If you’ve had trouble-free vision your entire life, it’s natural to take healthy eyes for granted. However, as we age, our vision begins to deteriorate—whether we suddenly require reading glasses or develop an increased sensitivity to light and glare. Additionally, as you age, your eyes become more prone to a variety of conditions, including cataracts, diabetic eye disease, low vision, and glaucoma.
Another common age-related condition is macular degeneration, which affects over 10 million Americans and is the leading cause of vision loss in people over the age of 50, according to the National Eye Institute. Despite its prevalence, there is still considerable confusion surrounding macular degeneration. To ascertain the facts, we spoke with Yasha Modi, MD, Assistant Clinical Professor of Ophthalmology at NYU Langone in New York City, to obtain answers to frequently asked questions and vital information about the eye condition.
What is macular degeneration exactly?
Simply put, when people discuss macular degeneration, they are referring to age-related macular degeneration (AMD). This is a breakdown of the macula, the central portion of the retina that is responsible for the sharpest vision.
“While these patients never go completely blind, they develop central blind spots that severely impair their vision and daily function,” Dr. Modi explains. “They must rely on their peripheral vision, which necessitates re-education on how to open bottles, navigate through doorways, and perform a variety of other everyday tasks.” Additionally, individuals with advanced AMD frequently lose their ability to read, drive, see fine detail, and recognize faces and colors. They also frequently lose their ability to read, write, and recognize faces and colors.
Additionally, it’s critical to remember that macular degeneration is a spectrum of diseases—generally classified as “early,” “intermediate,” or “late” AMD—that can progress over decades, according to Dr. Modi. AMD’s early stages are frequently asymptomatic. However, “patients may initially notice some distortion or central blurring of vision, and as this progresses to scarring or tissue atrophy, they develop complete central blind spots.”
Additionally, AMD is classified into two subgroups: dry and wet. With dry AMD, clumps of lipid and protein called “drusen” accumulate beneath the macula, gradually thinning or atrophying the retina. Wet AMD occurs when abnormal blood vessels begin to grow beneath the retina, leaking blood or other fluids, scarring the macula, and resulting in vision loss. Dry AMD is much more prevalent than wet AMD, accounting for approximately 80% of AMD cases, according to the American Academy of Ophthalmology. Dr. Modi points out, however, that people with wet AMD typically have both wet and dry AMD, which work in concert to impair their vision. Therefore, even if the wet form is corrected, they will retain the dry variety.
And, while macular degeneration is more common as people age, Stargardt disease is a very rare form of macular degeneration that affects children and adolescents and is caused by a recessive gene, according to the American Macular Degeneration Foundation.
What are the signs and symptoms?
Dry macular degeneration symptoms typically manifest gradually and vary. They can include visual distortions, decreased central vision in one or both eyes, the need for brighter light when reading, difficulty adjusting to low light levels (such as in a dim restaurant), blurriness while reading, and difficulty recognizing faces.
These are all signs of advanced AMD. However, if you notice that your central vision is blurred or that you’re having difficulty recognizing colors and fine details, particularly if you’re over 50, you should consult your doctor to determine if you’re experiencing early signs of macular degeneration.
Is there anything that could be considered a risk factor?
Given that the majority of people are diagnosed with age-related macular degeneration, the primary risk factor, according to Dr. Modi, is being over the age of 50.
Additionally, there is some evidence that genetics play a role. “We know that the majority of people who have macular degeneration are of European ancestry,” he explains. “And there are additional strong indications that this is a genetically inherited disorder.” Having said that, there is still no conclusive scientific evidence linking AMD to genetics.
While age and genetics are uncontrollable, doctors have discovered additional risk factors for AMD, most notably smoking and diet.
“We know that patients who smoke are at a greater risk of not only progressing to later stages of macular degeneration, but also of experiencing significant vision loss as a result of macular degeneration,” Dr. Modi explains. Nonetheless, even if someone has smoked for a long period of time, quitting immediately can significantly reduce their risk of AMD.
According to Dr. Modi, diet may also play a role. He recommends a diet low in red meat and animal fats, but high in vegetables and dark leafy greens.
Is it treatable?
While there is no definitive cure for macular degeneration, Dr. Modi notes that treating patients with early stages of macular degeneration with “eye vitamins” or “AREDS” vitamins has been extremely successful. Indeed, the Age Related Eye Disease Study’s (AREDS) initial trial discovered that a combination of vitamin C, vitamin E, beta-carotene, zinc, and copper reduced the risk of developing more advanced forms of AMD by 25%. Additionally, researchers tested a new formula (AREDS2) that substituted lutein and zeaxanthin for beta-carotene with comparable results.
Dr. Modi explains that in cases of wet macular degeneration, when blood vessel growth threatens the quality of vision, doctors will inject medication directly into the eyes. If initiated early enough, this treatment can help preserve existing vision and even help recover some lost vision.
Is there a way to avoid this?
While many of the causes of AMD are unavoidable, Dr. Yasha notes that it doesn’t hurt to avoid smoking, maintain a healthy cholesterol level, and live an overall healthy lifestyle—especially if you have a family history of macular degeneration.
“It is also critical for patients to receive appropriate clinical screenings, particularly once they reach the age of 50,” he adds. That means an annual eye examination with dilated pupils and a thorough examination of the retina in this case. This type of screening is critical not only for detecting early stages of macular degeneration, but also for detecting other eye conditions such as glaucoma, which frequently exhibit no symptoms until they progress to a more serious stage. This way, you can identify the condition early on, potentially halt its progression, and even reverse its effects with treatment. Numerous types of Medicare plans cover an annual eye exam.