Answering Common Questions About Age-Related Macular Degeneration

Age-related macular degeneration (AMD or ARMD) is one of the most common retinal diseases among older adults. It does not lead to total vision loss, but AMD does impair vision in the central area of the retina. Vision impairment can progress and eventually affect a person’s ability to drive, read, and even recognize faces.

There are different types of AMD, and it can progress differently for different people. For anyone diagnosed with AMD or caring for someone with AMD, understanding more about the disease and its impact on daily life is essential. Here are answers to some of the most common questions about AMD.

What is age-related macular degeneration?

If we think of the eye like a camera, the retina is like film where light is converted to electrical signals that are sent to the brain. The macula is the central and most vital area of the retina. As people get older, they can develop spots on the macula known as drusen, which are similar to age spots on the skin. As a result, central vision becomes washed out and loses detail, and straight lines may appear wavy.

What is the difference between wet and dry age-related macular degeneration?

There are 2 types of AMD: dry and wet. All AMD starts as the dry type. In dry AMD, which is characterized by the drusen deposits, the tissues of the macula become thin as cells disappear.

In dry AMD, the loss of central vision occurs slowly and painlessly over years. People may have few or no symptoms but, when they do have symptoms, they often occur in both eyes. As the disease progresses, central blind spots (scotomas) usually occur and can sometimes severely impair vision.

About 10% to 15% of people with dry AMD go on to have wet AMD. Wet AMD develops when abnormal blood vessels grow under the damaged macula and leak fluid and blood (hence the description as "wet"). The abnormal blood vessels cause vision loss to progress quickly. Eventually, a mound of scar tissue develops under the macula. The wet form develops in one eye first but eventually may affect both eyes.

What causes AMD?

There’s no single known cause of AMD. It’s a degenerative condition that develops over time, most often in people over the age of 50. It can run in families, although having a family history does not mean someone will definitely develop it.

Several risk factors can increase the likelihood of AMD, including smoking, poor nutrition, high blood pressure, and cardiovascular disease.

Can AMD be prevented?

The best ways to lower the risk of AMD include avoiding smoking, controlling blood pressure, staying physically active, and eating a healthy diet, especially one rich in omega-3 fatty acids found in fish and dark, leafy green vegetables.

There is no universal screening guideline for AMD, but people with a family history should have a dilated eye exam beginning around age 50. In addition, anyone diagnosed with AMD should see an ophthalmologist right away if they notice any change in vision. The sooner a transition to wet AMD is detected and treated, the better the chances of preserving sight.

How is AMD treated?

For people with intermediate or advanced AMD in at least one eye, certain dietary supplements (based on the AREDS2 formula) are recommended to help slow disease progression.

In the wet form of AMD, medications can be injected directly into the eye (intravitreal injections) to stop abnormal blood vessels from leaking. These treatments significantly reduce the risk of vision loss and can even improve reading vision in about one-third of patients.

For people with severe vision loss from AMD, doctors may also:

• Give additional injections in the back of the eye
• Use laser or light-based treatments to seal abnormal blood vessels
• Recommend low-vision tools, such as magnifiers, special reading glasses, or electronic devices
• In select cases, implant a miniature telescope inside the eye to improve central vision

Can people with AMD still drive?

It is very common for people with AMD to worry about losing the ability to drive, and understandably so. Driving is central to independence for many adults. The good news is that most people with dry AMD keep enough vision to continue driving safely and to read, especially in the earlier stages. However, AMD is a progressive condition, so regular monitoring for any vision changes is important.

For caregivers, a helpful guideline is this: if you feel unsafe as a passenger while a family member with AMD is driving, it is time to encourage an evaluation with their eye doctor.

Beyond driving, AMD can affect many daily activities, but there are excellent low vision tools and resources available to support both near and distance vision. The first step is to meet with an ophthalmologist, who can recommend the right aids or specialty care based on the individual’s current vision.

This is a rapidly advancing field. New treatments and technologies are emerging all the time. Even with vision loss, there is real reason to remain hopeful.

To learn more about AMD, visit the Manuals page or the Quick Facts on the topic.