Symptoms and Treatment Options for Macular Degeneration
Age-related macular degeneration (AMD) is usually asymptomatic in its early stages, but as it progresses, patients may experience blurred vision, distorted vision (metamorphopsia), and central vision loss, requiring early diagnosis and treatment to preserve vision and quality of life. 1
Symptoms of Macular Degeneration
Early AMD
- Early AMD is typically asymptomatic, making regular comprehensive eye examinations crucial for early detection 1
- Subtle changes in vision may occur but often go unnoticed by patients 1
Progressive and Advanced AMD Symptoms
- Blurred central vision that cannot be corrected with glasses 1
- Distorted vision (metamorphopsia) - straight lines appear wavy or bent 1
- Dark or empty areas in the center of vision (scotomas) 1
- Difficulty reading, recognizing faces, or performing detailed tasks 1
- Decreased color perception 1
- Need for brighter light when reading or doing close work 1
- Difficulty adapting to low light levels 1
Diagnostic Tool for Self-Monitoring
- The Amsler grid is a useful tool for patients to self-monitor for early signs of metamorphopsia (distorted vision) 1
- Patients are instructed to look at the central dot and evaluate if any grid lines appear wavy or distorted 1
Types of AMD and Their Characteristics
Dry AMD (Geographic Atrophy)
- Accounts for approximately 85-90% of AMD cases 1
- Characterized by drusen (yellow deposits beneath the retina) and retinal pigment epithelial changes 1
- Progressive atrophy of retinal layers and retinal pigmented epithelial cells 1
- Slower progression compared to wet AMD 1
Wet AMD (Neovascular)
- More severe form with faster progression and greater vision loss 1
- Characterized by abnormal blood vessel growth (choroidal neovascularization) 1
- May present with sudden vision loss due to fluid leakage or hemorrhage 1
- Accounts for approximately 10-15% of AMD cases but responsible for 80-90% of severe vision loss from AMD 1
Risk Factors
- Advanced age (prevalence increases significantly after age 65) 1
- Cigarette smoking (directly correlated with disease progression) 1
- Family history of AMD 1
- Genetic factors (including CFH and ARMS2/HTRA1 gene variants) 1
- Presence of large drusen or pigmentary changes in the retina 1
- Obesity and poor diet (low in green leafy vegetables) 1
- Cardiovascular disease 1
Treatment Options
Dry AMD Management
- AREDS2 supplement formulation (vitamin C, vitamin E, zinc, copper, lutein, zeaxanthin) for patients with intermediate or advanced AMD in one eye 1
- This supplementation has been shown to reduce risk of progression to advanced AMD 1
- Smoking cessation counseling (smoking increases risk of AMD progression) 1
- Regular monitoring with comprehensive eye examinations 1
Wet AMD Treatment
- Anti-vascular endothelial growth factor (anti-VEGF) therapy is the primary treatment 1
- Photodynamic therapy may be used in some cases, combining verteporfin (photoreactive agent) with low-level laser light 1
- Older treatments like laser photocoagulation are rarely used now due to associated blind spots in the treatment area 1
Importance of Early Detection and Treatment
- AMD is a leading cause of severe, irreversible vision impairment 1
- Early detection through regular comprehensive eye examinations is crucial as early symptoms may be subtle 1
- Patients with neovascular AMD report substantial decline in quality of life and increased need for assistance with daily activities as visual acuity worsens 1
- Early treatment is associated with more favorable prognosis and better preservation of vision 1
Monitoring and Follow-up
- Regular use of the Amsler grid at home to monitor for changes in vision 1
- Prompt reporting of new visual symptoms to an ophthalmologist 1
- Regular comprehensive eye examinations based on risk factors and disease stage 1
- Any patient age 50 or older with distorted vision or vision loss should be immediately referred to an ophthalmologist 2