- Mercy Nurse
- Symptom Navigator
- Levitt Medical Library
- Health Information
- Body Guide
- Multimedia Encyclopedia
- In-Depth Health Reports
- Complementary & Alternative Medicine
- Drug Information Center
- Drug Interactions
- Wellness Tools
- Today's Medical News
- Pregnancy Health Center
- Recursos EspaÃ±oles De la Salud
- Enciclopedia Multimedia
- Centro de Information sobre el Embarazo
Age-related macular degeneration (AMD) is a chronic eye disease that affects more than 10 million Americans. It is the leading cause of vision loss in people over 60 in the United States, and the number of people with AMD rises as they get older.
Macular degeneration affects tissue in the part of your retina that is responsible for central vision, called the macula. It causes blurred vision or a blind spot in the center of your vision, and can interfere with reading, driving, or other daily activities. You may first notice symptoms when you need more light to see up close.
There are two forms of AMD. Dry AMD affects about 85% of those with the disease and causes gradual loss of central vision, sometimes starting in one eye. Wet AMD, which accounts for 90% of all severe vision loss from the disease, often involves a sudden loss of central vision. Most people with the wet form of AMD previously had the dry form.
Signs and Symptoms
What Causes It?
The macula, a part of your eye’s retina, is made of cells called rods and cones that are sensitive to light and needed for central vision. Underneath the macula is a layer of blood vessels called the choroids, which provides blood to the macula. A layer of tissue on the retina called the retinal pigment epithelium (RPE) keeps the macula healthy by transporting nutrients from the blood vessels to the macula and moving waste products from the macula to the blood vessels.
As you get older, the RPE can thin and not move nutrients and waste back and forth as efficiently. Waste builds up in the macula, and cells in the macula become damaged from lack of blood, affecting your vision.
With dry AMD, RPE cells lose their color and don’t get rid of waste products from the rods and cones. As waste builds up, the rods and cones deteriorate.
With wet AMD, blood vessels grow underneath the macula and leak fluid or blood. Researchers don’t know exactly what causes the new blood vessels to grow, although they think that it may be the breakdown in waste removal. That could explain why people with the wet form almost always start out with the dry form. The new blood vessels interfere with getting nutrients to the macula, and the rods and cones start to break down.
Who's Most At Risk?
People with the following conditions or characteristics are at risk for developing AMD:
What to Expect at Your Provider's Office
Your eye doctor can screen you for AMD as you get older. However, if you have any changes in your central vision or in your ability to see colors, you should see your doctor right away. Your doctor may use several methods to test you for AMD:
There is no known cure for AMD. However, there are procedures that can help slow vision loss. Certain procedures and medications may stop the wet form of the disease from getting worse. Adding antioxidants to your diet may help prevent the wet and dry forms of AMD and slow their progression.
The dry form of AMD can progress to the wet form. If you have dry AMD, you will test your eyes daily at home using an Amsler grid. Let your doctor know immediately if there is any change in your vision,.
For wet AMD, a type of medication called anti-vascular endothelial growth factor (anti-VEGF) can be injected into your eye to stop new blood vessels from growing. Two such drugs are approved to treat AMD:
Surgical and Other Procedures
Surgical and other procedures may help some cases of wet macular degeneration.
Photocoagulation (laser surgery) -- In photocoagulation, doctors use a laser to seal off blood vessels that have grown under the macula. Whether this procedure is used depends on where the blood vessels are located, how much fluid or blood has leaked out, and how healthy the macula is.
Photodynamic therapy -- Often used to seal off blood vessels that are under the center of the macula. Using photocoagulation on that location would result in permanent central vision loss. With photodynamic therapy, the doctor gives you a drug that stays in the blood vessels under the macula. When a light is shined in your eye, the drug closes them off without damaging the rest of the macula. Photodynamic therapy slows vision loss but doesn’t stop it.
Complementary and Alternative Therapies
Supplements are a valuable treatment for dry AMD. They may also help prevent both wet and dry types. However, you should not try to self-treat vision problems. See your doctor first for a diagnosis and treatment plan.
To treat AMD
Ocuvite PreserVision is formulated to contain the proper amounts of these nutrients. People who already take a multivitamin should let their doctor know before taking this formulation. Zinc can be harmful at a dose of 80 mg, so be sure to take this combination only under your doctor’s supervision. Zinc can cause copper deficiency, so a small amount of copper is added to the nutrients.
In the study, 7.5% of people who took zinc had problems including urinary tract infections, enlarged prostate, and kidney stones, compared to 5% of the people in the study who did not receive zinc.
To prevent AMD
Folic acid can mask a vitamin B12 deficiency. Talk to your doctor before taking these vitamins at these doses.
The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner.
Severe AMD can cause legal blindness. Low vision aids may help if you have partial blindness. Sometimes blood vessels build up underneath the retina, causing the retina to become detached or scarred. If this happens, the chances of preserving your central vision are poor. This condition, called subretinal neovascularization, happens in about 20% of cases of AMD. It often comes back even after laser treatment.
Your eye doctor will see you regularly to monitor your vision and eye health.
Ahmadi MA, Lim JI. Pharmacotherapy of age-related macular degeneration. Expert Opin Pharmacother. 2008;9(17):3045-52.
Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Arch Ophthalmol. 2001;119(10):1417-1436.
Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 9. Arch Ophthalmol. 2001;119(10):1439-1452.
Augood C, et al. Oily fish consumption, dietary docosahexaenoic acid and eicosapentaenoic acid intakes, and associations with neovascular age-related macular degeneration. Am J Clin Nutr. 2008;88(2):398-406.
Bartlett HE, Eperjesi F. Effect of lutein and antioxidant dietary supplementation on contrast sensitivity in age-related macular disease: a randomized controlled trial. Eur J Clin Nutr. 2007 Sep;61(9):1121-7.
Bone RA, Landrum JT, Guerra LH, Ruiz CA. Lutein and zeaxanthin dietary supplements raise macular pigment density and serum concentrations of these carotenoids in humans. J Nutr. 2003;133(4):992-998.
Cai J, Nelson KC, Wu M, Sternberg P Jr, Jones DP. Oxidative damage and protection of the RPE. Prog Retin Eye Res. 2000;19(2):205-221.
Carpentier S, Knaus M, Suh M. Associations between lutein, zeaxanthin, and age-related macular degeneration: an overview. Crit Rev Food Sci Nutr. 2009;49(4):313-26.
Chang CW, Chu G, Hinz BJ, Greve MD. Current use of dietary supplementation in patients with age-related macular degeneration. Can J Opthalmol. 2003;38(1):27-32.
Cho E, Hung S, Willet WC, et al. Prospective study of dietary fat and the risk of age-related macular degeneration. Am J Clin Nutr. 2001;73(2):209-218.
Christen WG, Glynn RJ, Chew EY, Albert CM, Manson JE. Folic acid, pyridoxine, and cyanocobalamin combination treatment and age-related macular degeneration in women: The Women's Antioxidant and Folic Acid Cardiovascular Study. Arch Intern Med. 2009;169(4):335-41.
Coleman H, Chew E. Nutritional supplementation in age-related macular degeneration. Curr Opin Ophthalmol. 2007 May;18(3):220-3. Review.
Cong R, Zhou B, Sun Q, Gu H, Tang N, Wang B. Smoking and the risk of age-related macular degeneration: a meta-analysis. Ann Epidemol. 2008;18(8):647-56.
Diamond BJ, Shiflett SC, Feiwell N, Matheis RJ, Noskin O, Richards JA, et al. Ginkgo biloba extract: mechanisms and clinical indications. Arch Phys Med Rehabil. 2000;81(5):668-678.
Eat fish and protect against MD. Health News. 2006 Sep;12(9):8.
Evans JR. Antioxidant vitamin and mineral supplements for age-related macular degeneration. Cochrane Database Syst Rev. 2002;(20:CD000254.
Falsini B, Piccardi M, Iarossi G, Fadda A, Merendino E, Valentini P. Influence of short-term antioxidant supplementation on macular function in age-related maculopathy: a pilot study including electrophysiologic assessment. Ophthalmology. 2003;110(1):51-60;discussion 61.
Fies P, Dienel A. [Ginkgo extract in impaired vision – treatment with special extract Egb 761 of impaired vision due to dry senile macular degeneration]. Wiedn Med Wochenschr. 2002;152(15-16):423-426.
Flood V, Smith W, Wang JJ, Manzi F, Webb K, Mitchell P. Dietary antioxidant intake and incidence of early age-related maculopathy: the Blue Mountains Eye Study. Ophthalmology. 2002;109(12):2272-2278.
Gohel P, Mandava N, Olson J, Durairaj V, Age-related Macular Degeneration: An Update on Treatment. Amer J of Med. 2008;121(4).
Hambridge M. Human zinc deficiency. J Nutr. 2000;130(5S suppl):1344S-1349S.
Heber D, Bowerman S. Applying science to changing dietary patterns. J Nutr. 2001;131(11 Suppl):3078-3081S.
Hodge WG, Barnes D, Schachter HM, Pan YI, Lowcock EC, Zhang L, et al. Evidence for the effect of omega-3 fatty acids on progression of age-related macular degeneration: a systematic review. Retina. 2007 Feb;27(2):216-21. Review.
Hyman L, Neborsky R. Risk factors for age-related macular degeneration: an update. Burr Opin Ophthalmol. 2002;13(3):171-175.
Jones AA. Age related macular degeneration--should your patients be taking additional supplements? Aust Fam Physician. 2007 Dec;36(12):1026-8.
Kuzniarz M, Mitchell P, Flood VM, Wang JJ. Use of vitamin and zinc supplements and age-related maculopathy: the Blue Mountains Eye Study. Ophthalmic Epidemiol. 2002;9(4):283-295.
Landrum JT, Bone RA. Lutein, zeaxanthin, and the macular pigment. Arch Biochem Biophys. 2001;385(1):28-40.
Ma L, Dou HL, Wu YQ, Huang YM, Huang YB, Xu XR, Zou ZY, Lin XM. Lutein and zeaxanthin intake and the risk of age-related macular degeneration: a systematic review and meta-analysis. Br J Nutr. 2011 Sep 8:1-10. [Epub ahead of print]
Mataix J, Desco MC, Palacios E, Garcia-Pous M, Navea A. Photodynamic therapy for age-related macular degeneration. Ophthalmic Surg Lasers Imaging. 2009;40(3):277-84.
McBee WL, Lindblad AS, Ferris III FL. Who should receive oral supplement treatment for age-related macular degeneration? Curr Opin Ophthalmol. 2003;14(3):159-162.
Merle B, Delyfer MN, Korobelnik JF, Rougier MB, Colin J, Malet F, Féart C, Le Goff M, Dartigues JF, Barberger-Gateau P, Delcourt C. Dietary omega-3 fatty acids and the risk for age-related maculopathy: the Alienor Study. Invest Ophthalmol Vis Sci. 2011 Jul 29;52(8):6004-11.
Michels S, Kurz-Levin M. Age-related macular degeneration (AMD). Ther Umsch. 2009;66(3):189-95.
Morris MS, Jacques PF, Chylack LT, Hankinson SE, Willett WC, Hubbard LD, Taylor A. Intake of zinc and antioxidant micronutrients and early age-related maculopathy lesions. Ophthalmic Epidemiol. 2007 Sep-Oct;14(5):288-98.
Peeters A, Magliano DJ, Stevens J, Duncan BB, Klein R, Wong TY. Changes in abdominal obesity and age-related macular degeneration: the Atherosclerosis Risk in Communities Study. Arch Ophthalmol. 2008;126(11):1554-60.
Robman L, Vu H, Hodge A, Tikellis G, Dimitrov P, McCarty C, Guymer R. Dietary lutein, zeaxanthin, and fats and the progression of age-related macular degeneration. Can J Ophthalmol. 2007 Oct;42(5):720-6.
Seddon JM. Multivitamin-multimineral supplements and eye disease: age-related macular degeneration and cataract. Am J Clin Nutr. 2007 Jan;85(1):304S-307S. Review.
Seddon JM, Rosner B, Sperduto RD, Yannuzzi L, Haller JA, Blair NP, Willett W. Dietary fat and risk for advanced age-related macular degeneration. Arch Opthalmol. 2001;119(8):1191-1199.
Supplements may slow age-related macular degeneration. Mayo Clin Health Lett. 2002;20(3):4.
Supplements slow the course of macular degeneration. Harv Womens Health Watch. 2001;9(5):1-2.
Trieschmann M, Beatty S, Nolan JM, Hense HW, Heimes B, Austermann U, et al. Changes in macular pigment optical density and serum concentrations of its constituent carotenoids following supplemental lutein and zeaxanthin: the LUNA study. Exp Eye Res. 2007 Apr;84(4):718-28.
Review Date: 10/14/2011
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.