FAQs

  • Choroid: The layer of blood vessels and connective tissue between the retina and the white of the eye, also known as the sclera
  • Choroidal neovascularization (CNV): Growth of abnormal, new blood vessels in the choroid layer of the eye that grow under the retina and macula, disrupting vision
  • Disciform scar: A scar that develops in the macula area of the retina resulting from leakage and bleeding from abnormal blood vessels (neovascularization) in the eye
  • Drusen: Yellow deposits under the retina made up of fats and proteins; drusen occur naturally with age and may be a sign of age-related macular degeneration (AMD)
  • Fluorescein angiography (FA): An imaging technique in which a yellow dye called sodium fluorescein is injected into a vein in the arm, allowing a special camera to record the circulation of blood in the retina and choroid in the back of the eye
  • Fovea: Small depression in the retina where vision sharpness is highest; the fovea is located within the center of the macula
  • Fundus: The inside, back surface of the eye, which is made up of the retina, macula, optic disc, fovea, and blood vessels
  • Intravitreal injection: Treatment in which a medication is injected into the vitreous cavity in the middle of the eye
  • Macula: A small area at the center of the retina, which is responsible for central (straight-ahead) vision, the majority of color vision, and the ability to see small details
  • Neovascularization: Excessive growth of new blood vessels on abnormal tissue as a result of lack of oxygen
  • Optical coherence tomography (OCT): A noninvasive imaging technique that uses light to create a 3-dimensional image of your eye for physician evaluation
  • Photodynamic therapy (PDT): A treatment for macular degeneration in which a light-activated medicine (verteporfin) is injected into the bloodstream followed by the application of a cold laser, which targets abnormal blood vessels growing in the macula
  • Retina: Thin layer of nerve tissue that lines the back of the eye; it receives and converts light into electrical signals, which are then sent to the brain by the optic nerve, resulting in sight
  • Slit lamp: An instrument that combines a high-intensity light source with a microscope to examine the external and internal structures of the eye, including the optic nerve and retina
  • Vitreous: A gel-like substance that fills the inside of the eyeball
Figure: Parts of the eye and the effects of macular degeneration

References:

American Optometry Association. Macular degeneration. https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/macular-degeneration?sso=y.

American Society of Retina Specialists (ASRS). Age-related macular degeneration. https://www.asrs.org/patients/retinal-diseases/2/agerelated-macular-degeneration.

American Academy of Ophthalmology (AAO). What are drusen? 2021. https://www.aao.org/eye-health/diseases/what-are-drusen.

ASRS. The Foundation Retina Health Series. Glossary. 2022. https://www.asrs.org/patients/retinal-diseases/10/glossary#Neovascularization.

All URLs accessed 2/10/22.

AMD is characterized by complex changes in the eye, and what causes it is not completely understood.

Age is a major risk factor for AMD; the disease is most likely to occur after age 60 years, but it can occur earlier.1 Other risk factors for AMD include2-6:


  • Age: People over age 50 years are at increased risk

  • Genetics (family history): People with a family history of AMD are at higher risk

  • Obesity: Speak with your primary care provider (PCP) if you’d like help losing weight

  • Northern European ancestry: AMD is more common among Caucasians than among Blacks/African-Americans or Hispanics/Latinos

  • Smoking or history of smoking: Research shows that smoking doubles the risk of AMD; speak with your healthcare provider or PCP if you would like help quitting

Researchers have identified at least 20 genes that can affect the risk of developing AMD. Because AMD is influenced by so many genes, plus environmental factors such as smoking and nutrition, no genetic tests can diagnose AMD, or predict with certainty who will develop it. The American Academy of Ophthalmology (AAO) does not currently recommend routine genetic testing for AMD.1

References:

  1. National Institutes of Health/National Eye Institute (NIH/NEI). Age-related macular degeneration: what you should know. https://www.nei.nih.gov/sites/default/files/health-pdfs/WYSK_AMD_English_Sept2015_PRINT.pdf. Accessed 2/10/22.
  2. Klein R, Klein BE, Linton KL. Prevalence of age-related maculopathy: the Beaver Dam Eye Study. Ophthalmology. 1992;99:933-943.
  3. Warwick A, Lotery A. Genetics and genetic testing for age-related macular degeneration. Eye (Lond). 2018;32:849–857.
  4. Adams MKM, Simpson JA, Aung KZ, et al. Abdominal obesity and age related macular degeneration. Am J Epidemiol. 2011;173:1246-1255.
  5. Merle BMJ, Colijn JM, Cougnard-Grégoire A, et al. Mediterranean diet and incidence of advanced age-related macular degeneration: The EYE-RISK consortium. Ophthalmology. 2019;126:381-390.
  6. Tomany SC, Wang JJ, Van Leeuwen R, et al. Risk factors for incident age-related macular degeneration: pooled findings from 3 continents. Ophthalmology. 2004;111:1280-1287.

An eye care specialist will perform a dilated eye examination using a slit lamp to assess the retina for drusen, retinal abnormalities, growth of abnormal blood vessels under the retina, fluid, and hemorrhage.1

The diagnosis of AMD is usually made clinically based on your history, symptoms, and confirmation with the dilated eye exam. However, other imaging tests can be used to gain a better understanding of AMD and to monitor progress before and after therapy.1, 2

  • Optical coherence tomography (OCT): Imaging technique that is not invasive and provides high-resolution, cross-sectional images of the retina; it can also help distinguish AMD from other retinal disorders
  • Fluorescein angiography (FA): Imaging technique that allows visualization of the blood circulation in the retina and blood vessels called the choroid using a special camera and dye injected into the arm; this test can also be useful in diagnosing other retinal disorders

References:

  1. Cunningham J. Recognizing age-related macular degeneration in primary care. JAAPA. 2017;30(3):18-22.
  2. American Society of Retina Specialists (ASRS). The Foundation Retina Health Series. Glossary. 2022. https://www.asrs.org/patients/retinal-diseases/10/glossary#Neovascularization.

Everyone with AMD should be educated about healthy lifestyle choices including regular exercise, smoking cessation, wearing protective eyewear in the sun, and following a healthy diet that incorporates fruits, vegetables, fish, and nuts.1 Early recognition and coordinated care between primary care providers and vision specialists may also help decrease the occurrence of permanent blindness due to AMD.1

First-line therapy for persons with wet AMD is intravitreal injections with vascular endothelial growth factor (VEGF) inhibitors; these agents limit the destructive effects of abnormal new blood vessel growth on retinal tissue, and can stabilize or may possibly reverse vision loss.1,2 Photodynamic therapy (PDT) is typically used when there is no response to treatment with VEGF-inhibitors, and it can be used alone or in combination with VEGF-inhibitor medications. With photodynamic therapy, a dye that is sensitive to light is injected with an activating laser applied through the eye. Tissues with new vessels hold more dye than other vessels; when the dye is activated by the laser, it damages the abnormal, new blood vessels, making them nonfunctional.1

No US Food and Drug Administration (FDA) – approved treatment exists for early AMD. Two studies sponsored by the National Institutes of Health (NIH), the Age-Related Eye Disease Study 1 and 2 (AREDS 1 and 2), have provided evidence that support nutritional supplements can reduce the risk of intermediate AMD progressing to a more advanced state.1, 3, 4 These nutrients include4:

  • Vitamin C
  • Lutein
  • Vitamin E
  • Zeaxanthin
  • Zinc

Based on the results from AREDS 1 and 2, persons with intermediate AMD or severe dry AMD, or vision loss in one eye due to AMD, are advised to take a combination of antioxidant supplements and zinc.1

  • Nonsmokers and former smokers: Follow the regimen outlined in AREDS 1, which includes supplements of vitamin C, vitamin E, beta-carotene, and zinc
  • Smokers: AREDS 2 replaced beta-carotene with lutein and zeaxanthin with similar risk reduction; smokers are advised to follow this regimen due to an increased risk of lung cancer with beta-carotene supplementation

Lutein, zeaxanthin, and beta-carotene all belong to the same family of vitamins, and are abundant in green leafy vegetables.5 Nutritional supplements formulated based on these studies are available, and their labels may refer to either AREDS or AREDS 2.5

References:

  1. Cunningham J. Recognizing age-related macular degeneration in primary care. JAAPA. 2017;30(3):18-22.
  2. Michalska-Malecka K, Kabiesz A, Nowak M, Spiewak D. Age related macular degeneration—challenge for future: pathogenesis and new perspectives for the treatment. Eur Geriatr Med. 2015;6(1):69-75.
  3. Schmidl D, Garhöfer G, Schmetterer L. Nutritional supplements in age-related macular degeneration. Acta Ophthalmol. 2015;93(2):105-121.
  4. American Society of Retina Specialists (ASRS). The Foundation Retina Health Series. Age-related macular degeneration. 2022. https://www.asrs.org/patients/retinal-diseases/2/agerelated-macular-degeneration.
  5. NIH/NEI. Age-related macular degeneration: what you should know. https://www.nei.nih.gov/sites/default/files/health-pdfs/WYSK_AMD_English_Sept2015_PRINT.pdf.
All URLs accessed 2/10/22.

Researchers have found links between AMD and some lifestyle choices, such as smoking.1 In addition, regular exercise, wearing protective eyewear in the sun, and following a healthy diet that incorporates fruits, vegetables, fish, and nuts may be helpful lifestyle changes to incorporate.2 You might be able to reduce your risk of AMD or prevent it from getting worse by making these healthy choices1, 3:


  • Avoid Smoking

  • Exercise RegularlyExercise Regularly

  • Maintain normal blood pressure and cholesterol levels

  • Eat a healthy diet rich in green leafy vegetables and fish (click here for resources on following a Mediterranean diet)

Based on the results from 2 studies sponsored by the National Institutes of Health (NIH), the Age-Related Eye Disease Study 1 and 2 (AREDS 1 and 2), persons with intermediate AMD or advanced AMD, or vision loss in one eye due to AMD, may be advised to take a combination of antioxidant supplements and zinc.2

      • Nonsmokers and former smokers should follow the regimen outlined in AREDS 1: Vitamin C, vitamin E, beta-carotene, and zinc
      • Current Smokers should follow the regimen outlined in AREDS 2, which replaced beta-carotene with lutein and zeaxanthin with similar risk reduction. Smokers are advised to follow this regimen due to an increased risk of lung cancer with beta-carotene supplementation

References:

All URLs accessed 2/10/22.

Some sample questions are listed below to help you begin the conversation with your clinician about your condition.

  • Can worsening of macular degeneration be prevented? Should I make any lifestyle changes?
  • What symptoms may I experience?
  • Will I need treatment(s)?
  • If I develop macular degeneration, will I lose my vision?
  • If one eye is affected, will the other be automatically affected?
  • How often should I see a specialist?
  • Is it possible to recover vision lost because of macular degeneration?

Use this tool for an easy symptom guide and questions to ask your primary care and eye care providers: AMD Checklist

Taking part in a clinical trial can be a great way to help improve treatment for your eye disease. Your participation can help both you and others who may benefit from the treatment if it is approved by the US Food and Drug Administration in the future. Here are a few things to consider about participating in a clinical trial:

  • Ask your eye doctor about clinical trials related to your eye disease
  • If your eye doctor says you may be a good candidate for a clinical trial, don’t be afraid to ask questions about the trial. Some possible questions: What would you need to do to participate? How many visits/appointments are needed related to the trial? Is there any assistance with transportation costs for trial-related appointments?
  • If you speak another language, find out if trial-related paperwork is available in your native language

Before you join the trial, leaders of the clinical trial will let you know what you need to do to participate. They can also let you know how you can leave the trial if you choose to do so. Providing information about the trial and any potential treatment side effects is called informed consent.1

For more information about clinical trials, click here to access a variety of educational videos and information about medical research, as well as important questions to ask provided by the US Department of Health and Human Services (HHS).2 Sharing this information with your provider can help you identify appropriate trials for your retinal condition and support discussions on whether or not participation in a clinical trial is right for you.

References:

  1. US Food and Drug Administration. Clinical trial diversity. https://www.fda.gov/consumers/minority-health-and-health-equity/clinical-trial-diversity
  2. HHS, Office for Human Research Protections. About research participation. https://www.hhs.gov/ohrp/education-and-outreach/about-research-participation/index.html

Scientific Council

Neil M. Bressler, MD

James P. Gills Professor of Ophthalmology
Professor of Ophthalmology, Johns Hopkins University School of Medicine
Wilmer Eye Institute, Johns Hopkins Medicine
Baltimore, MD

A. Paul Chous, MA, OD, FAAO

Specializing in Diabetes Eye Care & Education, Chous Eye Care Associates
Adjunct Professor of Optometry, Western University of Health Sciences
AOA Representative, National Diabetes Education Program
Tacoma, WA

Steven Ferrucci, OD, FAAO

Chief of Optometry, Sepulveda VA Medical Center
Professor, Southern California College of Optometry at Marshall B. Ketchum University
Sepulveda, CA

Julia A. Haller, MD

Ophthalmologist-in-Chief
Wills Eye Hospital
Philadelphia, PA

Allen C. Ho, MD, FACS

Director, Retina Research
Wills Eye Hospital
Professor and Chair of the Department of Ophthalmology
Thomas Jefferson University Hospitals
Philadelphia, PA

Charles C. Wykoff, MD, PhD

Director of Research, Retina Consultants of Houston
Associate Professor of Clinical Ophthalmology
Blanton Eye Institute & Houston Methodist Hospital
Houston, TX

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Patient & Caregiver Educational Resources

The RELIEF Patient Toolkit is a resource center for patients who have been diagnosed with or who are interested in learning about age-related macular degeneration (AMD). Choose from the options below to learn more.

This activity is provided by Med Learning Group. This activity is co-provided by Ultimate Medical Academy/Complete Conference Management (CCM). This activity is supported by an independent medical education grant from Regeneron Pharmaceuticals, Inc.

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