Macular Degeneration – Symptoms, Causes, And Treatments

Do you know that macular degeneration, also known as age-related macular degeneration (AMD) is the leading cause of vision loss? It affects millions of people across the globe. Compared to other issues like glaucoma or cataracts, AMD is the top-most cause of vision problems. While AMD is considered an incurable eye disease, you can stop it with early intervention.

About Macular Degeneration

AMD is the common eye problem resulting in central vision loss. When you look straight ahead, then your central vision is important. The condition leads to problems with seeing straight. Your peripheral vision is what you see on the side. AMD does not result in total blindness as your peripheral vision has no issues. This condition occurs due to the deterioration of the retina’s central portion.

Why Macular Degeneration Causes Vision Problem?

You can compare your eyes to a camera. In your eye, you have a sensitive part in the central region known as the macula. The main function of the macula is to collect highly comprehensive images at the center of your field of vision. It sends these images to the optic nerve present in the brain. The images are interpreted as sight and you can see these images with clarity. With the deterioration of the macula, your brain does not receive these images properly. In the early stages of AMD, you see observe the wavy or blurred vision. As the condition worsens, you lose the central vision completely. Advanced cases of AMD in people result in blindness. So, such people are considered legally blind.

The condition means you lose the central vision. But, because of the working of the rest of your retina, you may retain peripheral vision. Unfortunately, it is not clear as your clear vision. So, you cannot see things properly.

Types Of Macular Degeneration

Doctors classify macular degeneration into two types:

Dry Macular Degeneration

It is the most common type of AMD as 85% to 90% have this condition. Dry AMD is the type of eye vision that causes no leakage of blood vessels in the eye. Due to the condition, drusen or the small yellow deposits start to develop under the macula. So, it results in retinal damage along with loss of vision. In most cases, affected people suffer from this condition in both their eyes. Without treatment, this condition progresses over time. It becomes worse and results in wet AMD. During the early stages, the condition causes minimal symptoms. Affected people suffer from vision loss during the mid and late stages of the disease. In some cases, only one eye is affected. The problem in one eye is easy to detect as you can notice changes in the vision. When you lose vision in one eye, your other eye starts compensating for the loss of vision.

Wet Macular Degeneration

While wet macular degeneration affects only 10% to 15%, it is an advanced form of the disease. This causes irreversible vision loss due to the growth of abnormal blood vessels in the eye. Due to the condition, the blood vessels present below the central part (macular) of your retina starts to leak. This results in seeing a dark spot in the center of the vision. It is because of the blood vessel leaking fluid or bleeding. Some people suffer from this condition when dry AMD progresses over time. Since it is a serious condition causing loss of vision permanently, it requires the immediate attention of the eye doctor.

Juvenile Macular Degeneration

When you hear the name, you can confuse it for the subtype of AMD. But, juvenile macular degeneration is not a subtype of AMD. Also known as Stargardt’s disease, this is a separate disease. Stargardt’s disease is inherited from parents. So, children whose parents carry gene mutations related to Vitamin A processing in the eye can suffer from the disease. While the parents may not suffer from the disease due to carrying recessive genes, their children can suffer from it.

Stages Of Macular Degeneration

You can classify age-related macular degeneration (AMD) into three distinct stages. Each stage may or may not have symptoms. But, a comprehensive eye examination detects the problem:

Early AMD

During the initial stages of macular degeneration, an affected person may not observe any symptoms like vision loss. But, these symptoms are easy to detect during a comprehensive eye exam. So, you can detect it when you schedule a routine eye examination with an ophthalmologist. The ophthalmologist can detect the yellow deposit below your retina. With early detection, you can get the necessary treatment to slow the progression of the disease and avoid its complications.

Intermediate Stage AMD

In the middle stages of the disease, you can experience some vision problems or loss. But, it is not drastic. So, it does not alarm the affected individual. When you get the eye test, it can detect changes occurring in the retina.

Late Stage AMD

It is the final stage and affected people begin to observe the central loss of vision.

Symptoms Of Macular Degeneration

When do you realize you suffer from the disease? Unfortunately, you may not see any signs during the initial stage of the disease. As it is a progressive disease, your symptoms worsen over time. So, as the disease progresses, you notice vision changes. The condition can affect both eyes at the same time. As mentioned above, you classify the condition as dry AMD and wet AMD. Here are the symptoms associated with the two conditions:

Symptoms Dry Macular Degeneration

People suffering from dry macular degeneration can experience the following signs or symptoms:

• A reduced central vision
• Observe a bend of the straight line in the field of vision
• The need for brighter lights to see properly
• Trouble adapting your eyes to low lights
• Blurred vision
• Difficulty in recognizing people’s faces

Symptoms Of Wet Macular Degeneration

While some of the symptoms associated with wet AMD resembles that of dry AMD like reduced central vision and visual distortions. But, other symptoms can also appear like:

• Hazy vision
• Develop a blurry spot in the field of vision
• Rapid worsening of symptoms

Both wet and dry AMD cause no issues to your peripheral vision. While the condition never causes complete blindness, it prevents your direct vision. So, you are unable to see things present directly in front of your field of vision.

Causes Of Macular Degeneration

The exact reason why some people develop AMD and others never develop it remains unclear. But, here are some of the causes linked to the vision problem:

Causes Of Dry Macular Degeneration

With advanced age, you can detect little white spots in your retina. These small spots are known as drusen. You can suffer from oxidative stress, which results in the condition. Oxidative stress is referred to as the imbalance caused by the highly reactive oxygen-containing molecules. These molecules can negatively interact with the other molecules present in your cells. So, it affects your body’s ability to neutralize the oxygen molecules. You can suffer from oxidative stress due to several underlying causes like a poor diet with insufficient antioxidants, exposure to bright lights, and high levels of iron present in the retina. The condition can cause inflammation, which can contribute to several diseases, including AMD.

Causes Of Wet Macular Degeneration

Wet AMD is the advanced and the last stage of the condition. You develop it when abnormal cells grow behind the choroidal neovascularization (macula), the center portion of the retina.

Fluid leaks and vision is distorted. Bruch’s membrane is damaged, new, abnormal blood vessels can invade the retina in a type of healing response gone wrong. These blood vessels leak blood and fluid into the retina, causing it to become wet. This fluid in the retina immediately disrupts vision and, over time, can lead to damaged retinal scar tissue.

Risk Factor Associated With Macular Degeneration

You may have seen some people suffering from macular degeneration compared to others. The risk factors increasing your chances of developing AMD are:

• • Advanced age (people above 65 years)
  • Race and ethnicity (Whites people suffer the highest risk of developing AMD while African-Americans have the least risk)
  • Hereditary (people with a family history of AMD)
  • Exposure to cigarette smoke
  • High blood pressure

 

• Excess body weight
• Suffering from cardiovascular problems

Diagnosing Macular Degeneration

Macular degeneration is hard to detect in the early stages as your vision appears normal. You need annual eye exams even when you feel the vision appears normal. Make an appointment with the doctor when you see any changes in the vision. To detect the actual problem, you need to undergo several tests. Here are the diagnostic techniques used to confirm the problem:

Eye Examination To Detect Macular Degeneration

Your doctor performs a preliminary eye examination by using special eye drops. It dilates the eyes and helps your ophthalmologist check the back of the eye for symptoms of yellow deposits, blood, or fluid. The doctor uses a special instrument to examine the back of the eye. During the exam, the eye doctor also checks for mottled appearance. It occurs due to the presence of drusen or the yellow deposit forming under your retina. In the majority of the people suffering from AMD, doctors find the presence of drusen.  The doctor can suggest other tests based on the initial assessment.

Amsler Grid Test

So, you need to look at a grid. When you are unable to see the grid properly as it appears broken, distorted, or faded, then it means you are suffering from macular degeneration.

Fluorescein Angiography

 

This test is used to detect the presence of abnormal blood vessels or the changes in the retina. During the diagnostic test, your doctor injects a colored dye. It is injected into the vein in your arm. This dye travels to your blood vessels in the eye and highlights it. Using a special camera, your doctor several pictures. It captures the photos of dye traveling through the blood vessels.

Indocyanine Green Angiography

Just like the above-mentioned diagnostic test, this test also uses an injected dye. Your doctor usually suggests this test confirms the diagnosis of fluorescein angiography. It is also used to identify any specific type of AMD.

Optical Coherence Tomography

This noninvasive imaging test displays detailed cross-sectional images of the retina. It identifies areas of retina thinning, thickening, or swelling. These can be caused by fluid accumulations from leaking blood vessels in and under your retina.

Complications Associated With Macular Degeneration

Macular degeneration is a progressive condition. Without treatment, the condition escalates and causes severe complications. Here are some of the complications associated with the condition:

Vision Loss

Due to vision loss, you fail to perform regular activities. With the progression of the disease, your eyesight is affected and results in difficulty to drive, read, or complete other regular activities.

Depression

When you lose vision, it makes you feel anxious and depressed. A small percentage of people (around 30%) who suffer from AMD can experience mental issues. So, AMD can affect your mental health, which affects their normal life. People observing such symptoms of mental health issues need to seek assistance from the doctor to deal with such problems. You need medications, counseling, or a support group to get tips to deal with vision impairments.

Trouble Driving Car

People with AMD find it difficult or unable to drive a car. You cannot see other vehicles directly in front of you. So, people who suffer from AMD need to undergo a complete vision test at regular intervals to ensure you are capable of driving a car.

One Of The Complications Of Macular Degeneration: Vision Hallucinations

Macular degeneration can cause visual hallucinations. It is a complication affecting one in ten people suffering from the AMD. These complications occur due to low vision stimulation. When your vision decreases, then your brain tries to compensate for the loss by creating false images. This is referred to as visual hallucinations. But, it is not a mental health problem. You need to discuss the condition with your eye doctor. Support groups are also available who offer you tips to cope with the condition.

Treatment For Macular Degeneration

Remember, you have no permanent cure available for AMD. With proper care and medical treatment from a doctor, you can slow the progression of the disease and prevent vision loss.

Treatment For Dry Macular Degeneration

For dry AMD, your doctor suggests steps to prevent the escalation of the disease. Early detection is essential to prevent severe vision loss. Here are some of the treatment options available:

Lifestyle Changes

You need to stop smoking as it increases the risk of AMD worsening. A healthy diet and taking Vitamin D supplements is beneficial.

Low Vision Rehabilitation

AMD does not affect your peripheral (side) vision. So, it does not cause total vision loss. As it affects your central vision, it reduces or eliminates your vision in the center. So, it becomes difficult to read, drive vehicles, or recognize faces of people. So, eye doctors work with a low vision rehabilitation specialist along with occupational therapists to train affected people to adapt to the changing vision. The specialists find different ways you can live your life with a low vision.

Surgical Implantation Of Telescopic Lens

In some selected number of people suffering from advanced stages of dry AMD in both eyes, the doctor suggests surgery to implant a telescopic lens. It is effective in improving the vision. The eye surgeon uses a telescopic lens. The lens looks like a tiny plastic tube, but it has lenses effective to magnify the field of vision. The implanted lens can improve your close-up and distance vision. The downside of the surgery is the narrow field of vision. But, this surgery is effective for people in an urban environment as it helps identify street signs.

Treatment For Wet Macular Degeneration

If you suffering from wet AMD, then get immediate assistance from an ophthalmologist. The eye specialist can suggest working with a low vision rehabilitation specialist for better outcomes. Because at this stage, you suffer from vision loss. Here are some of the treatment options available:

Photodynamic Therapy For Macular Degeneration

When you suffer from wet macular degeneration, photodynamic therapy can offer results. During the treatment, the doctor injects medication in the veins in the arm. After that, a special laser is used to close the blood vessel lea. While photodynamic therapy can improve your vision, you need multiple treatments to get results.

Photocoagulation Therapy

Photocoagulation is another treatment suggested for wet AMD. The treatment destroys abnormal blood vessels using high-energy laser beams. So, using the treatment, it is possible to stop bleeding and prevent further damage occurring to the macula. However, you need to know the side effects associated with the treatment. Laser treatment can cause scarring. So, the chances of the treatment leaving a blind spot on your eye are high. Unfortunately, even with successful treatment, the chances of regrowth of abnormal blood vessels are high. Therefore, you need to return to the doctor for another treatment.

Preventive Tips To Avoid Macular Degeneration

Scientists have not yet uncovered the exact method to prevent macular degeneration. But, you can take some effective steps to slow down vision loss caused due to the condition. A good and healthy lifestyle is important to avoid issues with vision in the future. These steps can slow down vision problems in people who have received a dry AMD diagnosis and prevents it from escalating to wet AMD.

Avoid Smoking

Smoking is injurious to your health. If you are thinking about lung or mouth cancer, then the habit increases the risk of AMD. So, smoking can lead to blindness. Smokers are at high risk of developing AMD compared to non-smokers. Try to quit smoking. But, if you are not able to quit the habit, then get assistance from your doctor to kick the bad habit.

Choose A Good Diet

For better eye health, you need to include fresh fruits and vegetables. The antioxidants vitamins in vegetables and fruits reduce the risk of developing AMD. So, include a diet rich in a variety of vegetables and fruits. Here are some of the tips you can follow:

Fresh Vegetables

• Try to include the following antioxidant vegetables like:
• Broccoli
• Spinach
• Kale
• Squash
• Green leafy vegetables
• Brussels sprouts

Including vegetables containing zeaxanthin and lutein also benefits people with AMD.

Foods Containing Zinc

You need to include zinc in your diet as it is known as the helper molecule or trace mineral. It plays a significant role in transferring Vitamin A from your liver to the retinal part. Then, it produces melanin, which forms the protective pigment in your eyes.

Non-Vegetarian Foods Containing Zinc To Avoid Macular Degeneration

You can include the following foods to overcome vision loss like:

• Lamb
• Pork
• Beef

Vegetarian Foods Options Containing Zinc

You also have the non-meat options of food items containing high levels of zinc. Here are some of the options:

• Cheese
• Milk
• Yogurt
• Whole-wheat bread
• Whole-grain cereals

Eat Omega-3 Fatty Acids

Studies indicate that including a diet rich in omega-3 fatty acids will lower the risk of AMD. So, you can consume the following that contains high amounts of omega-3 fatty acids like:

• Salmon
• Walnuts
• Tuna

But, this benefit is not available when you take supplements like fish oils pills that contain omega-3 fatty acids.

Manage Underlying Medical Conditions

It is important to manage any underlying health condition that increases the risk of AMD. So, if you suffer from high blood pressure or cardiovascular disease, then you need to follow the instructions provided by the doctor. You have to take steps to lower your blood pressure. Also, you need to manage your cholesterol levels. Cholesterol is the fatty substance accumulating in the blood vessels. So, it prevents proper blood flow needed to maintain the health of your eye tissue. Several studies indicate that controlling cholesterol can protect you from AMD.

Use Eye Accessories

You need to protect the eye from harmful sun rays to avoid vision loss or AMD. Cumulative eye damage caused by overexposure to sunlight can result in AMD. So, you need to protect your eyes from both ultraviolet (UV) rays and high energy visible (HEV), which is also known as blue light. Wear sunglasses with UV ray protection while going out to prevent such damage.

Maintain A Healthy Weight

According to recent studies, obesity is one of the risk factors of AMD. Excess body weight can cause high cholesterol, high pressure, and high blood sugar levels. So, to reduce the risk of AMD, you need to maintain a healthy weight. Include exercise in your routine. It will help you lose weight and maintain your BMR. Weight loss is achieved when you spend more calories compared to the calories you consume. So, consume fewer calories and increase the number of calories you spend with exercise.

Schedule Routine Eye Examination

With early intervention, you can prevent AMD from affecting your vision. In some cases, early medical assistance can reverse vision problems. So, you need to ask the doctor regarding the schedule for eye examination and the follow-ups. Between checkups, you can perform a self-assessment of your vision a home. You can use an Amsler grid to perform the assessment. Follow the steps suggested to detect if your condition escalates to wet AMD, which needs prescription drugs for managing it.

While you have no sure method to prevent AMD. With better care and medical assistance, you can slow the progression of the disease. It minimizes vision loss and associated complications.

Conclusion

When you suffer from macular degeneration, early intervention can avoid severe complications. The condition may not cause complete vision loss. But, you will experience poor central vision. It may not affect your day-to-day life or activities. Without treatment, this condition results in the wet form of AMD. This is a more severe form of the condition, leading to irreversible blindness. But, this severe condition, may not affect your quantity of life. It only affects the quality as it decreases your ability to see and observe things around you. With early intervention and prevention tips, you can restrict its complication. Follow the instructions as well as the recommendation of your ophthalmologist to avoid any issues. Routine eye tests and timely treatments can slow the rate of vision loss. With better medical care, you can enjoy improved vision.

References

What is Macular Degeneration?

https://www.webmd.com/eye-health/macular-degeneration/age-related-macular-degeneration-overview#1

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