Age-Related Macular Degeneration

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Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is the leading cause of vision loss in adults over the age of 60. It primarily affects the retina, the thin layer of light-sensitive tissue located at the back of the eye. The macula, the central part of the retina responsible for our ability to see fine details, read, drive, and recognize faces, can deteriorate with age, resulting in AMD.

Currently, there is no cure for AMD, but promising treatments and ongoing clinical trials are available. At Northeast Wisconsin Retina Associates, we use advanced technology along with personalized care to help slow or stop the progression of AMD.

Types of AMD: Dry and Wet

There are two types of AMD: dry and wet. Most people with AMD have the dry form, which can affect one or both eyes. Dry AMD is typically painless but causes changes in vision, such as increased blurriness, distortions, and a reduced ability to perceive colors. There are three stages of dry AMD: early, intermediate, and late (advanced). Symptoms may not be noticeable until the disease is in the late stage.

In about 10% of cases, dry AMD can progress to wet AMD. While wet AMD is less common than dry AMD, it's generally more severe and is considered an advanced stage of the disease. Wet AMD occurs when abnormal blood vessels form in the retina and begin to leak blood or fluid into the macula. For some patients, wet AMD can lead to permanent vision loss.

Geographic Atrophy

Geographic atrophy (GA) refers to the last stage of dry AMD, typically affecting both eyes. This condition is characterized by atrophic lesions that initially develop in the outer retina and gradually expand to include the macula and the fovea, which is the central part of the macula where vision is sharpest. Vision loss due to geographic atrophy is permanent.

AMD Symptoms

The macula is responsible for sharp central vision. If it becomes damaged, the brain may struggle to process the visual information it receives. In the early stages of AMD, patients often don't notice any symptoms. As the condition progresses, however, symptoms may start to appear, including:

• Blurry vision
• Difficulty seeing in low light
• Changes in color perception
• Straight lines appearing curvy or wavy
• Blank or dark spots in the field of vision
• Issues reading or seeing fine details

Who Is at Risk for Developing AMD?

Age is the most significant risk factor for developing AMD. Other risk factors include family history of AMD, smoking, and obesity. Other conditions and lifestyle factors that can increase the risk of developing the disease include:

• High blood pressure
• High cholesterol
• Diabetes
• Poor diet

AMD isn’t always preventable, but there are several steps you can take to reduce your risk. It’s essential to schedule regular eye exams, especially if you’re over the age of 50, even if you aren’t experiencing any symptoms. The earlier AMD is diagnosed and treatment begins, the better your vision outcomes will be. Other ways to help reduce your risk include:

• Eating a well-balanced diet
• Maintaining healthy blood pressure and cholesterol levels
• Not smoking
• Protecting your eyes from UV rays by wearing sunglasses and hats

Diagnosing AMD

During an eye exam, your doctor will look for signs of AMD, including the presence of drusen. Drusen are yellow or white deposits of fatty proteins that accumulate beneath the retina. While small amounts of drusen are common as people age, larger quantities may indicate the presence of AMD. The size and number of drusen can also help retina specialists determine the stage of the disease.

Other diagnostic tests include:

• Eye dilation: During an eye exam, the doctor will apply special drops to widen the pupil, allowing for a more thorough examination of the retina.
• Optical coherence tomography (OCT): This non-invasive technique uses infrared light waves to capture cross-sectional images of the retina.
• Fluorescein angiography: In this test, a colored dye is injected into the bloodstream. The dye travels to the blood vessels in the eye, and a special camera captures images to identify any abnormalities in the retina.
• Indocyanine green angiography: Similar to fluorescein angiography, this test also involves an intravenous injection of dye. However, this dye responds to infrared light, making it easier to see the deeper blood vessels in the retina.
• Amsler grid test: The Amsler grid is a simple square containing a grid pattern and a dot in the middle that can help identify problem areas in the field of vision.

Medications and Treatment Options for AMD

Treatment options for AMD that can help manage disease progression and protect existing vision include:

• Focal laser treatment: Also known as photocoagulation, this procedure utilizes a high-energy laser to close abnormal blood vessels, preventing further leakage.
• Photodynamic therapy: During this treatment, a retina specialist injects a light-activated medication intravenously. Then, they use a laser to activate the drug, which helps seal off abnormal blood vessels.
• Anti-vascular endothelial growth factor (anti-VEGF) medications: Anti-VEGF medications are a group of drugs used to inhibit the growth of blood vessels in the eye. Examples of anti-VEGF medications include Vabysmo, Eylea HD, Cimerli, and Lucentis, which are administered directly into the eye via injection.
• Other eye injections: Pegcetacoplan (SYOFOVRE™) and avacincaptad pegol (IZERVAY™) are intraocular injections that can slow the progression of geographic atrophy.