FAQ

  • Choroid: The layer of blood vessels and connective tissue between the retina and the white of the eye, also known as the sclera
  • Choroidal neovascularization (CNV): Growth of abnormal new blood vessels in the choroid layer of the eye that grow under the retina and macula and disrupt vision
  • Disciform scar: A scar that develops in the macula area of the retina resulting from leakage and bleeding from abnormal blood vessels (neovascularization) in the eye
  • Drusen: focal yellow deposits of acellular debris that can be seen through an ophthalmoscope
  • Fluorescein angiography (FA): An imaging technique where a yellow dye called sodium fluorescein is injected into a vein in the arm, allowing a special camera to record circulation in the retina and choroid in the back of the eye. This test can be very useful in diagnosing a number of retinal disorders
  • Fovea: Small depression in the retina of the eye where visual sharpness is highest; the center of the field of vision is focused in this region
  • Fundus: The part of a hollow organ that is farthest from the opening; in the eye, the part of the eyeball opposite the pupil
  • Intravitreal injection: Treatment where a medication is injected into the vitreous cavity in the middle of the eye
  • Macula: A small area at the center of the retina where light is sharply focused to produce the detailed color vision needed for tasks, such as reading and driving
  • Neovascularization: Excessive growth of new blood vessels on abnormal tissue as a result of lack of oxygen
  • Optical coherence tomography (OCT): A non-invasive imaging technique that uses light to create a 3-dimensional image of your eye for physician evaluation
  • Photodynamic therapy (PDT): A treatment for macular degeneration in which a light-activated medicine (verteporfin) is injected into the bloodstream followed by application of a cold laser which targets abnormal blood vessels growing in the macula at the center of the retina
  • Retina: Thin layer of tissue that lines the back of the eye on the inside located near the optic nerve; it receives light that the lens has focused, converts the light into neural signals, and sends these signals on to the brain for visual recognition
  • Slit lamp: An instrument that combines a high-intensity light source with a microscope to examine the external and internal structures of the eye, including the optic nerve and retina
  • Vitreous: A gel-like substance that fills the inside of the eyeball
Figure: Parts of the eye and effects of macular degeneration

References:

American Optometry Association. Macular Degeneration Fact Sheet. https://www.aoa.org/Documents/MacularDegeneration_FactSheet_Web.pdf. Accessed April 7, 2020.

American Society of Retina Specialists (ASRS). Age-related macular degeneration. https://www.asrs.org/patients/retinal-diseases/2/agerelated-macular-degeneration. Accessed April 7, 2020.

ASRS. Diabetic retinopathy. https://www.asrs.org/patients/retinal-diseases/3/diabetic-retinopathy. Accessed April 7 2020.

AMD is characterized by complex changes in the eye and what causes it is not completely understood.

Age is a major risk factor for AMD; the disease is most likely to occur after age 60, but it can occur earlier. Other risk factors for AMD include:1

  • Smoking: research shows that smoking doubles the risk of AMD
  • Race: AMD is more common among Caucasians than among African-Americans or Hispanics/Latinos
  • Family history and genetics: people with a family history of AMD are at higher risk

Researchers have identified at least 20 genes that can affect the risk of developing AMD. Because AMD is influenced by so many genes, plus environmental factors, such as smoking and nutrition, there are currently no genetic tests that can diagnose AMD, or predict with certainty who will develop it. The American Academy of Ophthalmology (AAO) does not currently recommend routine genetic testing for AMD.1

Other risk factors that have been associated with AMD, at different degrees and levels of support include: female sex, high body mass index (BMI), cardiovascular disease, increased sunlight exposure, systemic inflammation, and low antioxidant levels.2,3

References:

  1. NIH/NEI. Age-related Macular Degeneration: What You Should Know. https://www.nei.nih.gov/sites/default/files/health-pdfs/WYSK_AMD_English_Sept2015_PRINT.pdf. Accessed April 6, 2020.
  2. Cunningham J. Recognizing age-related macular degeneration in primary care. JAAPA. 2017;30(3):18-22.
  3. Marra KV, Wagley S, Kuperwaser MC, et al. Care of older adults: role of primary care physicians in the treatment of cataracts and macular degeneration. J Am Geriatr Soc. 2016;64(2):369-377.

An eye care specialist will perform a dilated eye examination using a slit lamp to assess the retina for drusen, retinal abnormalities, choroidal neovascularization, fluid, and hemorrhage.1

The diagnosis of AMD is usually made clinically based on your history, symptoms, and confirmation with the dilated eye exam. However, other imaging tests can be used to gain a better understanding of AMD and to monitor progress before and after therapy.1

  • Optical coherence tomography (OCT): imaging technique that is not invasive and provides high-resolution, cross sectional images of the retina; it can also help distinguish AMD from other retinal disorders.
  • Fluorescein angiography (FA): technique usually performed when choroidal neovascularization is suspected. A dye that is sensitive to light is injected, and when an activating laser is applied through the eye, tissues with new vessels hold more dye than other vessels which causes damage to these new vessels (photodynamic therapy [PDT]).

References:

  1. Cunningham J. Recognizing age-related macular degeneration in primary care. JAAPA. 2017;30(3):18-22.

Everyone with AMD should be educated about healthy lifestyle choices including regular exercise; smoking cessation; wearing protective eyewear in the sun; and a diet that incorporates fruits, vegetables, fish, and nuts.1 Early recognition and coordinated care between primary care providers and vision specialists will lead to timely management, which may decrease the occurrence of permanent blindness due to AMD.1

First-line therapy for persons with wet AMD is intravitreal injections with vascular endothelial growth factor (VEGF) inhibitors; these agents limit the destructive effects of neovascularization on retinal tissue and can stabilize or may possibly reverse vision loss.1,2 Photodynamic therapy is typically used when there is no response to treatment with VEGF inhibitors. It can be used alone or in combination with VEGF-inhibitor medications. With photodynamic therapy, a dye that is sensitive to light is injected with an activating laser applied through the eye. Tissues with new vessels hold more dye than other vessels which causes damage to these new vessels.1

No approved treatment exists for early AMD. Two studies sponsored by the National Institutes of Health (NIH), the Age-Related Eye Disease Study 1 and 2 (AREDS 1 and 2), have provided evidence which support that nutritional supplements can reduce the risk of AMD progressing to a more advanced state.1,3 These nutrients include:4

  • Glutathione (GSH)/selenium and vitamin D3 status
  • The family of vitamin E molecules known as tocotrienols/tocopherols
  • Polyphenols
  • The calcium/magnesium ratio
  • Omega-3 fatty acids
  • Zeaxanthin
  • Activities that enhance endothelial nitric oxide production

Based on the results from AREDS 1 and 2, persons with intermediate AMD or advanced AMD, or vision loss in one eye due to AMD, are advised to take a combination of antioxidant supplements and zinc.1

  • Nonsmokers and former smokers can follow the regimen outlined in AREDS 1: vitamin C, vitamin E, beta-carotene, and zinc.
  • AREDS 2 replaced beta-carotene with lutein and zeaxanthin with similar risk reduction; smokers are advised to follow this regimen due to an increased risk of lung cancer with beta-carotene supplementation.

Lutein, zeaxanthin, and beta-carotene all belong to the same family of vitamins, and are abundant in green leafy vegetables.5 Glutathione stimulating hormone (GSH) is also found within the following dietary sources:4

  • GSH: avocados, spinach, asparagus, watermelon, and walnuts; proteins such as chicken, chickpeas, and lentils
  • Cysteine (sulfur bearing): turkey breast, eggs, sockeye salmon, yogurt, wheat germ, whey protein, garlic, onions, soy, red bell peppers, and broccoli
  • Selenium: sardines, Brazil nuts, clams, oysters, turkey breast, and garlic

Nutritional supplements formulated based on these studies are available and their labels may refer to either AREDS or AREDS2.5

References:

  1. Cunningham J. Recognizing age-related macular degeneration in primary care. JAAPA. 2017;30(3):18-22.
  2. Michalska-Malecka K, Kabiesz A, Nowak M, Spiewak D. Age related macular degeneration—challenge for future: pathogenesis and new perspectives for the treatment. Eur Geriatr Med. 2015;6(1):69-75.
  3. Schmidl D, Garhöfer G, Schmetterer L. Nutritional supplements in age-related macular degeneration. Acta Ophthalmol. 2015; 93(2):105-121.
  4. Richer S, Ulanski L, Natalia A Popenko NA, et al. Age-related macular degeneration beyond the Age-related Eye Disease Study II. Adv Ophthalmol Optometry. 2016;1(1):335-369.
  5. NIH/NEI. Age-related Macular Degeneration: What You Should Know. https://www.nei.nih.gov/sites/default/files/health-pdfs/WYSK_AMD_English_Sept2015_PRINT.pdf. Accessed April 6, 2020.

Researchers have found links between AMD and some lifestyle choices, such as smoking.1 In addition, regular exercise, wearing protective eyewear in the sun; and a diet that incorporates fruits, vegetables, fish, and nuts may be helpful practices to incorporate.2 You might be able to reduce your risk of AMD or slow its progression by making these healthy choices:1

  • Avoid smoking
  • Exercise regularly
  • Maintain normal blood pressure and cholesterol levels
  • Eat a healthy diet rich in green, leafy vegetables and fish

Based on the results from 2 studies sponsored by the National Institutes of Health (NIH), the Age-Related Eye Disease Study 1 and 2 (AREDS 1 and 2), persons with intermediate AMD or advanced AMD, or vision loss in one eye due to AMD, may be advised to take a combination of antioxidant supplements and zinc.2

  • Nonsmokers and former smokers can follow the regimen outlined in AREDS 1: vitamin C, vitamin E, beta-carotene, and zinc.
  • AREDS 2 replaced beta-carotene with lutein and zeaxanthin with similar risk reduction; smokers are advised to follow this regimen due to an increased risk of lung cancer with beta-carotene supplementation.

References:

  1. NIH/NEI. Age-related Macular Degeneration: What You Should Know. https://www.nei.nih.gov/sites/default/files/health-pdfs/WYSK_AMD_English_Sept2015_PRINT.pdf. Accessed April 6, 2020.
  2. Cunningham J. Recognizing age-related macular degeneration in primary care. JAAPA. 2017;30(3):18-22.

Some sample questions are listed below to help you begin the conversation with your clinician about your condition.

  • Can macular degeneration be prevented? Should I make any lifestyle changes?
  • What symptoms may I experience?
  • Will I need treatment(s)?
  • If I develop macular degeneration, will I lose my vision?
  • If one eye is affected, will the other be automatically affected?
  • How often should I see a specialist?
  • Is it possible to recover vision lost as a result of macular degeneration?

Patient & Caregiver Educational Resources

The RELIEF Patient Toolkit is a resource center for patients who have been diagnosed with or who are interested in learning about age-related macular degeneration (AMD). Choose from the options below to learn more.

This activity is provided by Med Learning Group. This activity is co-provided by Ultimate Medical Academy/Complete Conference Management (CCM). This activity is supported by an independent medical education grant from Regeneron Pharmaceuticals, Inc.

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Scientific Council

Neil M. Bressler, MD

James P. Gills Professor of Ophthalmology
Professor of Ophthalmology, Johns Hopkins University School of Medicine
Wilmer Eye Institute, Johns Hopkins Medicine
Baltimore, MD

A. Paul Chous, MA, OD, FAAO

Specializing in Diabetes Eye Care & Education, Chous Eye Care Associates
Adjunct Professor of Optometry, Western University of Health Sciences
AOA Representative, National Diabetes Education Program
Tacoma, WA

Steven Ferrucci, OD, FAAO

Chief of Optometry, Sepulveda VA Medical Center
Professor, Southern California College of Optometry at Marshall B. Ketchum University
Sepulveda, CA

Julia A. Haller, MD

Ophthalmologist-in-Chief
Wills Eye Hospital
Philadelphia, PA

Allen C. Ho, MD, FACS

Director, Retina Research
Wills Eye Hospital
Professor and Chair of the Department of Ophthalmology
Thomas Jefferson University Hospitals
Philadelphia, PA

Charles C. Wykoff, MD, PhD

Director of Research, Retina Consultants of Houston
Associate Professor of Clinical Ophthalmology
Blanton Eye Institute & Houston Methodist Hospital
Houston, TX