Macular degeneration guide, causes, treatment

The A-Z Guide to Macular Degeneration: From Causes to Treatments (and Can Eye Vitamins Help?)

What is macular degeneration (AMD)?

Age-related macular degeneration (AMD) is a progressive eye condition affecting the macula of the eyes, impacting vision in the long term. Every year, one of the leading causes of blindness in the world is seen as undetected and untreated AMD.

In older adults, blindness is seen as the accumulation of fat in the retina, making it difficult to carry out normal cell function. Fat deposits block the nutrient absorption process in the eyes, impact the network of blood vessels (choroid), and lead to loss of central vision.

If you are worried about how macular degeneration can harm you and your loved ones, continue reading. Also, ee have shortlisted a summary of causes, treatment options, and lifestyle choices that increase the risk factors for AMD.

Basis Dry AMD Wet AMD
Number of AMD cases Commonly, around 85–90% of AMD cases Less common: 10–15% of AMD cases
Distinction Photoreceptive cells of the retina die off Abnormal growth of blood vessels in the macula
Symptoms Unusually fuzzy or distorted vision A blind spot in the center of the vision
Alternative names Non-neovascular, atrophic, or non-exudative AMD Neovascular or exudative AMD
Leakage No leakage of fluid or blood; hence, dry Atypical blood vessels in the eyes leak
Vision loss Gradual loss of central vision Considerable vision loss (permanent)
Disease progression Dry AMD can change to wet AMD Cannot be altered to dry

After comparing the two common types of AMD, you might inquire about how dry AMD is converted. When waste products are deposited underneath the macula, the retinal function is disrupted. This can again progress to wet AMD, as new blood vessels can still grow behind the retina. When it happens, swelling, bleeding, and scarring result, resulting in considerable loss of vision.

How does macular degeneration progress?

Macular degeneration begins with the deposition of cholesterol between the pigmented layer of the retina and the elastic membrane in its central portion. Since the transfer of nutrients is hindered and oxidative stress results, photoreceptor cells in the eyes start to die, ultimately resulting in night blindness and decreased sensitivity to light.

There is good news! New technologies, such as optical coherence tomography (OCT), are used. This macular degeneration test machine has started to detect early signs of the progression of the disease. Let’s discuss several stages and vision issues in several stages of AMD.

Stages of AMD Drusen Pigmentary abnormalities Dark adaptation
No AMD No drusen, or small ≤ 63 μm No Normal
Subclinical AMD No drusen, or small ≤ 63 μm No Impaired
Early AMD Medium drusen > 63 μm and ≤ 125 μm No Impaired
Intermediate AMD 1 large drusen > 125 μm Any AMD pigmentary abnormalities Impaired
Advanced AMD N/A N/A 2 forms; Geographic Atrophy and Neovascular AMD

What are the early warning signs of macular degeneration?

A healthy eye when facing early signs of macular degeneration need not be ignored. This common eye disease can severely impact the patients, by thinning the macula of the eyes. Still, there is no absolute care for AMD, but you can prevent the progression of the eye disease by identifying these warning signs and symptoms of macular degeneration.

  • Blurry or fuzzy vision
  • Trouble recognizing familiar faces
  • Difficulty reading in dim light
  • Straight lines start to get wavy
  • A blind spot in the center of the vision
  • Loss of central vision
  • The presence of tiny yellow deposits in the retina (Drusen)
  • Reduced intensity of colors
  • Abnormal blood vessel growth causing leakage (wet AMD)

What are the primary tests for macular degeneration?

Macular degeneration can worsen if left untreated, leading to complete blindness, so to check the risk of macular degeneration, certain tests are conducted let’s see what they are,

  • Visual acuity test
  • Dilated pupil exam
  • Amsler grid test
  • Optical coherence tomography (OCT)
  • Fluorescein angiography

Causes: Risk factors of Macular degeneration

Let’s learn in detail about the risk factors for AMD. Take the first step toward preventing your vision by knowing the preliminary causes of this common and chronic eye disease.

1. Age

Age is a significant factor resulting in macular degeneration. As per research, AMD is common in people over the age of 60. Chances remain that macular degeneration is also caused in people in their 50s.

When people age, the cells in the central part of the retina, called the macula, start to deplete, increasing the risk of AMD. A reduction in the delivery of oxygen and nutrients to the retina is seen as age and disease progress. So, the importance of early detection of AMD cannot be denied.

Dry AMD is the most common type of macular degeneration observed in the elderly population, resulting in a gradual loss of central vision. Wet AMD is also seen in people in their 50s and 60s, but dry AMD is common in people over 70. Prevent dramatic vision loss by implementing measures and knowing the risk factors.

2. Genetics

Individuals with a family history of macular degeneration are susceptible to losing vision from the eye disease. Several genes are linked to AMD, and they cannot be modified. Even cascade, part of the body’s immunology is also associated with AMD.

Large genome-wide association studies further clarify that over 30 genetic variants are responsible for progressing AMD to the advanced stage. In addition, Gene mutations, variations, and environmental factors combined to impair the vision of older adults throughout the world,

3. Race

White Caucasian people with lighter eye colors are more susceptible to macular degeneration. The Journal of the American Medical Association (JAMA) has published a survey report stating that non-Hispanic white European people are at the highest risk of developing AMD. Above one-third of infected people are white Caucasians, and Hispanic, Black, and Asian people are on the list to follow.

4. Smoking

Smoking is a prolonged risk factor for macular degeneration. Research actively demonstrates that this is one of the modifiable risk factors resulting in the progression of MD, if not stopped or limited within time. Here’s how smoking can be infectious to eye health,

  • Damage to the retina and choroid

Smoking is a nemesis for the retina and choroid of the eyes. It results in molecular and pathological stimulation in the eye portion, causing vascular inflammation and endothelial dysregulation, and therefore impacting central vision.

  • Toxic compounds in cigarette smoke

Cigarette smoke contains toxic components, i.e., more than 4,500 chemicals that impact the delicate tissues of the eyes. The tar in the smoke results in the formation of drusen, thus, smoking is an early detectable sign of AMD.

  • Oxidative stress

Smoking results in aging in an individual by affecting the oxygen-derived molecules. The effectiveness of antioxidants has decreased. Also, the lutein level in the macula is degenerated or depleted, making one susceptible to early infection with AMD.

  • Damage to blood vessels

Smoking damages the choroid, the network of blood vessels that supply oxygen to the retina. Also, large blood vessels in the heart are impacted as a result of extensive smoking over time.

  • Genetic susceptibility

Smoking also interrupts genetic factors, increasing the risk of AMD in the genes. Also, smokers are prone to mutation and have a 20 times higher chance of infecting with AMD than non-smokers.

5. Obesity

Obesity puts a person at risk of many diseases, and macular degeneration is one of them. This is because obesity triggers metabolic syndrome, which is the main cause of AMD. High HDL cholesterol, high glucose levels, and high triglycerides are the risk factors for macular degeneration, in brief.

6. Cardiovascular disease

Cardiovascular disease and macular degeneration are related to some extent. Their causes, like hypertension, age, smoking, diabetes, and food habits, are also associated. On top of that, the research advocates that subretinal drusenoid deposits (SDD) (a specific type of AMD) result from underlying heart failure, heart attacks, and heart valve disease. Thus, frequent eye checkups should be conducted in case of any underlying cardiovascular condition

7. Prolonged sun exposure

Blue light, UV rays, and sun exposure are some of the active causes of macular degeneration. This is because, of chronic retinal photochemical damage from sunlight, especially blue light (wavelength of 380–550 nm) and near-ultraviolet light (UV-A)). Wear sunglasses, and a hat, and avoid peak hours of direct sunlight for your eyes.

Did you know? UV rays can hurt your eyes by putting your eyes at risk of eye cancer, cataracts, sunburned eyes, or growths on or near the eye surface. Also, get UV filters for your contact lenses for healthy eyes.

8. Diet

A high glycemic diet can be a concerning factor for infecting with age-related macular degeneration. Foods like white bread, rice, and others can spike blood sugar levels; hence, take them in optimal amounts. If you want to boost your vision health, incorporating vitamins, minerals, and antioxidants into your diet can help.

Common Treatments for AMD

A range of treatment plans are available and are still in clinical trials for restoring vision or preventing vision loss because of macular degeneration. As such, there are no current macular degeneration drugs or polls, but anti-vGEF drugs are given to inhibit the growth of abnormal blood vessels. Let’s learn about them in detail.

1. AREDS2 Supplement

The Age-Related Eye Disease Study 2 (AREDS2) supplement is a combination of eye vitamins and minerals treating the dry form of AMD. The supplements include the necessary dietary components for the eyes, like vitamin C, vitamin E, beta-carotene, lutein, zeaxanthin, zinc, and copper. Patients with an intermediate form of AMD, either in one or both eyes, find it beneficial to delay the progression of the eye disease.

2. Anti-VEGF Injections

Anti-VEGF injections are the most common treatment measures for wet age-related macular degeneration. The primary purpose of these injections is to stop the spread of abnormal blood vessels in the eyes, resulting in central vision loss. Syfobre for macular degeneration is effective in treating wet AMD.

The injection consists of anti-VEGF drugs such as Lucentis (ranibizumab), Eylea (aflibercept), Beovu (Brolucizumab), and Vabysmo (faricimab), which prevent the development and leakage of abnormal blood vessels. The treatment plan repeats once a month or every six months, depending on your ideal case.

3. Photodynamic therapy

Photodynamic therapy is an eye procedure to treat leaky blood vessels in the retina. Through the use of a light-sensitive drug called verteporfin and a low-energy laser, these vessels are sealed off. This is a less common treatment plan for wet AMD. It also comes with risk factors like the risk of new blind spots, back pain, and photosensitive reactions.

4. Lifestyle changes

Macular degeneration is not a disability; hence, practicing a healthy lifestyle and being physically active can make a difference. Incorporating nutrient-dense fruits, vegetables, and omega-3 fatty acids in your daily diet can help you retain vision. Try to quit smoking, it’s an active cause of wet AMD resulting as people age. Make sure you start the habit of wearing sunglasses and blue-ray-cut glasses when using a laptop, device, or exposure to UV lights to prevent AMD.

5. Stem Cell Therapy

Stem cell therapy is an eye procedure that replaces the damaged or dead cells in the eye with new ones. The clinical trials of the innovative treatment plans are underway for all cases of AMD, ranging from dry to wet.

6. Visual aids for macular degeneration

Various low-vision aids and lighting techniques can help people with macular degeneration make the most of their remaining vision. Magnifying glasses for macular degeneration have yellow-tinted lenses, which improve contrast and sensitivity.  Moreover, the best magnifiers for macular degeneration are video magnifiers, CCTV magnifiers, low-vision optical lenses, and electronic reading aids

7. New Treatment for macular degeneration 2024

Syfovre (pegcetacoplan) and Izervay (avacincaptad pegol) are the new treatments for dry macular degeneration. It is approved for treating geographic atrophy, also known as late-stage “dry” age-related macular degeneration. Macular degeneration pills include the AREDS2 supplement, pegcetacoplan (Syfovre), and avacincaptad pegol (Izervay).

The cost of eye injections for macular degeneration varies from $1,850 to $3,200 per dose in the USA. Did you know? The most expensive eye injection is Luxturna, sold for around $850,000 in the United States, against hereditary degeneration of the macula.

Eye injections need to be taken based on the severity of your AMD case, the most common ones are taken with vision therapy every 4 to 6 weeks, while some are taken at the gap every 3 months. Consult a low vision specialist for macular degeneration, in case of additional queries.

8. Macular degeneration vs cataracts

Macular degeneration and cataracts both affect vision, AMD affects central vision by deteriorating the macula, the central part of the retina, while cataracts cause clouding in the lens.

During cataract surgery, the clouded lens causing blurry vision is removed, and instead clear and artificial lenses are replaced, which has nothing to do with the macula. Therefore, cataract surgery does not cause macular degeneration.

Conclusion

While macular degeneration remains a serious concern, eye experts are hopeful about the clinical trials of advanced treatment options. Research is ongoing to determine causes, prevention, and treatment options to combat this vision threat.

Nutritional supplements, stem cell therapy, low vision rehabilitation, photodynamic therapy, and anti-VEGF drugs are some of the promising efforts to prevent vision loss in older adults.

Are you aware that both dry and wet AMDs can lead to color and night blindness? Before it is too late, take charge of your vision health by quitting smoking, maintaining healthy lifestyle choices, and consuming rich antioxidants. Also, prioritize eye health, and schedule comprehensive eye exams today with the top macular degeneration specialist near you!

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