • Wet ARMD: Wet ARMD is more severe and quickly causes damage to your central vision. It occurs when new, abnormal blood vessels grow in your retina. The blood vessels may break open, causing blood to leak out. When the blood vessels leak, they cause more damage to the macula of the retina.

What causes age-related macular degeneration?

The exact cause of ARMD is unknown. ARMD may occur when the retina does not get enough nutrients (substances needed for growth). Decreased nutrients cause the supporting tissues of the retina to break down and waste material to collect. The damaged tissues and waste material cause drusen to form under the retina. The light-sensitive cells of the eyes are then injured causing blurring in the center part of your sight.

What increases my risk of getting age-related macular degeneration?

The risk of getting ARMD increases in people over the age of 50. ARMD also occurs more often in women than men. Having ARMD in one eye puts you at higher risk of getting ARMD in your other eye. The following may also increase your risk for ARMD:

  • Having pale or sun-sensitive skin.
  • Having other family members with ARMD.
  • Hypertension (high blood pressure).
  • Repeated eye exposure to sunlight.
  • Smoking.
  • Weighing more than your healthcare provider suggests.

What are the signs and symptoms of age-related macular degeneration?

You may have any of the following:

  • A blind spot in the center of your vision. This can occur in one or both of your eyes.
  • Blurred vision in one or both eyes. You may not be able to see colors, depth, and detail clearly.
  • Distorted vision, such as seeing straight lines that look wavy to you.
  • Painless worsening of vision.
  • Trouble seeing at night, in the dark, or while reading. You may have more trouble reading if the light is dim.

How is age-related macular degeneration diagnosed?

ARMD may be diagnosed during an eye exam. The following may also be done to diagnose your ARMD:

  • Amsler grid test: During an Amsler grid test you will be asked to look at a dot in the center of lined, graph paper. While looking at the dot, you will tell your healthcare provider if you see any changes in the lines on the paper.
  • Visual acuity test: Your healthcare provider may ask you to read different eye charts. These charts help check how well you see colors, lines, and letters at different distances.
  • Slit-lamp test: During a slit-lamp test, healthcare providers use a microscope with a strong light to look into your eyes.
  • Dilated eye exam: Eye drops are placed into your eyes to dilate (widen) the pupils. Using a magnifying lens, healthcare providers check your retina and other parts of your eye.
  • Fluorescein angiography: During fluorescein angiography, pictures are taken of the blood vessels in your eye. You are given a dye for this test to help healthcare providers see your blood vessels better.
  • Optical coherence tomography: During an optical coherence tomography test, pictures are taken of the tissues in your eye. The pictures can show if you have fluid buildup behind your retina. Pictures can also show if your retina is thicker than it should be.

How is age-related macular degeneration treated?

The goal of treatment is to slow or stop your ARMD from getting worse. Ask your healthcare provider for more information about the following treatments:

  • Observation: When your ARMD is causing few or no symptoms, you may only need observation. This includes watching for changes in your condition and symptoms.
  • Antioxidant vitamins and minerals: Antioxidant vitamins and minerals are supplements that help protect your body cells from damage. Supplements used to treat ARMD may include vitamins C and E, beta-carotene, and zinc. These supplements may also help decrease your risk for advanced ARMD. Ask your healthcare provider for more information about treatment with vitamins and minerals. Talk with your healthcare provider before starting to take antioxidant vitamins and minerals. If you smoke, your healthcare provider may tell you not to take beta-carotene supplements.
  • Anti-vascular endothelial growth factor: Anti-vascular endothelial growth factor (anti-VEGF) is medicine given as an injection (shot) into your eye. The medicine is used to treat wet ARMD. The anti-VEGF medicine may stop blood vessels from growing and leaking. The injections may keep the disease from getting worse and in some cases, the medicine may improve your vision. Ask your healthcare provider for more information about anti-VEGF injections.
  • Laser photocoagulation: During laser photocoagulation, a thermal (uses heat) laser is directed at leaking blood vessels in your retina. The laser treatment seals the leaking blood vessels to prevent more damage to your retina.
  • Photodynamic therapy: During photodynamic therapy (PDT), you are given a shot of medicine into a vein (blood vessel). The medicine collects in the leaking blood vessels in your eye. A healthcare provider will shine a laser light into your eye. The laser light will seal the leaking blood vessels in your eye.
  • Visual rehabilitation: Visual rehabilitation (rehab) uses activities to help you function with your vision loss in your daily life. A healthcare provider may help you choose tools to use, and suggest ways to keep your home or workplace safe. You may learn to use certain assistive devices during visual rehab. Assistive devices include corrective and magnifying glasses, large print books, and other large print materials. Calculators with large number pads, and other devices may also help you see better. Talking books and computer programs that type as you speak may also be used. Ask your healthcare provider for information about assistive devices you can use. Together, you and your healthcare provider will plan a visual rehab program that is right for you.

How can I help myself when I have age-related macular degeneration?

  • Improve the lighting in your home: Have enough light in your home to help you see objects better. Use light bulbs that reduce glare. Ask your healthcare provider what type of light bulbs are best, and if there are certain light bulbs you should avoid.
  • Manage your diet and medical problems: If you weigh more than your healthcare provider suggests, try to lose weight and exercise regularly. Your healthcare provider may suggest eating more fresh fruits and vegetables. Talk with your healthcare provider if you are overweight and need help to lose weight. Controlling your medical problems, such as high blood pressure can also help prevent your ARMD from getting worse.
  • Protect yourself from the sun: Always wear sunglasses with ultraviolet (UV) protection lenses to protect your eyes when outdoors. If you have had PDT, it is best to avoid direct sunlight for as long as your healthcare provider suggests. Protect yourself by wearing clothing that covers your skin, such as long-sleeved shirts and hats. Always wear sunscreen to protect your skin when outdoors. Carry a card with you that says you are very sensitive to light. The card can be helpful to others in case of an emergency.

  • Stop smoking: If you smoke, it is never too late to quit. Smoking harms your body in many ways. Your ARMD is likely to get worse if you smoke. You are also more likely to have cancer, heart disease, lung disease, and other health problems if you smoke. Quitting smoking will improve your health and the health of those around you. Ask your healthcare provider for more information about how to stop smoking if you are having trouble quitting.

When should I call my healthcare provider?

Call your healthcare provider if:

  • You have discomfort or pain in your eye after getting treatment for ARMD.
  • You have new or increased blurred vision or blind spots.
  • You have new or increased redness in your treated eye.
  • You have new or increased trouble seeing or eye pain when in the light.
  • You see new or an increased number of floaters (spots).
  • Your symptoms prevent you from doing your daily activities.
  • You have questions or concerns about your condition, treatment, or care.

When should I seek immediate care?

Seek care immediately or call 911 if:

  • You suddenly lose vision in one or both of your eyes.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2017 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.