Introduction

Photo of couple taking a walk on the beach (PantherMedia / Nils Weymann) It is normal for vision to gradually worsen with age. Some people also have medical conditions that further affect their vision or may even lead to blindness. One possible cause of worsening vision is age-related macular degeneration (AMD).

AMD is a chronic condition that usually affects both eyes and is brought about by a metabolic disorder. It develops in the macula, the part of the eye especially important for seeing sharp images. Vision loss usually only occurs as a result of a more advanced form of AMD. There are two types of AMD: “dry” and “wet.” Wet AMD causes vision loss more quickly. Neither can be cured. But treatment for wet AMD can help to keep and sometimes even improve vision, or at least slow down the progression of the disease.

Symptoms

Macular degeneration causes the gradual loss of central vision in the part of the eye where we see things in sharpest detail. This area is at the center of the retina and takes its full Latin name from its yellowish color (“macula lutea,” meaning “yellow spot”). This is the type of vision we need to read, drive a car or recognize faces.

Central vision loss makes objects appear blurry and distorted when you look at them directly. In advanced AMD people can no longer see them at all. Although objects towards the edge of your field of vision usually remain visible, it is difficult to see what they are.

Causes and risk factors

The causes of age-related macular degeneration are not fully understood. AMD is believed to result from an imbalance in the metabolic processes that take place in the sensory cells of the retina. These processes produce by-products that are usually broken down by the body. But if the body cannot break these substances down, small deposits called drusen start to form. These deposits prevent enough oxygen and nutrients from reaching the retina. In the dry form of AMD, the light-sensitive cells in the retina die off as a result. The pigments underneath the retina may also change.

In wet macular degeneration, new blood vessels start growing underneath and in the retina as a reaction to the deposits. As the vessels grow they can lift the retina. They may also become “leaky,” allowing blood and fluid to seep into the retina, damaging the cells there.

Your individual risk is somewhat greater if close relatives already have AMD. It is also known that AMD is more common in people who smoke, and they tend to get it at younger ages than non-smokers. Frequent exposure to the sun may also possibly increase the risk, but this is not certain.

Prevalence

AMD is more common in older people: about 1 out of 100 people between the ages of 65 and 75 have age-related macular degeneration, and as many as 10 to 20 out of 100 people over the age of 85 are affected.

Most people with advanced AMD have the wet form of the condition. In industrialized countries, macular degeneration is the most common cause of severe vision loss in older people.

Outlook

The course of AMD is different in different people. There are three stages:

  • Early-stage AMD: Medium-sized drusen deposits and no pigment changes, no loss of vision.
  • Intermediate AMD: Large drusen and/or pigment changes. There may be mild vision loss, but most people do not experience any problems.
  • Late-stage AMD: Dry or wet macular degeneration causing vision loss.

Dry AMD progresses much more gradually than wet AMD, and it is also less likely to cause vision loss or other vision problems.

The time it takes for the disease to progress to late-stage AMD with vision loss depends, among other things, on the size of the deposits that have formed in the retina. About 1 to 3 out of 100 people with small drusen experience vision problems within five years, and about 50 out of 100 people with larger drusen have late-stage AMD and vision loss within five years.

Dry AMD can turn into wet AMD, which quickly worsens if left untreated but can be stopped or slowed down by various treatments.

People with late-stage AMD may lose the ability to read or recognize faces. AMD does not usually cause complete blindness. Even at a very advanced stage of AMD in both eyes it is usually still possible to find your way around. But the overall vision loss can be so severe that it meets the legal definition of “blindness,” for which the German health care system guarantees monthly disability benefits.

Diagnosis

The eye doctor will first ask about symptoms and any other medical conditions. Then your eyes will be closely examined using a microscope with a light on it, called a slit lamp, to look at the front and middle sections of your eye. The fundus (the inside of your eye across from the lens) is also checked. Before the examination, eye drops are used to dilate your pupils. Different types of tests can help get an idea of how much your central vision has been affected.

Other tests can confirm the diagnosis and help to plan treatment. If the doctor thinks you have wet AMD, fluorescein angiography can be used. This involves injecting a dye solution into a vein in your arm. The solution is carried to the blood vessels in the retina. A special camera can then be used to detect changes in these vessels.

Optical coherence tomography (OCT) is another test that may be used. OCT measures the thickness of the retina with light from a laser and detects any fluid-filled pockets. In Germany this test is offered as an individual health care service (IGeL). It is not yet covered by the statutory health insurers because its advantages and disadvantages compared with the other types of tests are still being assessed.

Prevention

Not smoking lowers your risk of developing macular degeneration.

Dietary supplements are sometimes recommended to prevent AMD. The recommended supplements include beta-carotene, vitamins, zinc, omega-3 fatty acids and Ginkgo biloba. Research has shown that vitamin E and beta-carotene are not able to prevent macular degeneration in otherwise healthy people. The other supplements have not been tested in studies involving healthy people.

Treatment

There is currently no effective treatment for dry macular degeneration.

Wet AMD is typically treated with medicine that is injected into the eyeball to prevent blood vessel growth. This medicine is known as anti-vascular endothelial growth factor (anti-VEGF). Although this treatment cannot cure AMD, it can stop or at least slow down the progression. Sometimes vision even improves during treatment.

Photodynamic therapy is less effective, and therefore no longer that common. Laser therapy is also only rarely used. It involves heating and destroying abnormal blood vessels with laser beams. Photodynamic therapy applies a combination of medication and laser beams. Both of these therapies are only very rarely suitable for treating wet AMD. They also have more side effects than anti-VEGF therapy.

In some exceptional cases and when no other treatment has helped, abnormal blood vessels may be removed surgically.

Dietary supplements containing a combination of different ingredients (vitamin C, vitamin E, zinc, copper, and lutein with zeaxanthin or beta-carotene) may be able to slow the progression in people who are at greater risk of developing late-stage AMD.

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Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?”

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