Macular Degeneration

What is macular degeneration?

Macular degeneration is an eye disease that affects central vision. This means that people with macular degeneration can’t see things directly in front of them. This common age-related eye condition mostly occurs in people over the age of 50.

Macular degeneration affects your macula, the central part of your retina. Your retina is in the back of your eye and controls central vision. People with macular degeneration aren’t completely blind. Their peripheral vision (ability to see things off to the sides) is fine.

Does macular degeneration affect both eyes?

Macular degeneration may develop in one eye or both eyes with different levels of severity.

How common is macular degeneration?

Almost 20 million U.S. adults have macular degeneration. Globally, the prediction is that 288 million people will have the condition by 2040.

In the U.S., macular degeneration is a leading cause of vision loss in people who are 60 and older.

Who might get macular degeneration?

As the term “age-related macular degeneration” (AMD) implies, macular degeneration is more likely to occur as you get older. However, people can develop macular degeneration at younger ages because of several factors.

In addition to age, risk factors for macular degeneration include:

• Having a family history of macular degeneration.
• Being overweight.
• Smoking.
• Having high blood pressure (hypertension).
• Eating a diet high in saturated fats.
• Being white.

What are the types of macular degeneration?

There are two types of macular degeneration: dry and wet.

Dry (atrophic) macular degeneration

Nearly 90% of people with macular degeneration have the dry form. It develops when tiny yellow protein deposits called drusen form under your macula. The built-up deposits dry and thin your macula.

Vision loss with the dry form of macular degeneration tends to occur gradually. Most people don’t completely lose central vision. In some cases, the dry form can change to the wet form.

Wet (exudative) macular degeneration

Wet (exudative) macular degeneration occurs when abnormal blood vessels develop under your retina and macula. The blood vessels leak blood and fluid. “Exudative” is a term that refers to how the fluids ooze.

Because of fluid buildup, a bulge forms in your macula. You may see dark spots in your center of vision. About 10% of people with macular degeneration have the wet form. This type is more severe. It can quickly lead to total loss of central vision.

What are the stages of macular degeneration?

Dry macular degeneration has three stages. Often, symptoms like vision loss aren’t evident until the late stage. However, your eye care provider can see signs when doing an exam.

• Early: Your macula changes, but vision isn’t affected.
• Intermediate: Vision may get blurry or wavy.
• Late (advanced): Central vision fails completely.

Wet macular degeneration is already at an advanced stage.

What causes macular degeneration?

Macular degeneration can be an inherited eye disease. But it also develops in people with no family history of the disease. Macular degeneration occurs when the macula at the back of your eye starts to waste away for unknown reasons. Getting older is a factor in age-related macular degeneration.

Non-age-related macular degeneration may be associated with:

• Diabetes.
• Head injuries.
• Infections.
• A diet lacking in required nutrients.

What are the symptoms of macular degeneration?

The macula helps send images from your eye’s optic nerve to your brain. If you have a damaged macula, your brain can’t understand or read the images that your eyes see.

Many people with macular degeneration don’t have symptoms until the disease progresses. You may experience:

• Being less able to see in low light.
• Blurred vision.
• Problems or changes in the way you see colors.
• Low vision.
• Straight lines that you see as curving or wavy. If you’re looking at lines that you know should be straight but they appear wavy or curved, you should contact an eye care provider.
• Blank spots or dark spots in your field of vision.

How is macular degeneration diagnosed?

Macular degeneration rarely causes symptoms in its early stages, so annual eye examinations are very important. They’ll help your provider find the disease early and start treatments when they’re most effective.

During an eye exam, your eye care provider checks for changes to your retina and macula. Your provider may order one or more of these tests:

• Amsler grid test: An Amsler grid has a grid of straight lines with a large dot in the center. Your healthcare provider may ask you to identify lines or sections on the grid that look blurry, wavy or broken. A lot of distortion may indicate that you have macular degeneration or show that the disease is getting worse. You can use this at home to monitor your symptoms and look for any progression.
• Dilated eye exam: Eye drops dilate, or widen, your pupils. Your provider will give you the drops and dilate your eyes and then will use a special lens to look inside your eyes.
• Fluorescein angiography: Your healthcare provider injects a yellow dye called fluorescein into a vein in your arm. A special camera tracks the dye as it travels through blood vessels in your eye. The photos can reveal any leakage under your macula.
• Optical coherence tomography (OCT): This imaging machine takes detailed images of the back of your eye, including your retina and macula. Optical coherence tomography isn’t invasive or painful. You simply look into a lens while the machine takes pictures.
• Optical coherence tomography angiography (OCTA): This diagnostic tool uses laser light reflection (instead of fluorescein dye) and the OCT scanning device. It takes just a few moments and produces 3D images of blood flow through your eye.

How is macular degeneration managed or treated?

There’s no cure for macular degeneration. Starting treatments early can slow the progression of the disease and make symptoms less severe. Even with successful treatments, symptoms often return. Depending on the disease type, treatments include nutritional supplements, medications, photodynamic therapy (PDT) and laser therapy.

Nutritional supplements to treat dry age-related macular degeneration (AMD)

The Age-Related Eye Disease Studies (AREDS and AREDS2) found that a combination of vitamins and minerals might slow the progression of dry AMD. AREDS supplements include these ingredients:

• Vitamin C.
• Vitamin E.
• Lutein.
• Zinc.
• Copper.
• Zeaxanthin.

The first version of the supplements contained the antioxidant beta-carotene, but it raises the risk of lung cancer in people who smoke and people who used to smoke. In the newer version, zeaxanthin and lutein are the antioxidants.

Medications to treat wet age-related macular degeneration (AMD)

There are drugs that treat but don’t cure wet AMD. They include anti-vascular endothelial growth factor (anti-VEGF) injections. They block the production of VEGF, which is a protein that produces new blood vessels. Your provider, generally a retina specialist, will numb your eye before giving you a shot into the vitreous (intravitreal injections). Anti-VEGF shots can sometimes improve your vision.

These drugs include:

• Aflibercept (Eylea®).
• Ranibizumab (Lucentis®).
• Bevacizumab (Avastin®).
• Faricimab-svoa (VABYSMO®).
• Brolucizumab (Beovu®).

Photodynamic therapy to treat wet age-related macular degeneration

During photodynamic therapy (PDT), your eye care specialist uses a combination of an injectable light-sensitive drug and a laser to destroy extra blood vessels in your eye. Your provider may combine PDT with anti-VEGF shots.

Laser photocoagulation to treat wet age-related macular degeneration

During this treatment, your provider will use a laser to seal and destroy the leaking blood vessels. This was actually the first treatment for wet AMD.

Providers don’t use laser photocoagulation and PDT as often as they once did due to the development of anti-VEGF injections.

What are the side effects or risks of macular degeneration treatments?

Treatments for wet AMD carry some risk of complications, including:

• Eye infection.
• Retinal detachment.
• Structural eye damage.
• Faster onset of cataracts.
• Severe vision loss.

What are the complications of macular degeneration?

Losing your central vision can make it challenging to do certain tasks. Depending on the extent of vision impairment, you may not be able to:

• Read well.
• Recognize faces.
• Drive.
• Cook.
• Do home repairs.

Severe AMD may lead to you being legally blind.

Changes in your lifestyle can lead to depression and anxiety. Some people with AMD experience Charles Bonnet syndrome, a condition that causes visual hallucinations.

How can I prevent age-related macular degeneration?

You can take these steps to lower your risk of macular degeneration:

• Quit smoking.
• Maintain a healthy weight for you.
• Stay physically active.
• Maintain healthy blood pressure and cholesterol levels.
• Follow the Mediterranean diet.

What is the prognosis (outlook) for people with macular degeneration?

Not everyone who has macular degeneration experiences significant vision loss. With dry age-related macular degeneration, vision loss can happen slowly and take a long time to occur. Because the condition can affect just one eye, you may not notice any change in vision.

Even if you’re legally blind, you might be able to see better if you:

• Wear eyeglasses or contact lenses.
• Use brighter lights at home or work.
• Read with a magnifying device.

When should I call my healthcare provider?

You should call your healthcare provider if you have macular degeneration and experience:

• Painful eye inflammation (iritis or uveitis) and sensitivity to light (photophobia).
• A feeling of pressure behind your eye.
• Eye floaters or flashers.

What questions should I ask my healthcare provider?

If you have age-related macular degeneration (AMD), you may want to ask your healthcare provider:

• Why did I develop AMD?
• What type of AMD do I have?
• What’s the best treatment for the type of AMD I have?
• What lifestyle changes can I make to protect my vision?
• Are there any treatment risks or side effects?
• Is my family at risk for developing AMD? If so, what steps can they take to protect their vision?
• Should I watch for signs of complications?
• Am I eligible to participate in a clinical trial?

A note from Cleveland Clinic

Age-related macular degeneration (AMD) is the leading cause of vision loss in older adults. Although AMD doesn’t cause complete blindness, the loss of central vision can make it harder to do everyday tasks. Dry macular degeneration, a condition that causes gradual vision loss, is the most common form. Taking nutritional supplements may slow the disease. Wet macular degeneration can cause rapid vision loss and may lead to legal blindness. Your eye care provider can offer treatments that may help preserve vision. You also may benefit from wearing eyeglasses or using magnifying devices to read. You can also ask your provider to give you information on supportive services.