How to Minimize the Effects of Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is a leading cause of vision loss among individuals aged 60 and above. This painless condition affects the macula, the part of the retina responsible for central vision. The macula helps you with reading, driving, recognizing faces, and viewing other images. Although there is no cure for AMD yet, you can lessen its impact through lifestyle changes, eye care therapies, and other preventive measures.

Learn about the stages of AMD. An ophthalmologist will assess which stage of AMD you are in based on the number of drusen in your eyes. Drusen are yellow or white deposits that accumulate on the retina.

• Early stage: Drusen is medium-sized, about the diameter of a hair, and vision remains unaffected.
• Intermediate stage: Drusen becomes larger and/or pigment changes occur; vision loss is not common at this stage.
• Late stage: This stage has two types:
  • Dry macular degeneration: The cells responsible for light sensitivity in the macula get damaged, and the eye can no longer use light to transmit images to the brain. You may gradually lose vision as the disease progresses.
  • Wet macular degeneration: This condition involves abnormal blood vessel growth, leading to swelling and rupture. Fluid accumulates within and beneath the macula, altering vision. Wet AMD progresses faster than dry AMD.

Understand the Development of 'Dry' Macular Degeneration. Dry macular degeneration occurs due to the degeneration of retinal cells. The deterioration or death of these cells, along with a lack of fluid, is why this condition is called 'dry' macular degeneration. These cells, known as light-sensitive cells, are responsible for using light entering the retina to help the brain interpret images via the visual cortex. Essentially, the light-sensitive areas allow us to understand the images we see.

• As we age, the accumulation of fatty deposits called drusen at the macula leads to degeneration. Through eye examinations, the presence of drusen is detected as yellow spots at the macula. AMD does not cause total blindness, but it significantly limits central vision.
• Dry macular degeneration is more common than the wet form. The symptoms of dry macular degeneration include:
  • Blurred text.
  • Needing more light to read.
  • Difficulty seeing in the dark.
  • Difficulty recognizing faces.
  • Severely narrowed central vision.
  • Prominent blind spots in the visual field.
  • Gradual vision loss.
  • Confusing geometric shapes or still life images for people.

Learn About 'Wet' Macular Degeneration. This form of AMD occurs when abnormal blood vessels grow underneath the macula. As the macula enlarges, these blood vessels can leak fluid and blood into the retina and macula; in rare cases, they may even rupture the retina and macula. Wet macular degeneration is less common than dry macular degeneration but is a more serious condition that can lead to blindness. The exact cause of wet AMD remains unclear, though many studies have indicated risk factors related to aging. Symptoms include:

• Seeing straight lines appear wavy.
• Developing blind spots.
• Loss of central vision.
• Rapid vision deterioration.
• Painless.
• Scarring forms in blood vessels, which could cause permanent vision loss if untreated.

Be Aware of the Aging Process. Age-related macular degeneration is an age-related disease. The risk of developing AMD increases with age. At least one-third of people over 75 have some degree of AMD.

Understand the Role of Genetics. If your parents, or either of them, have AMD, you are more likely to develop it when you turn 60. However, it's important to remember that genetics do not determine everything, and self-care is equally important.

• In general, women and people of Caucasian descent have a higher risk of developing AMD.

Know that smoking is a high-risk factor. Smokers are at a greater risk of developing this condition. Numerous studies have shown a connection between smoking and macular degeneration. Cigarette smoke also harms the retina.

• If you smoke (especially women or Caucasians), it’s important to be aware of macular degeneration, even if symptoms haven’t appeared yet.

Monitor your health condition. Your overall health status may indicate risk factors for developing AMD. People with high blood pressure or diabetes are at a higher risk.

• Even those who don’t have diabetes but consume a diet high in carbohydrates with a high glycemic index are prone to developing macular degeneration as they age. Remember that blood leaking from retinal blood vessels is a sign of wet macular degeneration. This condition worsens when arteries are blocked due to plaque buildup.

Consider your environment. Do you frequently come into contact with fluorescent light? UV rays from fluorescent lighting are believed to increase the risk of eye diseases. Additionally, the risk can be higher if you live in areas with intense sunlight and your eyes are often exposed to the sun's rays.

Visit an ophthalmologist. An ophthalmologist will diagnose the condition during routine eye exams. The doctor will use eye drops to dilate your pupils. In the case of dry macular degeneration, the doctor can easily detect drusen during the exam.

Test your vision using the Amsler grid. You will be asked to look at the Amsler grid, a chart-like grid. If you notice any lines appearing wavy, you may be experiencing macular degeneration. To check for symptoms, you can print the Amsler grid from the Prevent Blindness website and follow these steps:

• Hold the grid at eye level, about 61 cm away from your eyes.
• Wear reading glasses and cover one eye with your hand.
• Focus on the center point for one minute, and repeat with the other eye.
• If you see any wavy lines, it's important to contact an eye care professional immediately.

Ask your ophthalmologist about ocular angiography. In this procedure, a dye is injected into a vein in your arm. Photos are taken as the dye travels through the veins in the retina. This method can detect leaks, which is a sign of wet macular degeneration.

• 8-12 seconds after the injection, the dye will be visible in the optic nerve.
• 11-18 seconds after the injection, the dye will be visible in the retinal area.

Optical Coherence Tomography (OCT) imaging. This technique uses light waves to observe the layers of the retina. The test can evaluate the retinal thickness, the structure of the retinal layers, and any abnormalities like fluid, blood, or new blood vessels.

• You may have your pupils dilated before the OCT scan, although the OCT can also work without dilation.
• You will place your chin on a chin rest to keep your head still.
• A light beam will be directed into your eye.
• This method uses light waves to capture live tissue images within seconds without causing pain.

Consider anti-VEGF injections. Vascular Endothelial Growth Factor (VEGF) is a chemical that primarily causes the abnormal growth of blood vessels. When this chemical is blocked through anti-VEGF agents, also known as anti-angiogenics, the growth of blood vessels can be inhibited. Your doctor will determine whether this option is appropriate for you.

• Bevacizumab is a common anti-VEGF agent. The typical dose is 1.25 to 2.5 milligrams injected into the vitreous cavity of the eye. These injections are typically done every 4 weeks for 4 to 6 weeks. Other medications, such as Ranibizumab (0.5 mg) and Aflibercept (2 mg), are also used.
• The procedure is performed using a very fine needle, with a local anesthetic to reduce discomfort. Generally, the entire process is not painful, though slightly uncomfortable.
• Side effects may include increased eye pressure, infection, bleeding, or cataract damage.
• Your vision may improve within a year. Improvements can be noticeable after two weeks, with peak results occurring after the third injection.

Learn about photodynamic therapy (PDT). This treatment uses light and a drug to prevent the growth of abnormal blood vessels. PDT can be effective for treating wet macular degeneration.

• This procedure is done in two steps during a single visit. A drug called verteporfin or Visudyne is injected into the vein. It works to stop the growth of blood vessels, a process seen in wet macular degeneration, and is performed 15 minutes before PDT.
• Next, light with the appropriate wavelength is directed at the eye, focusing on the abnormal blood vessels. The light activates the verteporfin injected earlier, closing the leaking blood vessels.
• The light's wavelength is carefully controlled to avoid causing scar tissue that might impair vision.
• Consult your doctor to determine if this method is safe for you. Anti-VEGF is currently the first-line treatment option, and PDT may be used in combination with Anti-VEGF.

Seek medical attention immediately if you experience severe symptoms. Visit the nearest emergency facility or contact your ophthalmologist if you suddenly experience headaches, vision changes, or unexplained pain during treatment.

Use a magnifying glass. When macular degeneration occurs, the central part of your vision is most affected, while your peripheral vision may remain somewhat intact. Therefore, individuals with macular degeneration can still rely on peripheral vision to compensate. A magnifying glass helps by enlarging objects, making it easier for patients to see them.

• Magnifying glasses offer magnification from 1.5 to 20 times. They are compact and portable, making them easy to carry. Many models can be folded to fit in your pocket.
• Consider trying a magnifying glass with a stand. These typically magnify from 2 to 20 times and can stand on their own, so you don't need to hold them. This type is especially helpful for patients with hand tremors. Some magnifying glasses with stands also include a light for use in low-light conditions.

Use a monocular or telescope. This device offers magnification from 2.5 to 10 times and is useful for distant viewing.

Use binoculars. These work similarly to telescopes, providing the same level of magnification, but they allow you to use both eyes to view objects.

Use clip-on magnifying glasses. These magnifiers attach to the patient's eyeglasses and help with distance vision. Clip-on magnifiers allow the patient to switch between distance viewing and telescope vision. There are also clip-on lenses for normal vision.

• This type of magnifier works similarly to bifocals.
• These magnifiers are recognized and prescribed by low vision specialists.

Use a video magnifier. This is a camera-based device that magnifies text on a video screen. You can use this type of magnifier to assist with tasks such as reading, writing, and viewing images. Some models even allow you to underline or bold information. This device can also be connected to a computer.

Use a text-to-speech reader. This machine reads printed text aloud.

• Use Optical Character Recognition (OCR) software to turn your personal computer into a text reader.

Learn about photochromic lenses. These lenses work by absorbing light passing through the eye, reducing glare and harmful ultraviolet rays.

• These lenses can switch between light and dark environments.
• Photochromic lenses can be used on prescription eyeglasses.

Schedule regular eye exams. While age-related factors can't be prevented, macular degeneration can be detected early and treated effectively through consistent eye exams. Early detection can help slow the progression of vision loss.

• Starting at age 40, it is recommended to have an eye exam at least once every six months, or as directed by your ophthalmologist.

Ask your doctor about special eye tests. You should have your ophthalmologist perform specialized eye exams to detect drusen, blood vessel damage, pigment changes in the retina, and other vision disorders. Some common vision tests include:

• Visual acuity test: This test uses a chart to assess distance vision.
• Amsler grid: This test evaluates central vision by having the patient look at a grid to check for straight or wavy lines. If wavy lines are noticed, macular degeneration might be present.
• Dilated eye exam: This test involves dilating the pupils to allow the doctor to examine the optic nerve and retina for signs of damage. The doctor will also look for pigment changes, which indicate poor light reception in the retina.
• Fluorescein angiography: This test evaluates blood vessels in the eye for leaks by injecting dye into a vein in your arm.
• Optical coherence tomography: This test is conducted after pupil dilation, using infrared light to capture detailed images of the retina, allowing the doctor to identify damaged areas.

Avoid smoking. In addition to its harmful effects on overall health, smoking can contribute to macular degeneration. The tar produced by smoking can trigger the formation of drusen (debris accumulation in the eye). Additionally, cigarettes contain caffeine, a stimulant that can raise blood pressure. This can cause the blood vessels beneath the retina and macula to rupture.

• Smokers are at twice the risk of macular degeneration compared to non-smokers. Smoking harms your eyes, your organs, and even those around you.
• Even if you've quit smoking, its effects can linger for years. Consider this a reason to start your journey toward quitting as soon as possible.

Manage pre-existing conditions like hypertension. Take medication, have regular check-ups, and adjust your lifestyle to accommodate your health condition.

• For example, if you have hypertension and are diagnosed with wet macular degeneration, damaged blood vessels in the eye will be harder to heal due to high blood pressure. This increases the risk of further ruptures, leading to more blood leakage.

Exercise regularly. Physical activity has many health benefits, including promoting eye health. Drusen formation is associated with high cholesterol and fat levels. Exercise helps burn fat and eliminate bad cholesterol, preventing the buildup of debris.

• It is recommended to exercise at least three times a week. Focus on aerobic exercises that get you sweating and burning fat.

Increase vitamin intake. Your eyes are constantly exposed to harmful ultraviolet (UV) rays from sunlight and pollutants in the air. Frequent exposure to these harmful elements can lead to oxidative damage. Oxidative damage to the cells in the eyes may result in macular degeneration and other eye diseases. To combat this, it is important to consume foods rich in antioxidants. The most common antioxidants include vitamin C, vitamin E, zinc, lutein, and copper.

• Vitamin C: The recommended daily dose of vitamin C is 500 milligrams. Rich sources of vitamin C include broccoli, cantaloupe, cauliflower, guava, bell peppers, grapes, oranges, berries, lychees, and squash.
• Vitamin E: The recommended daily dose of vitamin E is 400 milligrams. Rich sources of vitamin E include almonds, sunflower seeds, wheat germ, spinach, peanut butter, collard greens, avocados, mangoes, hazelnuts, and rainbow chard.
• Zinc: The recommended daily dose of zinc is 25 milligrams. Zinc-rich foods include lean beef, skinless chicken, lean lamb, pumpkin seeds, yogurt, soybeans, peanuts, beans, sunflower butter, walnuts, kale, spinach, beet greens, lettuce, asparagus, okra, artichokes, watercress, persimmons, and green peas.
• Copper, lutein, and zeaxanthin: Both lutein and zeaxanthin are found in the retina and lens. These natural antioxidants play a role in absorbing harmful UV rays from the sun. Both are found in leafy green vegetables.
  • Supplement with 2 mg of copper daily.
  • Supplement with 10 mg of lutein daily.
  • Supplement with 2 mg of zeaxanthin daily.

Reduce beta carotene intake. Studies have shown that beta carotene can increase the risk of lung cancer, especially in smokers. Research also suggests that beta carotene does not slow the progression of age-related macular degeneration (AMD). Nowadays, doctors typically recommend avoiding supplements containing beta carotene.

Wear eye protection, including sunglasses. High exposure to UV rays from sunlight can damage the eyes and contribute to the development of macular degeneration. Sunglasses can help protect against UV rays and blue light, providing the best protection for your eyes.

Be cautious with certain activities. Some activities that might seem like everyday tasks now require extra caution. Depending on the severity of your vision, you may need assistance from friends, family, or caregivers for certain tasks. In many situations, it's better to ask for help rather than risk negative consequences by acting impulsively. Be extra careful when engaging in the following activities:

• Driving
• Riding a bicycle
• Operating heavy machinery

Stay informed. If you have macular degeneration, it might feel like your life has suddenly spiraled out of control. However, with the proper care from your ophthalmologist, there are still things you can do to manage your condition. Staying informed is the best way to understand the disease and follow your treatment regimen. Start by researching AMD, treatment options, and new technologies that can help restore vision.

• The most common risk factors for developing age-related macular degeneration include age, family history, race, body weight, and the progression of other existing health conditions.