Advanced Macular Degeneration Caused by Aging Processes
In the realm of age-related macular degeneration (AMD), two main types - dry and wet AMD - present unique symptoms, causes, and treatment options.
Dry AMD, also known as atrophic AMD, progresses slowly and gradually over many years. It begins with the accumulation of drusen, tiny yellow deposits, under the macula, leading to thinning of the macular tissue and gradual vision loss, often initially mild or unnoticed. In contrast, wet AMD, or neovascular AMD, can cause rapid and severe vision loss within weeks or months due to the sudden growth of abnormal blood vessels beneath the retina that leak blood and fluid, damaging the macula quickly.
The causes of these two conditions differ significantly. Dry AMD arises from the build-up of drusen and thinning of retinal cells, while wet AMD develops when abnormal, fragile blood vessels grow under the retina and macula, breaking and leaking fluid or blood.
Treatment options also vary. Dry AMD currently has no cure, but its slow progression gives time for protective actions such as lifestyle changes and monitoring. On the other hand, wet AMD requires prompt treatment - such as anti-VEGF injections - to halt the growth of abnormal vessels and prevent rapid vision loss; delayed treatment can lead to irreversible damage.
All wet AMD cases develop from dry AMD, but not all dry cases become wet. Once wet AMD develops, it does not revert to dry AMD.
For late-stage dry AMD, an option is the use of an implantable miniature telescope (IMT), a procedure involving the placement of a tiny telescope in one eye by surgeons. Regular comprehensive eye exams can detect macular degeneration before it causes vision changes.
In the intermediate stage, a person may notice mild blurriness in their central vision or difficulty seeing in low light. For intermediate dry AMD, the Age-Related Eye Disease Studies 2 (AREDS2) supplement may be recommended.
Factors that may increase the risk of developing dry AMD include smoking, having high blood pressure, having a family history of AMD, obesity, an unbalanced diet, being white, and being female.
In addition to nutritional supplements, doctors have other treatment options to prevent further vision loss in wet AMD, including drugs that can be injected into the eye and photodynamic therapy. A doctor may recommend using an Amsler grid at home to monitor for vision changes.
Early treatment for dry AMD involves lifestyle changes such as quitting smoking, adopting a balanced diet high in antioxidants, getting regular exercise, managing high blood pressure, and attending regular appointments with an ophthalmologist. Blurry vision is often the first sign of AMD.
Doctors divide dry AMD into three stages: early, intermediate, and late, each with different symptoms. To diagnose AMD, an ophthalmologist performs a comprehensive eye exam that includes an eye chart test, autofluorescence, a dilated eye exam, fundoscopy or ophthalmoscopy, fundus photography, optical coherence tomography (OCT), and may also use a specialized camera to photograph the back of the eye.
There is no cure for AMD, but treatment can slow the progression of the disease. It is important to begin treatment as early as possible to preserve vision. Vision rehabilitation is a type of support for people with more advanced vision loss, helping them learn how to live with changes to their vision. People with dry AMD may need to adapt to changes in their vision, such as blurriness, and may find it helpful to use brighter lights, a magnifying glass, or anti-glare sunglasses.
The Food and Drug Administration (FDA) has approved several medications for treating advanced forms of dry macular degeneration. In the early stage of dry AMD, a person experiences no symptoms. In 10-15% of people with dry AMD, the disease progresses to the wet form, which is more serious and can lead to severe vision loss. In the late stage, a person can have a variety of symptoms, including one or more blurred or blank areas toward the center of their vision, straight lines appearing wavy or wonky, and colors appearing less bright.
Sources: [1] American Academy of Ophthalmology. (2021). Age-Related Macular Degeneration. https://www.aao.org/eye-health/diseases/amd-macular-degeneration [2] National Eye Institute. (2021). Age-Related Macular Degeneration (AMD). https://nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/age-related-macular-degeneration [3] Mayo Clinic. (2021). Age-Related Macular Degeneration. https://www.mayoclinic.org/diseases-conditions/macular-degeneration/symptoms-causes/syc-20355412 [4] Macular Society. (2021). Dry AMD. https://www.macularsociety.org/information/dry-amd/ [5] BrightFocus Foundation. (2021). Age-Related Macular Degeneration. https://www.brightfocus.org/macular/understanding/what-is-macular-degeneration
- For people dealing with dry AMD, making lifestyle changes such as quitting smoking, adopting a balanced diet high in antioxidants, and getting regular exercise can be beneficial.
- Although there is no cure for age-related macular degeneration (AMD), prompt treatment for wet AMD can halt the growth of abnormal vessels and prevent rapid vision loss.
- In comparison to dry AMD, wet AMD can cause rapid and severe vision loss within weeks or months due to the sudden growth of abnormal blood vessels beneath the retina.
- Regular comprehensive eye exams can help detect AMD in its early stages, before it causes vision changes, allowing for early treatment and possible prevention of further vision loss.
- Doctors may recommend nutritional supplements, drugs that can be injected into the eye, or photodynamic therapy to prevent further vision loss in wet AMD.
- Skin conditions like psoriasis and rheumatoid arthritis, both autoimmune disorders, can increase the risk of developing dry AMD according to certain studies.
- Regular eye chart tests, autofluorescence, dilated eye exams, and fundus photography are common methods used by ophthalmologists to diagnose AMD.
- Chronic diseases like type-2 diabetes, COPD, chronic kidney disease, and heart diseases can also increase the risk of AMD, making workplace-wellness programs focusing on medical-conditions and cardiovascular-health vital.
- In addition to AMD, therapies and treatments for other chronic diseases can have an impact on eye-health, hearing, mental-health, skin-care, and digestive-health.
- Fitness-and-exercise, nutrition, and mental-health strategies are fundamental components of a holistic approach to health-and-wellness, focusing on the prevention and management of chronic diseases and chronic conditions.
- With early detection and treatment, people with AMD can preserve their vision and even learn to adapt to changes in their vision through vision rehabilitation programs.
- In the intermediate stage of dry AMD, an Amsler grid may be used at home to monitor for vision changes and the Age-Related Eye Disease Studies 2 (AREDS2) supplement may be recommended.
- For those with late-stage dry AMD, an option is the use of an implantable miniature telescope (IMT) after evaluating the potential benefits and risks with a doctor.
- Symptoms of late-stage dry AMD can include one or more blurred or blank areas toward the center of a person's vision, straight lines appearing wavy or wonky, and colors appearing less bright.
- Incorporating skin-care routines, dealing with mental-health challenges, and seeking therapies and treatments for chronic-diseases—all while maintaining a balanced diet, regular exercise, and regular eye exams—can contribute to a person's overall health-and-wellness for years to come.
