Macular Degeneration: Causes, Symptoms, & Treatment

Among people 50 and older, macular degeneration is the most common cause of severe loss of eyesight. It’s caused by deterioration within your retina, and as this condition develops, it may affect your ability to do certain things like reading, driving, and recognizing faces. 

If you feel you are experiencing the signs and symptoms of macular degeneration, know that this doesn’t mean you will lose all of your sight. Treatment is available, and early detection and certain self-care measures can delay vision loss due to macular degeneration. 

What is macular degeneration? 

Macular degeneration is a common eye disorder caused by the deterioration of the macula, a small area in the center of the retina in the back of the eye. In macular degeneration, only your central vision is affected—what you can see when you stare straight ahead. Your peripheral vision—what you see on the side when you’re staring straight ahead—is not affected by this condition. This means that even those with severe macular degeneration will not experience total vision loss. 

There are two types of macular degeneration: dry and wet. Dry macular degeneration, which affects about 85 to 90 percent of those with the condition, is caused by small yellow deposits called drusen that develop under the macula. Wet macular degeneration, on the other hand, occurs when abnormal blood vessels develop under the retina and macula. 

What are the symptoms of macular degeneration? 

The signs and symptoms of macular degeneration develop slowly over time, without pain, though symptoms of wet macular degeneration usually progress more quickly. 

Symptoms of dry macular degeneration include: 

• a reduction in central vision
• a distortion of straight lines in your field of vision
• the need for brighter lighting
• difficulty adapting to low lights
• blurriness
• trouble recognizing faces
• retinal damage

While some symptoms of wet macular degeneration resemble those of dry macular degeneration, they can also include: 

• a blurry spot in your field of vision
• a dark spot in the center of your vision due to blood vessels bleeding or leaking fluid
• hazy vision
• rapidly worsening symptoms

How is macular degeneration diagnosed? 

To evaluate you for macular degeneration, your ophthalmologist or optometrist will conduct a physical and thorough eye exam. They may also perform a number of other tests, including examining the back of your eye and testing for defects in the center of your vision. They may also perform a fluorescein angiography test which will show if you have retinal changes or abnormal blood vessels, or a indocyanine green angiography test which is used to identify specific types of macular degeneration. Lastly, your doctor may want to do an optical coherence tomography test which displays detailed cross-sectional images of the retina. 

How is macular degeneration treated? 

There is currently no cure for macular degeneration, but there are treatments available to slow its progression. 

Wet macular degeneration 

If you have wet macular degeneration, you may want to consider working with a low-vision rehabilitation specialist who can help you adjust to and manage your vision loss. Treatments include: 

• Anti-vascular endothelial growth factor (anti-VEGF) drugs. Anti-VEGF drugs work by slowing the growth of blood vessels in the eye. This slows or stops damage from the abnormal blood vessels and slows down vision loss. Sometimes it can even improve vision. To treat wet macular degeneration, these drugs are injected by your doctor directly into the eye. 
• Photodynamic therapy. During photodynamic therapy, your doctor will inject medication into a vein in one of your arms and then use a special laser to close leaking blood vessels. This produce is much less common today, and usually requires multiple treatments. 
• Photocoagulation. Photocoagulation involves the use of high-energy laser beams to destroy abnormal blood vessels. While this treatment can help stop bleeding and reduce further damage to your macula, abnormal blood vessels can regrow, which will require further photocoagulation. 

Dry macular degeneration 

Treatment for dry macular degeneration also usually involves working with a low-vision rehabilitation specialist. 

Your doctor may also recommend surgery. For some people with advanced dry macular degeneration in both eyes, you may be able to have surgery to implant a telescopic lens in one eye which helps magnify your field of vision and can improve both distance and close-up vision. 

While macular degeneration is not preventable, it’s possible to catch the condition early on with regular dilated eye exams. Early detection of the condition can help slow the disease progression and minimize vision loss. If you are experiencing symptom of dry or wet macular degeneration, or have a family history of the condition, make an appointment with your provider and make sure to set up regular eye exams, too. 

Sources 

• Age-Related Macular Degeneration (AMD). (n.d.). Johns Hopkins Medicine.
• Macula. (2017, March 7). American Academy of Ophthalmology.
• Bahadorani S and Singer M. Recent advances in the management and understanding of macular degeneration [version 1; peer review: 2 approved]. F1000Research 2017, 6(F1000 Faculty Rev):519 (https://doi.org/10.12688/f1000research.10998.1). 
• Age-Related Macular Degeneration. (n.d.). National Eye Institute.
• What Is Fluorescein Angiography? (2021, June 28). American Academy of Ophthalmology.
• Yannuzzi L. A. (2011). Indocyanine green angiography: a perspective on use in the clinical setting. American journal of ophthalmology, 151(5), 745–751.e1. https://doi.org/10.1016/j.ajo.2011.01.043. 
• Optical Coherence Tomography. (n.d.). University of British Columbia.
• Anti-VEGF Treatments. (2020, February 3). American Academy of Ophthalmology.