Spots in the Retina

When first diagnosed with AMD, in most cases you will have either no symptoms or a mild decrease or distortion in central vision. The diagnosis is made when the eye doctor sees tiny white spots in the retina when looking into your eyes with an ophthalmoscope. These spots are called “drusen,” which means “pebbles.” They represent tiny deposits of cellular waste products and immune system proteins. The doctor may then take several types of pictures of your retina to record its current appearance and to help determine whether there’s any worsening in the future.

Antioxidant Vitamins

If you have early AMD and at least a minimum number and size of drusen, you will be told to take certain antioxidant vitamins. A large clinical trial called the Age-Related Eye Disease Study 2 (AREDS2) showed that a mixture of lutein, vitamin C, vitamin E, zinc, and copper can reduce the risk of progression to advanced AMD by 25 percent. While there are many types of eye vitamins on the market, only those that use the “AREDS2” formula have been proven effective.

Lifestyle Changes

Modifications to your lifestyle can also reduce your risk of AMD progression. If you have any form of AMD, you will be advised to eat lots of fruits and vegetables, and fatty fish (salmon, tuna, sardines, or mackerel twice a week). Smoking is a major risk factor, so smoking cessation is critical. Evidence also suggests that excessive simple sugars or red meat are also risk factors. Sunglasses are advisable when out in bright light.

Home Monitoring with the Amsler Grid

If you have early AMD, it may progress to advanced AMD. It’s important to detect this change, if it occurs, because early treatment can be helpful. You should see an ophthalmologist at least once a year and should check your vision at home with a graph called an “Amsler” grid. Check each eye independently by closing one eye and looking at the dot in the center of the grid while wearing your reading glasses. If you see any missing or wavy lines on the graph that are worse than before, call your ophthalmologist.

Advanced Wet and Dry AMD

If your AMD progresses to advanced “wet” AMD, it will mean that new, leaky blood vessels have grown into your retina, and are damaging your vision. These vessels can be halted by injections of “anti-VEGF” medicines (Eylea, Lucentis, or Avastin) into the eye every month or two. Your ophthalmologist will determine the required frequency by monitoring your progress with exams and retinal photographs. These injections may improve your vision, and are very likely to help prevent you from losing more central vision. Researchers are exploring longer-lasting treatments.

If your AMD progresses to the advanced “dry” form called “geographic atrophy,” which involves the slow, progressive wasting away and death of cells of the central retina (atrophy) with expansion of a central blind spot, then you may qualify to enroll in a clinical trial. There are currently no proven treatments for geographic atrophy, but several types of oral or injected drugs are being tested.

Low Vision Specialists

If you have lost a significant amount of central vision, then you should visit an optometrist called a “low vision specialist.” These specialists will provide advice regarding appropriate magnifiers and lights to help you make optimal use of your remaining vision.

Heredity and Prevention

AMD is partially hereditary; you inherit “risk genes.” However, there is currently no benefit in testing for these genes because the results don’t change prevention or treatment recommendations. Your children are at moderately increased risk of AMD and should adhere to the anti-AMD lifestyle mentioned above, but AREDS2 vitamins are only recommended for patients who have developed AMD.

Resources:

• Why is My Doctor Always Talking About “Drusen”? (Article)
• Vitamins for Age-Related Macular Degeneration: Do You Have the Correct Formula?  (Article)
• Smoking and Age-Related Macular Degeneration (Article)
• The Amsler Grid (Eye Test)
• Are You Getting What You Need from Your AREDS Supplements? (Article)
• The Top Foods for Eye Health (Article)
• How to Choose the Right Sunglasses (Article)
• Injections for Wet Macular Degeneration: What to Expect (Article)
• What is Geographic Atrophy? (Article)
• How Low Vision Services Can Help You (Audio Presentation)
• Update on Genetics and Age-Related Macular Degeneration (Article)
• A Close Relative Has Age-Related Macular Degeneration: How Can I Decrease My Risk? (Article)
• Clinical Trial Information for Macular Degeneration (Fact Sheet)
• Macular Degeneration: Essential Facts (Publication)
• Macular Degeneration Toolkit (Helpful Information to Understand and Manage Macular Degeneration)