Age-related Macular Degeneration (AMD)

It is a condition caused by an abnormality of the retina, an essential organ for vision. Patients often begin to experience symptoms such as blurred vision, distorted images, or a dark spot in the center of their field of vision, which are signs of macular degeneration. If left untreated, it can lead to permanent vision loss. Some individuals may confuse it with other eye conditions that have similar symptoms, such as corneal dystrophy or retinal detachment. Therefore, understanding the symptoms and getting examined by an ophthalmologist is crucial for timely prevention and treatment.

What is the retina? The importance of the retina

The retina is a thin, complex layer of tissue located at the innermost part of the eye. It functions like camera film by receiving light that passes through the cornea and lens, then converting it into neural signals sent to the brain to interpret as the images we see.

The structure of the retina consists of 2 main types of photoreceptor cells:

1. Rods – Work well in low light, helping with night vision and peripheral vision
2. Cones – Work well in bright light, helping us see details and distinguish colors

The most important area of the retina is the macula, which contains the highest concentration of cone cells, allowing us to see clearly in the center of our vision. If the macula degenerates, it causes macular degeneration.

There are many types of retinal disorders, not only this condition, but also retinal detachment, which occurs when the retina separates from its supporting layer, leading to sudden vision loss. This differs from corneal dystrophy, which affects the cornea, the front layer of the eye. Although the locations differ, all of these conditions ultimately affect the quality of vision.

The retina therefore plays an extremely important role. If the retina is damaged even slightly, it can significantly affect daily life, from reading books to seeing the faces of loved ones. And this is why macular degeneration is a condition that should not be overlooked.

What is macular degeneration?

Age-related Macular Degeneration (AMD) is a condition that occurs when the central part of the retina deteriorates due to age or other factors, causing central vision to become blurry or distorted. Patients may still retain good peripheral vision, but they are unable to focus on central images, which presents a major obstacle to daily activities such as reading, using a computer, or driving.

This disease is divided into 2 main types:

1. Dry Age-related Macular Degeneration (Dry AMD)
   • Most common
   • It is caused by the accumulation of a substance called Drusen under the retina, causing the nerve cells to gradually deteriorate.
   • The disease progresses slowly, but if left untreated, it can lead to permanent vision loss.
2. Wet Age-related Macular Degeneration (Wet AMD)
   • Less common, but more severe
   • It is caused by abnormal blood vessel growth under the retina. These blood vessels are fragile and leak, causing blood or fluid to seep into the macula.
   • Resulting in rapid vision loss

Many patients mistakenly believe that these symptoms are just common eye conditions, such as nearsightedness or farsightedness. However, in reality, they are signs of retinal degeneration—a condition that requires diagnosis by a specialist. Early detection is the key to preserving vision for as long as possible.

Causes of Macular Degeneration

Macular degeneration is a multifactorial condition influenced by both internal bodily factors and lifestyle habits. While there is no definitive answer as to a single cause, researchers and doctors confirm several risk factors that contribute to the onset and rapid progression of this disease.

1. Age

Increasing age is the primary factor associated with this condition. People over the age of 50 are many times more likely to develop macular degeneration than younger individuals because the structure of the retina deteriorates over time, blood and nutrient circulation decreases, photoreceptor cells function less effectively, and waste deposits accumulate under the retina.

2. Genetics

Having a family history of this disease significantly increases the risk. Scientists have found that certain genes are associated with macular degeneration. A family history of the condition further increases your risk.

3. Lifestyle behaviors

• Smoking is the most significant controllable risk factor, as smoking damages the blood vessels that supply the retina and reduces antioxidants in the body.
• Eating a diet lacking in fruits, vegetables, and essential eye nutrients such as vitamins C, E, zinc, lutein, and zeaxanthin may accelerate retinal degeneration.
• Excessive alcohol consumption decreases blood flow to the retina.

4. Underlying Disease

People with high blood pressure, diabetes, and high cholesterol have a higher risk of developing macular degeneration because these conditions cause the small blood vessels in the retina to deteriorate more easily.

5. Other Factors

• Exposure to intense sunlight without eye protection
• Overweight and lack of exercise
• Females are at a slightly higher risk due to having a longer life expectancy than males.

Symptoms of Macular Degeneration

Symptoms of this disease vary depending on the type and severity, but a common feature is worsening central vision, which causes great difficulty for patients.

1. Early symptoms

• Seeing distorted text or straight lines
• Need more light than usual when reading
• Unclear or distorted color vision
• Perceiving small details, such as small numbers or fine lines, starts to become more difficult.

2. Symptoms as the disease worsens

• Seeing a dark spot in central vision (Central scotoma)
• Loss of central vision, but peripheral vision remains.
• Difficulty reading or seeing the faces of people nearby.
• Patients may feel as if a shadow or fog is constantly obscuring their vision.

3. Differences from other diseases

• Retinal detachment – Patients will see flashes of light, floaters, a dark shadow like a curtain, and may experience sudden vision loss, unlike macular degeneration which progresses slowly.
• Corneal degeneration – causes light entering the eye to distort before reaching the retina. The main symptom is gradually blurry vision, but it does not cause a dark spot in the center of the image.

Treatment for Macular Degeneration

Treatment depends on the type and stage of the disease detected, with the main goal of slowing progression and preserving vision for as long as possible.

1. Treatment for Dry Age-related Macular Degeneration (Dry AMD)

There is no cure yet, but the risk of progression can be reduced through health care and vitamin supplementation. The accepted formula is

1. AREDS (Age-Related Eye Disease Study) which consists of:
   • Vitamin C
   • Vitamin E
   • Zinc
   • Lutein and Zeaxanthin
2. Injections used to treat advanced macular degeneration, specifically geographic atrophy, are newer medications gaining increased use, such as Pegcetacoplan. Approved by the US FDA in 2023, it requires periodic intravitreal injections to help slow disease progression, though it cannot restore cells that have already been lost.

2. Treatment of Wet Age-related Macular Degeneration (Wet AMD)

• Anti-VEGF injections – such as Ranibizumab and Aflibercept – help inhibit the formation of abnormal blood vessels, reducing leakage and bleeding beneath the retina.
• Laser treatment – uses lasers to seal abnormal blood vessels, but is now used less frequently because it may damage healthy tissue.
• Photodynamic Therapy (PDT) – Uses medication in combination with low-intensity laser to destroy abnormal blood vessels

3. Surgery and New Innovations

In some cases, special lenses (Implantable miniature telescope) or surgical techniques to relocate the macula may be used to reduce the impact of the disease, but it is a high-risk surgery and not currently a standard procedure (Macular translocation surgery).

4. Vision Rehabilitation

Although it cannot be completely cured, visual aids such as special magnifying glasses, electronic devices, and training to use peripheral vision more effectively can be used.

5. Lifestyle Recommendations

• Eat an eye-healthy diet
• Avoid smoking and alcohol
• Wear sunglasses when outdoors
• Get regular eye check-ups

Care and Prevention of Macular Degeneration

Although macular degeneration cannot be cured, we can reduce the risk and slow down the progression of the disease through proper self-care.

1. Nutrition for Eye Health

• Consume green leafy vegetables, such as kale and spinach, which contain lutein and zeaxanthin.
• Eat deep-sea fish, such as salmon and tuna, that contain omega-3 fatty acids.
• Reduce red meat, processed foods
• Fruits rich in vitamin C, such as oranges, kiwis
• Nuts and seeds containing vitamin E
• Specific vitamin formula based on AREDS2 Study

2. Avoid risk factors

• Quit smoking, which is the most important risk factor
• Reduce alcohol consumption
• Wear sunglasses when outdoors to protect against UV rays

3. Regular eye exams

People over the age of 50 should get a retina exam at least once a year for early screening, so that any signs of macular degeneration can be treated in a timely manner.

Frequently Asked Questions (FAQ)

Q1: Can macular degeneration be completely cured?
A: It cannot be fully cured, but it can be controlled and slowed down with appropriate treatment, such as Anti-VEGF injections.

Q2: What are the early symptoms of macular degeneration?
A: Usually starts with seeing distorted images, crooked text, and a dark spot in the center of vision.

Q3: How is retinal detachment different from macular degeneration?
A: Retinal detachment causes rapid vision loss, whereas macular degeneration progresses more slowly.

Q4: Is this disease related to corneal dystrophy?
A: Not directly related, but both conditions can cause reduced vision and patient confusion.

Q5: How often should you get your eyes checked?
A: If you are over 50 years old, you should have an eye exam at least once a year, or sooner if you experience any abnormal symptoms.