Age-Related Macular Degeneration

What is AMD?
Age-related macular degeneration (AMD) is a common cause of vision loss in people over the age of 60. You may already have it. Or you may be concerned because you’re at risk for it. Read on to find out more about this condition, and how to treat it, adapt to it or decrease your risk of developing it.

What You May See
AMD can cause loss of sharp central vision in one or both eyes. With AMD, you may have no obvious vision loss. Or you may have one or more of the following vision problems:

  • Fuzzy or blurry areas
  • Distorted lines and wavy edges
  • Faded color vision
  • Dark spots in your central vision
  • Vision that varies from day to day

How You May Feel
The thought of vision loss can be frightening. You may fear going blind. Or you may worry about being unable to drive, read, or be independent. Although AMD can cause vision loss that ranges from mild to severe, it rarely causes total blindness. Some aspects of your life may change, but AMD won’t make your world go dark.

What You Can Do
Whether you have AMD or are at risk for it, there are ways you can protect the vision that you have. Vision monitoring and regular eye exams can help you and your eye doctor (ophthalmologist) work together to preserve your vision. In some cases, laser treatment may keep AMD from getting worse. Changes in your lifestyle can help protect your eye health. There are many things you can do to adapt to vision changes if they occur.

Tips for Families
When a loved one has AMD, you can help. Look for tips in this booklet. Encourage your loved one:

  • To protect his or her vision.
  • To have regular eye exams.
  • To use his or her remaining vision as much as possible.
  • To stay active and involved.

The eye receives and processes light, allowing you to see. Central vision is the sharp detailed vision that you use when you look straight ahead. Peripheral vision is side vision the less acute vision that you may call “seeing out of the corner of your eye.” AMD affects central vision.

How the eye sees
Light enters the eye through the pupil. The retina (inside lining of the eye) turns this light into signals. The brain turns these signals into visual images what you see.

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The Healthy Macula
The macula is the part of the retina where central vision takes place. The fovea is the most sensitive part of the macula. The whole retina, including the macula and the fovea, has several layers:

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Dry Macular Degeneration
Dry macular degeneration may cause a slow decline in vision over time. It is caused by the breakdown of he RPE. This breakdown damages the light-sensing cells. It may also lead to the formation of drusen (yellow deposits) beneath the retina. These changes may cause distorted or blurry vision.

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Wet Macular Degeneration
Wet macular degeneration may cause sudden loss of central vision. It is caused by the growth of new, weak blood vessels. These blood vessels grow from the choroid below or through the RPE. They may cause the macula to bulge, distorting vision. Fluid leaking from these weak blood vessels, or scarring on the surface of the retina, can cause dark or blurred spots in the field of vision.

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Monitoring Your Vision
Have regular eye exams and check your vision at home as directed by your eye doctor. Doing this can help you catch eye problems early. This can help preserve the vision that you have.

Regular Eye Exams
Having regular eye exams helps your doctor find and treat problems early, sometimes before they affect your vision. To best protect your vision:

  • Have regular eye exams even if you have no vision changes. Have a dilated eye exam (see page 8) yearly, or more often if recommended by your eye doctor.
  • Schedule an eye exam right away if you have any vision changes.

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Vision Monitoring
Check your vision often using the Amsler grid (at night). Note changes in your vision and report them to your eye doctor. Keep in mind that you may have vision problems that are not related to AMD. Making sure that any problems are treated helps you make the most of your remaining vision.

 

 

 

The Amsler Grid
An Amsler grid is a chart that you can use at home to check your vision. Cut out the grid below. Or your eye doctor may give you one. Use the grid regularly, as directed by your eye doctor. If you notice vision changes, contact your ophthalmologist as soon as possible.

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How to Use the Amsler Grid

  • Use the grid in a well lighted area.
  • Wear glasses or contacts if you usually wear them.
  • Hold the grid at your normal reading distance (about 16 inches).
  • Cover your left eye.
  • Look at the dot in the grid’s center with your right eye.
  • While looking at the dot, notice if any of the lines appear wavy or disappear or if the boxes change shape.
  • Jot down any changes from the last time you used the grid.
  • Repeat with your other eye.
  • If you’ve noticed any vision changes, call your eye doctor right away.

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Your Evaluation
Your evaluation assesses two things: your vision and the health of your eyes. Vision tests help your doctor learn about how well you see. By examining your eyes your doctor can find out more about your eye health.

Your Medical History
Your doctor will ask about your symptoms, age and health history. He or she may also ask about your family’s medical history and factors such as smoking, diet, and exercise.

A Routine Eye Exam
A routine eye exam includes:

  • Vision tests using an eye chart and the Amsler grid (see page7).
  • Tests of peripheral vision and color vision.
  • An eye pressure test, using a tonometer.
  • Examination of the front of your eye and your retina, using a machine called a slit lamp. Your pupils may be dilated (enlarged) for this part of the exam. A special contact lens may also be used.

 

Photographs of the Retina
If your doctor thinks you may have wet AMD, he or she may do an angiogram (a special photograph of the retina). For this procedure, dye is injected into a vein, usually in the arm or hand. It then travels to the eye. The dye highlights any abnormal blood vessels or leaking fluid. The doctor may do two angiograms using two different dyes. The whole procedure takes less than an hour.

 width=Laser treatment uses a highly focused beam of light. This beam can be aimed very precisely. During laser eye surgery, the laser beam travels through the pupil to the retina. There, it seals leaking blood vessels and dries up fluid. It also keeps abnormal blood vessel growth from spreading.

Photodynamic Laser Therapy (PDT)
PDT is a special type of laser treatment. For this treatment a light-sensitive dye is injected into a vein. The dye is then taken up by the new, weak blood vessels in the retina. The laser targets the dye-filled blood vessels and destroys them. PDT may be suggested if you have wet AMD that affects the fovea. It may cause less damage to healthy tissue than standard laser treatment. PDT needs to be repeated several times to be effective.

Risks and Complications of Laser Treatment
Complications of laser treatment are rare. They may include:

  • Watery eyes
  • Dilated pupils
  • Mild headache
  • Double or blurry vision
  • Seeing spots
  • Problems with glare
  • A new “blind spot”
  • Pain in and around the eye
  • Bruising near or under the eye

 

During Laser Treatment
Laser treatment for AMD takes 15 to 30 minutes. You go home the same day first, your pupils are dilated with eyedrops. Next, your eye is numbed with eyedrops or rarely with an injection under the eye. The doctor holds a contact lens against your eye. The laser is then turned on. During the procedure, you may see flashes of light. The procedure is usually painless, but if you do feel pain, tell your doctor right away.

After Laser Treatment
After treatment have an adult friend or family member drive you home. You may wear an eye patch or sunglasses for the first few hours. At first, your vision may be worse than before treatment. It should slowly improve over the next 2 to 3 weeks. In the weeks after treatment:

  • Follow your doctor’s instructions about work and exercise.
  • Use the Amsler grid to check your vision regularly.
  • Schedule a follow-up appointment. An angiogram is needed to assess the effect of the treatment.

 

When to Call your Doctor
Call your doctor right away if:

  • Your vision suddenly worsens.
  • Your eye becomes painful.
  • You feel dizzy or nauseated.

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Keeping Your Eyes Healthier
Protecting your general health helps to preserve your eye health and your vision. These tips may help delay or prevent AMD from progressing.

Eat a Healthy Diet
You can help keep your eyes healthy be eating a balanced diet that includes plenty of fruits and vegetables. Leafy green vegetables such as spinach may be especially good for protecting against AMD. Ask your doctor about taking a daily multivitamin or other supplement.

Control Blood Pressure
High blood pressure can make eye problems worse. To help you control your blood pressure, your doctor may suggest:

  • Regular blood pressure checks
  • Regular exercise
  • Cutting down on salt, fat alcohol, and caffeine
  • Weight loss
  • Stress reduction
  • Blood pressure medication

 

Use Sun Protection
Protect your eyes from damaging sunlight:

  • Wear sunglasses. Look for ones that block UVA and UVB light. Sunglasses that block blue light may also help protect against AMD.
  • Wear a hat when outdoors. Choose a hat with a brim that shades your face.

 

If You Smoke, Quit
Smoking damages blood vessels throughout your body, including those in your eyes. It can also worsen high blood pressure. If you smoke, ask your doctor about a program to help you quit.

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Living with AMD
AMD may never cause you serious vision loss. But if it does, certain changes in the way you do things can help you to stay active and enjoy life.

Use What You’ve Got
There are many ways to make the most of the vision you have.

  • Use your side vision. If you need to look at an object move it to one side and look at it out of the corner of your eye.
  • Make sure that other vision problems are corrected.
  • If a hobby or game requires close work, look for a similar one that doesn’t depend on such detailed vision. For example, you may choose to switch from needlework to rug hooking.

 

Drive Safely
You may find that you’re able to drive safely during the day, but not at night lf glare is a problem when you drive, special tinted glasses may help. But be realistic. If you can no longer drive safely, don’t drive. Giving up driving can be hard, but it may be the best way to keep yourself and others safe.

Tips for Families
Your loved one may need more help from you if his or her vision worsens. Offer to help, but let your loved one tell you what kind of help is needed. Be ready to:

  • Drive.
  • Help with chores and errands.
  • Help your loved one get out of the house and stay active.
  • Help in social situations. For example, greet people by name so that your loved one knows who is nearby.

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Making Changes at Home
Certain changes at home can make life safer and easier. Friends or family can help. A low-vision specialist or an occupational therapist can advise you. He or she can then visit your home to make sure the changes have been made safely.

Make Your House Safer
Protect yourself from falls, burns, and other accidents:

  • Improve lighting.
  • Install automatic lighting indoors and out.
  • Remove or secure rugs, cords, low tables, and other objects that might trip you.
  • Install railings on stairs, patios, and decks.
  • Mark the “off” position on stove and oven controls with colors or raised markings.

 

Make Daily Tasks Easier
Arrange your house to make tasks easier. For example:

  • Mark items such as spices or pill bottles with colors or textures.
  • Mark the edges of kitchen counters with contrasting tape or paint.
  • Arrange closets and drawers to make things easier to find by touch.

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Low Vision Aids
Low-vision aids can help you with close work, such as reading and writing. They can also help you to use appliances and tools. See the back cover of this booklet for sources of low vision aids.

Magnifiers and Reading Eyewear
These aids enlarge print, making it easier for you to read. Some have lights attached. Some magnifiers are designed to help with certain tasks, such as sewing or gardening.

Reading Machines
Reading machines display a page enlarged on a screen. These machines magnify print many times. Some can enable you to read curved surfaces, such as pill bottles.

Tips for Families
Low-vision aids can help your loved one function better and enjoy life more. To help:

  • Learn more about low-vision aids and where to find them.
  • Find out about local community resources for people with low vision.

 

Other Low-Vision Aids
These include:

  • Large-button telephones.
  • Large-print books and audio books, available at our local library or bookstore.
  • Signature guides for writing codes.
  • Talking appliances, such as watches, alarm clocks, and calculators.
  • High-contrast cutting boards and other kitchen tools.

 

An Active Life with AMD
Living with AMD can be a challenge. But making the most of the vision you have can help you get more out of life. Support from friends, family, a low-vision support group, or other community groups can also help.

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