Age-related Macular Degeneration (AMD) is a disease associated with aging that affects the macula, gradually
destroying sharp, central vision. Central vision is needed for seeing objects clearly and for common daily tasks such as
reading and driving.
AMD affects the macula, the part of the eye that allows you to see fine
detail. AMD causes no pain.
In some cases, AMD advances so slowly that people notice little change in
their vision. In others, the disease progresses faster and may lead to a loss
of vision in both eyes. AMD is a leading cause of vision loss in humans 60
years of age and older. AMD occurs in two forms: Wet and Dry.
Where is the macula?
The macula is located in the center of the retina, the light-sensitive tissue
at the back of the eye. The retina instantly converts light, or an image, into
electrical impulses. The retina then sends these impulses, or nerve signals, to the brain.
What is Wet AMD?
Wet AMD occurs when abnormal blood vessels behind the retina start to grow
under the macula. These new blood vessels tend to be very fragile and often leak
blood and fluid. The blood and fluid raise the macula from its normal place at the
back of the eye. Damage to the macula occurs rapidly.
With wet AMD, loss of central vision can occur quickly. Wet AMD is also known as
advanced AMD. It does not have stages like dry AMD. An early symptom of wet
AMD is that straight lines appear wavy. If you notice this condition or other changes
to your vision, contact Dr. Farah at once. You will need a comprehensive dilated eye
exam.
What is Dry AMD?
Dry AMD occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the
affected eye. As dry AMD gets worse, you may see a blurred spot in the center of your
vision. Over time, as less of the macula functions, central vision is gradually lost in the
affected eye.
The most common symptom of dry AMD is slightly blurred vision. You may have difficulty
recognizing faces. You may need more light for reading and other tasks. Dry AMD generally
affects both eyes, but vision can be lost in one eye while the other eye seems unaffected.
One of the most common early signs of dry AMD is the occurrence of drusen.
What are drusen?
Drusen are yellow deposits under the retina. They often are found in people over age 60.
Drusen are detected during a comprehensive dilated eye exam.
Drusen alone do not usually cause vision loss. An increase in the size or number of drusen
raises a person’s risk of developing either advanced dry AMD or wet AMD. These changes
can cause serious vision loss.
Dry AMD has three stages, all of which may occur in one or both eyes:
- Early AMD. People with early AMD have either several small drusen or a few medium-sized drusen. At this
stage, there are no symptoms and no vision loss. - Intermediate AMD. People with intermediate AMD have either many medium-sized drusen or one or more
large drusen. Some people see a blurred spot in the center of their vision. More light may be needed for reading
and other tasks. - Advanced Dry AMD. In addition to drusen, people with advanced dry AMD have an atrophy of light-sensitive
cells in the central retinal area. This can cause a blurred spot in the center of your vision. Over time, the blurred
spot may get bigger and darker, taking more of your central vision. You may have difficulty reading or
recognizing faces until they are very close to you.
Normal vision The same scene as viewed by a person
with age-related macular degeneration
If you have vision loss from dry AMD in one eye only, you may not notice any changes in your overall vision. With the
other eye seeing clearly, you still can drive, read, and see fine details. You may notice changes in your vision only if AMD
affects both eyes. If blurriness occurs in your vision, check with Dr. Farah for a comprehensive dilated eye exam. Ninety
percent of all people with AMD have this type.
Frequently Asked Questions about wet and dry AMD
Which is more common-the dry form or the wet form?
The dry form is much more common. More than 85 percent of all people with intermediate and advanced AMD
combined have the dry form. However, if only advanced AMD is considered, about two-thirds of patients have the wet
form.
Can the dry form turn into the wet form?
Yes. All people who have the wet form had the dry form first. The dry form can advance and cause vision loss without
turning into the wet form. The dry form also can suddenly turn into the wet form, even during early stage AMD. There is
no way to tell if or when the dry form will turn into the wet form.
The dry form has early and intermediate stages. Does the wet form have similar stages?
No. The wet form is considered advanced AMD.
Can advanced AMD be either the dry form or the wet form?
Yes. Both the wet form and the advanced dry form are considered advanced AMD. Vision loss occurs with either form. In
most cases, only advanced AMD can cause vision loss. People who have advanced AMD in one eye are at especially high
risk of developing advanced AMD in the other eye.
Causes and Risk Factors
Who is at risk for AMD?
The greatest risk factor is age. People over age 60 are clearly at greater risk than other age groups.
Other risk factors include:
Smoking
Obesity
Race. Whites are much more likely to lose vision from AMD than African Americans
Family history
Gender. Women appear to be at greater risk than men
Can my lifestyle make a difference?
Your lifestyle can play a role in reducing your risk of developing AMD.
Eat a healthy diet high in green leafy vegetables and fish
Don’t smoke
Maintain normal blood pressure
Watch your weight
Exercise
Symptoms and Detection
What are the symptoms?
Both dry and wet AMD cause no pain.
For dry AMD: the most common early sign is blurred vision. Often this blurred vision will go away in brighter light. With
progression, patients may see a small–but growing–blind spot in the middle of their field of vision.
For wet AMD: the classic early symptom is that straight lines appear crooked. This results when fluid from the leaking
blood vessels gathers and lifts the macula, distorting vision. A small blind spot may also appear in wet AMD, resulting in
loss of central vision.
How is AMD detected?
During an eye exam, the patient is asked to look at an Amsler grid. The pattern of the grid resembles a checkerboard.
While wearing your reading glasses, cover one eye and stare at the black dot in the center of the grid. While staring at
the dot, you may notice that the straight lines in the pattern appear wavy. You may notice that some of the lines are
missing. These may be signs of AMD.
Do NOT depend on the grid displayed below for any diagnoses. Check with Dr. Farah for a comprehensive eye exam.
The Amsler Grid
If Dr. Farah believes you need treatment for wet AMD, he may suggest a fluorescein angiogram. In this test, a special
dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your retina. The test
identifies any leaking blood vessels. An OCT of macula may also be needed. OCT is a noninvasive imaging technology
used to obtain high resolution cross-sectional images of the retina. It can assess the amount of macular swelling.
Treatment
How is wet AMD treated?
Wet AMD can be treated with laser surgery, photodynamic therapy, and injections into the eye. None of these
treatments is a cure for wet AMD. The disease and loss of vision may progress despite treatment.
Wet AMD can now be treated with new drugs that are injected into the eye (anti-VEGF therapy). You will need multiple
injections that may be given as often as monthly. The eye is numbed before each injection. After the injection, you will
remain in the doctor’s office for a while and your eye will be monitored. This drug treatment can help slow down vision
loss from AMD and in some cases improve sight.
How is dry AMD treated?
Once dry AMD reaches the advanced stage, no form of treatment can prevent vision loss. However, treatment can delay
and possibly prevent intermediate AMD from progressing to the advanced stage, in which vision loss occurs.
Taking a specific high-dose formulation of Vitamins (antioxidants and zinc) significantly reduces the risk of advanced
AMD and its associated vision loss. Slowing AMD’s progression from the intermediate stage to the advanced stage will
save the vision of many people.
What is the dosage of the formulation?
The specific daily amounts of antioxidants and zinc are 500 milligrams of vitamin C, 400 International Units of vitamin E,
15 milligrams of beta-carotene (often labeled as equivalent to 25,000 International Units of vitamin A), 80 milligrams of
zinc as zinc oxide, and two milligrams of copper as cupric oxide.
Who should take the formulation?
People who are at high risk for developing advanced AMD should consider taking the formulation. You are at high risk
for developing advanced AMD if you have either:
Intermediate AMD in one or both eyes.
OR
Advanced AMD (dry or wet) in one eye but not the other eye.
Dr. Farah will tell you if you have AMD, its stage, and your risk for developing the advanced form.
The Vitamin formulation is not a cure for AMD. It will not restore vision already lost from the disease. However, it may
delay the onset of advanced AMD. It may help people who are at high risk for developing advanced AMD keep their
vision.
Can people with early stage AMD take the formulation to help prevent the disease from progressing to the
intermediate stage?
There is no apparent need for those diagnosed with early stage AMD to take the formulation. Studies did not find that
the formulation provided a benefit to those with early stage AMD. If you have early stage AMD, a comprehensive dilated
eye exam every year can help determine if the disease is progressing. If early stage AMD progresses to the intermediate
stage, discuss taking the formulation with Dr. Farah.
Can diet alone provide the same high levels of antioxidants and zinc as the AREDS formulation?
No. The high levels of vitamins and minerals are difficult to achieve from diet alone. However, previous studies have
suggested that people who have diets rich in green leafy vegetables have a lower risk of developing AMD.
Can a daily multivitamin alone provide the same high levels of antioxidants and zinc as the formulation?
No. The formulation’s levels of antioxidants and zinc are considerably higher than the amounts in any daily multivitamin.
If you are already taking daily multivitamins and Dr. Farah suggests you take the high-dose formulation, be sure to
review all your vitamin supplements with your family doctor before you begin. Because multivitamins contain many
important vitamins not found in the formulation, you may want to take a multivitamin along with the formulation. For
example, people with osteoporosis need to be particularly concerned about taking vitamin D, which is not in the
formulation.
How can I take care of my vision now that I have AMD?
Dry AMD. If you have dry AMD, you should have a comprehensive dilated eye exam at least once a year. Dr. Farah can
monitor your condition and check for other eye diseases. Also, if you have intermediate AMD in one or both eyes, or
advanced AMD in one eye only, Dr. Farah may suggest that you take the formulation containing the high levels of
antioxidants and zinc.
Because dry AMD can turn into wet AMD at any time, you should get an Amsler grid. Use the grid every day to evaluate
your vision for signs of wet AMD. This quick test works best for people who still have good central vision. Check each eye
separately. Cover one eye and look at the grid. Then cover your other eye and look at the grid. If you detect any changes
in the appearance of this grid or in your everyday vision while reading the newspaper or watching television, get a
comprehensive dilated eye exam.
Wet AMD. If you have wet AMD and Dr. Farah advises treatment, do not wait. After Injection therapy, you will need
frequent eye exams to detect any recurrence of leaking blood vessels. Studies show that people who smoke have a
greater risk of recurrence than those who don’t. In addition, check your vision at home with the Amsler grid. If you
detect any changes, schedule an eye exam immediately.
What can I do if I have already lost some vision from AMD?
If you have lost some sight from AMD, don’t be afraid to use your eyes for reading, watching TV, and other routine
activities. Normal use of your eyes will not cause further damage to your vision.
If you have lost some sight from AMD, ask Dr. Farah about low vision aid services and devices that may help you make
the most of your remaining vision.