Age-Related Macular Degeneration: Prevention and Treatment

Age-related macular degeneration (AMD) is the leading cause of vision loss in Americans over age 50. While it doesn't cause complete blindness, AMD can significantly impact your quality of life by damaging the central vision needed for reading, driving, and recognizing faces. Understanding AMD and taking preventive measures can help protect your sight as you age.

As an ophthalmologist providing macular degeneration treatment in NYC and Flushing, I work with AMD patients every day. While we can't reverse damage that's already occurred, early detection and modern treatments can slow progression and help many patients maintain functional vision for years.

What Is Age-Related Macular Degeneration?

AMD affects the macula, a small but crucial area at the center of your retina responsible for sharp, detailed central vision. The macula allows you to see fine details clearly—essential for reading, driving, recognizing faces, and performing tasks requiring precision.

When AMD damages the macula, your central vision becomes blurry, distorted, or develops dark spots, while peripheral (side) vision typically remains intact. This creates a characteristic pattern where you can see around the edges but not straight ahead.

Types of Macular Degeneration

Dry AMD (Atrophic AMD)

Dry AMD accounts for approximately 85-90% of all cases and progresses more slowly than wet AMD:

Characteristics

• Gradual breakdown of light-sensitive cells in the macula
• Formation of drusen (yellow deposits under the retina)
• Slow progression over years
• Vision loss occurs gradually
• Can progress to geographic atrophy (advanced dry AMD)
• May eventually convert to wet AMD (about 10-15% of cases)

Stages of Dry AMD

• Early AMD: Medium-sized drusen, usually no symptoms
• Intermediate AMD: Large drusen, possible pigment changes, may have subtle symptoms
• Advanced Dry AMD (Geographic Atrophy): Areas of retinal cell death, noticeable vision loss

Wet AMD (Neovascular or Exudative AMD)

Wet AMD represents only 10-15% of cases but causes about 90% of severe vision loss from AMD:

Characteristics

• Abnormal blood vessels grow under the retina (choroidal neovascularization)
• These vessels leak fluid and blood
• Causes rapid vision loss—can progress in weeks or months
• May develop suddenly in people with dry AMD
• Always preceded by some degree of dry AMD
• Can affect one or both eyes

Wet AMD requires urgent treatment to prevent severe vision loss. If you have AMD in one eye, you're at increased risk of developing it in the other eye.

Symptoms of Macular Degeneration

Early Symptoms

AMD often develops without noticeable symptoms initially. As it progresses, you may notice:

• Blurred central vision
• Need for brighter light when reading or doing close work
• Difficulty recognizing faces
• Straight lines appearing wavy or distorted (metamorphopsia)
• Dark or blurry spot in the center of your vision
• Decreased intensity or brightness of colors

Advanced Symptoms

• Significant loss of central vision
• Blank spot in the center of your visual field
• Difficulty reading, even with reading glasses
• Problems seeing in dim lighting
• Difficulty adapting to different lighting levels
• Trouble distinguishing colors

Warning Signs of Wet AMD

If you have dry AMD, watch for these signs that it may be converting to wet AMD:

• Sudden decrease in central vision
• Straight lines appearing increasingly wavy
• Central blurry spot that rapidly worsens
• Distortion intensifying over days or weeks

Contact your eye doctor immediately if you notice any sudden vision changes.

Risk Factors for AMD

While aging is the primary risk factor, several other factors influence your likelihood of developing macular degeneration:

Non-Modifiable Risk Factors

• Age: Risk increases significantly after 60; highest in people over 75
• Family history: Having a first-degree relative with AMD increases your risk 3-6 times
• Genetics: Certain gene variants significantly increase risk (complement factor H, ARMS2)
• Race: More common in Caucasians than African Americans or Hispanics
• Gender: Slightly more common in women, possibly due to longer lifespan
• Light eye color: Blue or light-colored eyes may carry slightly higher risk

Modifiable Risk Factors

• Smoking: The single most important modifiable risk factor—doubles or triples your risk
• Cardiovascular disease: High blood pressure, high cholesterol, and atherosclerosis increase risk
• Obesity: Especially abdominal obesity, increases progression risk
• Diet: Low intake of antioxidants, omega-3 fatty acids, and nutrients increases risk
• Sun exposure: Prolonged UV exposure without protection may increase risk
• Lack of exercise: Sedentary lifestyle associated with higher risk

Diagnosis and Testing

During your comprehensive examination at our Flushing office, several tests evaluate macular health:

Dilated Eye Examination

After dilating your pupils, I examine the macula and retina for drusen, pigment changes, and signs of abnormal blood vessel growth.

Amsler Grid Test

This simple test uses a grid of straight lines. If you see wavy, missing, or distorted areas, it may indicate macular problems. Patients with AMD often use this at home to monitor their condition.

Optical Coherence Tomography (OCT)

This non-invasive imaging provides detailed cross-sectional views of retinal layers, revealing:

• Drusen size and distribution
• Fluid accumulation
• Retinal thickness changes
• Structural abnormalities

OCT is essential for detecting wet AMD and monitoring treatment response.

Fluorescein Angiography

For suspected wet AMD, fluorescent dye is injected into your arm, and photographs track its flow through retinal blood vessels, revealing:

• Abnormal blood vessel growth
• Leakage locations
• Extent of neovascularization

OCT Angiography (OCT-A)

A newer, non-invasive alternative to fluorescein angiography that creates detailed maps of retinal blood vessels without injection.

Fundus Autofluorescence

This imaging technique helps assess metabolic activity in the retina and map areas of geographic atrophy.

Treatment Options

Treatment for Dry AMD

AREDS2 Nutritional Supplements

The Age-Related Eye Disease Study (AREDS and AREDS2) demonstrated that specific high-dose vitamins and minerals can slow progression of intermediate to advanced AMD by about 25%:

AREDS2 Formula:

• Vitamin C: 500 mg
• Vitamin E: 400 IU
• Lutein: 10 mg
• Zeaxanthin: 2 mg
• Zinc oxide: 80 mg (or 25 mg for some patients)
• Copper: 2 mg

These supplements are recommended for intermediate AMD or advanced AMD in one eye. They don't help early AMD or prevent AMD in healthy eyes. Always consult your doctor before starting supplements, especially if you smoke (beta-carotene increases lung cancer risk in smokers).

Emerging Treatments

Several promising therapies for dry AMD are in clinical trials:

• Complement inhibitors to reduce inflammation
• Gene therapy approaches
• Stem cell treatments
• New drug delivery systems

Treatment for Wet AMD

Anti-VEGF Injections

The primary treatment for wet AMD involves medications injected into the eye that block vascular endothelial growth factor (VEGF), stopping abnormal blood vessel growth:

• Bevacizumab (Avastin): Effective, cost-effective option
• Ranibizumab (Lucentis): FDA-approved specifically for AMD
• Aflibercept (Eylea): May last slightly longer between injections
• Brolucizumab (Beovu): Newer option allowing extended dosing intervals
• Faricimab (Vabysmo): Dual-action medication blocking VEGF and Ang-2

Treatment Protocol

• Initial loading dose: Usually 3 monthly injections
• Maintenance: Continue as needed, often every 4-8 weeks
• Some newer medications allow longer intervals (up to 12-16 weeks)
• Treatment is typically ongoing; stopping often leads to recurrence

The injections are performed in-office with numbing drops and are generally well-tolerated. Most patients maintain or improve their vision with consistent treatment.

Photodynamic Therapy (PDT)

Once common, PDT is now rarely used since anti-VEGF injections are more effective. It may still be used in select cases or combination therapy.

Laser Photocoagulation

Traditional thermal laser treatment is now rarely used for wet AMD, as it destroys healthy tissue along with abnormal vessels. It's only considered when abnormal vessels are far from the center of the macula.

Prevention and Risk Reduction

While you can't completely prevent AMD, you can significantly reduce your risk:

Quit Smoking

This is the single most important action you can take. Smoking doubles or triples AMD risk. Quitting at any age reduces risk.

Eat a Healthy Diet

Emphasize foods rich in antioxidants and omega-3 fatty acids:

• Leafy green vegetables: Spinach, kale, collards (rich in lutein and zeaxanthin)
• Fish: Salmon, tuna, sardines (omega-3 fatty acids)
• Colorful fruits and vegetables: Carrots, sweet potatoes, berries
• Nuts and seeds: Almonds, sunflower seeds (vitamin E)
• Whole grains: Better glycemic control

Maintain Cardiovascular Health

• Control blood pressure
• Manage cholesterol levels
• Maintain healthy weight
• Exercise regularly (at least 150 minutes weekly)

Protect Your Eyes from UV Light

Wear sunglasses that block 100% of UVA and UVB rays when outdoors. A wide-brimmed hat provides additional protection.

Regular Eye Examinations

Early detection is crucial. Follow recommended exam schedules:

• Ages 55-64: Every 1-3 years
• Age 65 and older: Every 1-2 years
• If you have AMD: As frequently as recommended by your ophthalmologist

Consider AREDS2 Supplements

If you have intermediate AMD or advanced AMD in one eye, AREDS2 supplements may slow progression.

Living with AMD

Home Monitoring

If you have AMD, monitor your vision daily using an Amsler grid:

• Test each eye separately
• Wear your reading glasses if needed
• Look for wavy lines, missing areas, or distortion
• Report any changes to your doctor immediately

Low Vision Rehabilitation

Even with vision loss, many tools and strategies can help you maintain independence:

• Magnifying devices for reading
• Large-print books and materials
• High-contrast items for easier visibility
• Enhanced lighting throughout your home
• Audio books and voice-activated devices
• Smartphone accessibility features
• Low vision rehabilitation services

Emotional Support

Vision loss can be emotionally challenging. Consider:

• AMD support groups
• Counseling if needed
• Staying socially active
• Learning new adaptive skills

Frequently Asked Questions

Will I go completely blind from AMD?

AMD typically doesn't cause complete blindness. It affects central vision but usually preserves peripheral vision, allowing you to navigate and maintain some independence. However, severe AMD can significantly impact quality of life and ability to perform daily tasks.

How fast does AMD progress?

Dry AMD usually progresses slowly over years. Wet AMD can progress rapidly—sometimes within weeks—which is why immediate treatment is essential if it develops.

Are anti-VEGF injections painful?

We use numbing drops and sometimes a local anesthetic injection to minimize discomfort. Most patients report only mild pressure during the procedure. Any discomfort is brief.

How long will I need injections?

Most patients with wet AMD require ongoing treatment. Stopping injections often leads to recurrence and vision loss. However, some patients' disease becomes inactive and injections can be discontinued or spaced very far apart.

Can younger people get AMD?

Age-related macular degeneration primarily affects people over 50. However, certain inherited conditions can cause similar macular degeneration in younger individuals (these are distinct from AMD).

The Importance of Early Detection

AMD is most manageable when detected early. Regular comprehensive eye examinations allow monitoring of risk factors and immediate intervention if wet AMD develops. If you're over 50, have a family history of AMD, or have other risk factors, don't delay—schedule your comprehensive eye examination today.

At our Flushing office, we use advanced diagnostic technology to detect AMD in its earliest stages and provide state-of-the-art treatment for all forms of macular degeneration. Early intervention provides the best chance of preserving your vision.