What is macular degeneration?
Macular degeneration, also known as age-related macular degeneration (AMD), is a progressive eye disease affecting 10 to 15 million Americans. It is the leading cause of vision loss in people older than 55. In fact, it is responsible for more vision loss than glaucoma and cataracts combined. Signs and symptoms of macular degeneration include blurry vision, blank spots in your central vision, and more pronounced vision loss in dim light compared to bright light.
The macula is a critical visual zone within the retina, or light-sensing part of the eye, that is responsible for your central (reading) vision. Macular degeneration results from aging and changes to the cells that lie beneath the macula. With normal age, waste products from the pigmented cells beneath the retina, along with fats and proteins, collect under the macula. These yellow deposits are called “drusen.” Multiple, large drusen are a clinical sign of macular degeneration. Drusen reduces the amount of oxygen and nutrients that get to the macula, so light-sensing cells start dying off. Loss of macular function causes loss of central, or “straight-ahead” vision. Macular degeneration does not affect your peripheral vision.
Both genetic and lifestyle factors may contribute to aging and deterioration of the macula. It tends to run in families, suggesting it is hereditary and genes play a role in AMD. Other risk factors include excess weight, high blood pressure, and high cholesterol.
Living a healthy lifestyle, eating nutrient-dense food (or taking supplements), and managing any underlying risk factors may help prevent macular degeneration. They can also help slow the disease once you show signs of macular degeneration during an eye exam. In later stages of disease, known as “wet” macular degeneration, injecting medication into the eye and laser surgery may help preserve your vision.
What are the different types of macular degeneration?
There are two types of AMD: dry and wet. Dry AMD is more common. Vision loss from dry AMD tends to be gradual and less severe than wet AMD.
Dry AMD is the stage of macular degeneration where changes in the macula—the center of the retina—are visible during an eye exam. The macula may appear thinner than normal. An eye doctor can measure the loss of light-sensitive cells and pigment under the retina over time. There will also be many large deposits of fat (lipids), proteins, and waste products, known as drusen, under the macula in someone with dry AMD. With a retinal exam, an eye specialist can visualize, photograph, and document these changes.
Dry AMD may progress to wet AMD, even without noticeable symptoms. In response to the loss of light-sensitive cells, new blood vessels grow under the macula, leaking fluid or blood. This is “wet” macular degeneration, or exudative AMD. The fluid gets into the retina and damages cells. This causes blurry vision and scars the macula, disrupting vision more. Vision loss with wet AMD tends to be rapid and severe. Wet AMD affects about 10% of people with AMD.
What are the symptoms of macular degeneration?
In the early stages, symptoms may not be noticeable. As the disease progresses, symptoms appear and worsen over time. Because the macula is responsible for sharp central vision, the symptoms mainly affect central vision clarity.
The symptoms of dry AMD include:
Blurry or hazy vision
Blurry or blank spot in the center of your vision
Dim up-close vision, requiring brighter light to see up close
Loss of brightness or vividness of colors
Trouble adjusting from bright lighting to dim lighting
- Trouble recognizing people’s faces
The symptoms of wet AMD include:
Distorted vision where straight lines appear wavy, bent or crooked
Dark spots, blank spots, or complete loss of central vision
Loss of brightness or vividness of colors or colors look different in each eye
Objects appear to be different sizes in each eye or have distorted shapes
These symptoms affect your ability to read, watch TV, do close work, perform daily activities, and safely navigate stairs and other obstacles. See an ophthalmologist right away if you experience any of these symptoms. Early detection can help prevent further vision loss.
What are the stages of macular degeneration?
Macular degeneration progresses in these three stages:
Early macular degeneration is when drusen—deposits of waste products, fat and protein—have collected under the macula. The drusen are not large, and there may be no changes in pigment. People do not typically experience any loss of vision in early AMD.
Intermediate macular degeneration is when there are large drusen, pigment changes, or both. Some people experience symptoms at this stage.
- Late macular degeneration is when there is vision loss. It may be wet or dry, but most people with AMD vision loss have the wet form.
What causes macular degeneration?
Experts do not fully understand what causes macular degeneration in some people but not others. There is a link between age-related macular degeneration (AMD) and the accumulation of metabolic waste products from nearby cells called retinal pigment epithelium. These waste products, along with fats and proteins, form what is known as drusen. With age, deposits of drusen form under the macula. Some people have larger and more numerous deposits; one sign of dry AMD is multiple large drusen under the macula. Macular degeneration may be tied to a metabolic problem in the sensory cells of the retina.
Drusen block the normal flow of nutrients and oxygen to the macula, which results in the progressive loss of light-sensitive cells. These degenerative changes in cell metabolism can trigger abnormal blood vessel growth beneath the retina, causing the “wet” form of AMD. Wet AMD develops much more quickly than dry AMD.
What are risk factors for macular degeneration?
Risk factors for macular degeneration include:
Age; most cases occur in people older than 55
Family history of AMD
Poor diet and sedentary lifestyle
- Uncontrolled high blood pressure or high cholesterol
Can you prevent macular degeneration?
Living a healthy lifestyle can help prevent age-related macular degeneration and preserve your vision if you develop it. The risk of developing AMD is 2 to 3 times higher for smokers, so not smoking or quitting smoking if you smoke will help lower your risk.
Nutritional supplementation most benefits individuals with the intermediate form of AMD. Two of the most important vitamins for vision are lutein and zeaxanthin. They are yellow to red pigments present in the macula, thought to block the oxidative damaging effects of light. Lutein and zeaxanthin are present in many brightly colored fruits and vegetables. Taking lutein and zeaxanthin supplements may help slow the damage to the macula in people with macular degeneration. Lutein and zeaxanthin may also help prevent macular degeneration. The American Optometric Association advises 10 mg lutein and 2 mg of zeaxanthin per day to slow AMD progression. These vitamins may reduce the risk of other chronic eye diseases.
Zinc, omega-3 fatty acids, and Ginkgo biloba may also be beneficial for eye health.
Other prevention tips include:
Controlling blood pressure and cholesterol levels
Maintaining a healthy weight
- Shielding your eyes from the sun
Seeing an eye doctor every year or so will help identify early signs of macular degeneration.
What are the diet and nutrition tips for macular degeneration?
Your macula contains antioxidants called carotenoids, which are red and yellow pigments that protect the cells (photoreceptors) necessary for vision. The primary carotenoids are lutein and zeaxanthin. Eating foods that contain these and other antioxidants can help you maintain eye health as you age, and could slow vision loss if you do have age-related macular degeneration (AMD). There are also foods you should avoid, because they may increase your risk of age-related vision loss.
Best foods for macular degeneration
To protect your vision, focus on these foods in your diet:
- Carrots and colorful vegetables. Carrots are rich in beta-carotene (a carotenoid), the substance that gives carrots their distinctive color. They are also high in vitamin A and antioxidants. Other foods high in beta-carotene include sweet potatoes, cantaloupe, and red and yellow peppers.
- Leafy greens. Vegetables like spinach, kale and broccoli boost the amount of protective pigment around your macula, and can help prevent or slow AMD. Leafy green vegetables are also dense in vitamins (A, B2, B6, C, E and K), potassium and zinc, among others. Some studies have shown zinc to be helpful in delaying the progress of macular degeneration. Taking over-the-counter supplements with zinc could be helpful, but vitamins are usually best for the body if they are ingested through food.
- Eggs. Egg yolks are packed with vision-friendly vitamins, lutein and zeaxanthin.
- Fish and omega-3 fatty acids. There is some evidence that a diet high in omega-3s may reduce the risk of macular degeneration or slow it down if you’ve already been diagnosed.
- High-vitamin C fruits. People at high risk for AMD who take vitamin C, beta-carotene, vitamin E, and zinc may experience slower progression of late-stage AMD. Some of the best sources of vitamin C are citrus fruits. Bananas, apples and peaches also have a lot of vitamin C. Fruits also contain antioxidant carotenoids, so they do double duty for your eyes.
- Lima beans. Lima beans are high in lutein and zeaxanthin, more so than egg yolks. In fact, lima beans are often considered to be one of the healthiest foods we have, packed with nutrients. The healthiest way to prepare them is to boil dried lima beans in water until they’re soft and then use them in soups or in dips, burritos, and more.
- Nuts and nut oils. Nuts and nut oils also contain vitamin E. In one study, researchers found that some patients with early or intermediate macular degeneration saw their disease slow down after consuming a diet rich in nuts. Nuts also improve your cholesterol profile, relax your blood vessels, and help control sugar levels if you have prediabetes. The healthiest nuts are almonds, cashews, pistachios, and macadamias.
- Whole grains. Brown pasta and breads and other whole grains are a good source of vitamin E (as are eggs, green leafy vegetables, and fruit). The human body doesn’t produce vitamin E, so it’s important to choose foods that will provide it. Some research has found that vitamin E helps eye health overall, from reducing the formation of cataracts to slowing down the progress of macular degeneration.
Worst foods for macular degeneration
To protect your vision, avoid these foods:
- Saturated fats and sugar. An unhealthy diet has been linked to a higher risk of wet macular degeneration. Junk foods contain monounsaturated and polyunsaturated fats, which over time damages blood vessels and reduces the amount of healthy blood reaching your eyes (and other organs). If you eat a lot of processed food, including fast food, work on breaking the habit, one day at a time.
- Partially hydrogenated cooking oils. Found in coconut and palm oil, this type of fat is as bad for your cardiovascular system as excess saturated fat in your diet. Olive, canola and avocado oil are better choices for cooking, because they have anti-inflammatory properties, which is good for your arteries.
The important thing to remember is there is no one nutrient that will protect you from macular degeneration, but rather a combination of nutrients. Ask your healthcare provider for nutritional guidance if you are struggling with changes in your diet. He or she may refer you to a dietitian for nutrition counseling, which is covered under insurance in some cases.
What are some conditions related to macular degeneration?
Macular conditions other than age-related macular degeneration include:
- Cone dystrophy, due to loss of cone cell function in the retina
- Diabetic macular edema, due to abnormal blood vessel growth that damages the macula
- Macular dystrophy, a group of rare inherited conditions, including Stargardt disease
- Macular hole, a shearing injury to the retina caused by changes to the clear vitreous gel
- Myopic macular degeneration, which is linked to severe nearsightedness (myopia, where you can see close up but not far away)
- Retinal vein occlusion, which causes blood and fluid to seep into the retina and damage it
How do doctors diagnose macular degeneration?
An eye doctor can detect early signs of macular degeneration—changes in the macula—by examining the retina. The retina is the structure at the back of the eye, so the doctor uses special techniques and instruments to evaluate the health of the retina. More specifically, your doctor will perform special imaging studies to examine the deepest layer of the retina, the retinal pigment epithelium, for signs of disease and whether you have dry or wet age-related macular degeneration (AMD).
Your doctor will ask about vision problems you are experiencing, such as blind spots, blurry central vision, and the need for more lighting to see well.
Your eye doctor may start the exam with a visual acuity test to evaluate how well you see, including in bright and low light, and your field of vision, such as central vs. peripheral vision. Your doctor will also have you look at an Amsler grid. This is a checkerboard-like grid to determine if the straight lines in the pattern appear wavy or missing to the patient—both indications may signal the possibility of AMD. (Doctors also use it for other macular conditions.)
Macular degeneration tests include retinal imaging to evaluate the health of the retina and blood vessels. Imaging tests include:
Dilated eye exam, using eye drops to open the pupil. This allows more light to get to the back of the eye, so the doctor can more clearly see its structure.
Optical coherence tomography (OCT), which is a 3D scan of the eye that measures the thickness of the retina (including the macula). For this test, you look into the eyepiece of the scanner. Light passes over your eye as the scanner captures images and sends them to a computer. Pupil dilation is not necessary.
Fluorescein angiography (FA), specifically for diagnosing wet macular degeneration. FA may also be used to plan and perform certain eye procedures.
Fundus autofluorescence (FAF), which detects naturally fluorescent substances in the retina. The “fundus” refers to the interior of the eye visible from the pupil. FAF examines the retinal pigment epithelium.
- Fundus photography, which captures 30- to 50-degree views of the retina and optic nerve. It also can detect blood buildup in the eye. This test involves looking into an eyepiece as your doctor views your eye from the other side of the specialized camera.
Macular degeneration self-monitoring
If you are at risk for developing macular degeneration or in the early stages of it, your doctor may send you home with a handheld paper Amsler grid test.
What are the treatments for macular degeneration?
Unfortunately, there is no treatment or cure for dry age-related macular degeneration (AMD). It is not possible to restore vision loss from this common form of AMD. But finding it early can help you take steps to keep it from getting worse. And nutrition is a key step. Your doctor will likely recommend a diet high in antioxidants and vitamin supplements that may slow the progression of AMD. Other lifestyle changes may also be necessary. This includes quitting smoking, losing weight, and controlling blood pressure and cholesterol levels as needed.
There are treatments available for wet AMD. When prescribed early in the disease, these treatments may restore vision loss. Once scars form beneath the macula, treatments can’t restore vision loss but they can stop or slow its progression. These treatments include:
Laser therapy to destroy the abnormal blood vessels under the macula
Photodynamic therapy (PDT) also destroys the abnormal blood vessels. PDT uses a light-sensitive drug and a laser to activate the drug within the abnormal blood vessels.
- Anti-angiogenesis drugs that slow the growth of abnormal blood vessels and prevent them from growing back after laser therapy or PDT. Your ophthalmologist painlessly injects these drugs directly into your eye. Common medications target VEGF, for vascular endothelial growth factor. These include aflibercept (Eylea), bevacizumab (Avastin), brolucizumab (Beovu), and ranibizumab (Lucentis).
Rehabilitation can teach you to make the most of your vision and deal with vision loss. There are a variety of devices and technologies that can help you adjust to low vision and maintain your independence. Talk with your doctor about low vision services near you.
How does macular degeneration affect quality of life?
Vision impairment due to macular degeneration is associated with reduced quality of life, limiting social activities and independence. One study revealed that even mild to moderate vision impairment had negative effects on nearly all aspects of daily activities, including reading, leisure activities, and shopping. Study participants reported emotional reactions to vision loss, as well as concern about worsening vision and coping with life. Several studies have shown that age-related macular degeneration is associated with emotional distress and depression.
Coping tips for macular degeneration
People with advanced macular degeneration and vision loss can benefit from adaptive technologies to help them function more easily and independently, such as installing good lighting in the home. There are many different types of low vision aids for people who cannot see well.
Since macular degeneration can increase the risk of falls, remove fall hazards from the living space as well. Secure electrical cords, remove rugs or tack them to the floor, and install railings and lights at all steps.
It also helps to create a circle of supportive and understanding friends and family. As with any chronic condition, acknowledging your limits and asking for help are key to improving your overall well-being. Professional counseling may help treat vision-related depression.
If you have macular degeneration, ask your doctor for a referral to a low vision service provider, such as an occupational therapist. Setting up arrangements will help you prepare and may lessen any anxiety you have about future vision loss.
What are the potential complications of macular degeneration?
The most serious complication of macular degeneration is blindness. It does not cause complete blindness, but people with late-stage, or wet age-related macular degeneration have difficulty reading, recognizing faces, reading, and driving safely. People who cannot see better than 20/200 with corrective lenses or glasses are legally blind in most states. Wet age-related macular degeneration increases the risk of hemorrhage (bleeding) and retinal detachment.
Complications of low vision and blindness include:
Injury from falls and fractures due to poor vision
- Visual hallucinations (Charles Bonnet syndrome), which is rare