What Is Macular Degeneration?
Reviewed by: HU Medical Review Board | Last reviewed: May 2023 | Last updated: June 2023
Macular degeneration is an eye condition that destroys your central vision. You need your central vision to see objects clearly and read, drive, or do close-up work like sewing or cooking.1-3
One type of macular degeneration is called age-related macular degeneration (AMD). It is the leading cause of vision loss in adults over 60 and affects nearly 20 million people in the United States. AMD is a progressive condition. This means symptoms get worse over time.1-3
AMD occurs when the macula, the part of the eye that controls central vision, is damaged. The macula is part of the retina, the light-sensitive layer of tissue at the back of the eyeball. The exact cause of AMD is not known. But research has uncovered many of the genetic and environmental factors that lead to its development.1-3
Types of age-related macular degeneration
There are two types of age-related macular degeneration: dry and wet.1-3
Dry AMD occurs when the macula slowly gets thinner with age, causing loss of central vision. Dry AMD occurs in 3 stages: early, intermediate, and late.1-3
Dry AMD is also called atrophic AMD. It is the most common type of AMD.1-3
Wet AMD occurs when abnormal blood vessels grow beneath the retina. These blood vessels are prone to swelling and leaking, which can damage the macula. Any stage of dry AMD can turn into wet AMD. But wet AMD is always considered late-stage AMD.1-3
Wet AMD is also called advanced neovascular AMD. It is a less common type of late AMD, and it often causes faster vision loss.1-3
Some people with advanced AMD will develop geographic atrophy (GA). GA causes cells in the retina to die, causing blind spots in your central vision. GA can affect one or both eyes.4
Stargardt disease is a rare eye disorder of progressive vision loss that affects children and young adults. It is not age related. It is a genetic disease, meaning it is passed on to children from their parents. Stargardt disease is one form of juvenile macular degeneration.5
In people with Stargardt disease, photoreceptor cells in the macula die off. This process causes central vision loss. Stargardt disease can also make it hard for people to see colors well or for their vision to adjust when going between bright and dark areas.5
Myopic macular degeneration
Myopic macular degeneration (MDD) is a type of macular degeneration that can affect people with severe nearsightedness (myopia). Myopia means you can see objects that are nearby but have trouble seeing objects farther away. People who have myopia have a larger or oval-shaped eyeball. This makes light focus in front of the retina instead of on it.6
MMD occurs when the retina slowly stretches over time. This process causes the eyeball to become more oval-shaped and the retina to become thinner. As that happens, the macula also stretches and becomes thinner. This leads to blurry, distorted central vision.6
AMD risk factors
Age is the biggest risk factor for AMD. People age 55 and older are more likely to develop AMD. The risk for AMD is also greater in people who:3
- Have a family history of AMD
- Are white
- Are over a healthy weight, have a diet high in fat, or have high cholesterol levels
If you are at risk for AMD, talk to your doctor about how often you need to have eye exams. You can lower your risk of developing AMD or slow vision loss from AMD by:3
- Not smoking
- Staying physically active
- Maintaining healthy blood pressure and cholesterol levels
- Eating healthy foods, including leafy green vegetables and fish
Symptoms of macular degeneration
Many people do not have symptoms of macular degeneration until the disease has progressed to later stages. Symptoms may include:1-3
- Blurred or dark spots in the center of your vision
- Problems distinguishing faces
- Trouble seeing in low light
- Problems or changes in the way you see colors
- Seeing straight lines as curvy or wavy
Diagnosing macular degeneration
Eye doctors (ophthalmologists) use a variety of tests to diagnose macular degeneration. Most commonly, your doctor will give you eye drops to dilate (widen) your pupils. They will then use a special lens to check your eyes for macular degeneration and other eye problems.1-3
Other tests to diagnose macular degeneration include:1-3,7,8
- Fluorescein angiography – This is an eye test that uses dye and a camera to check blood flow in the retina and choroid. It helps doctors diagnose and monitor eye diseases that can affect your retina.
- Optical coherence tomography (OCT) – This is a noninvasive test that uses light waves to take pictures of your retina. The pictures allow your eye doctor to map and measure the layers in your retina. The results help doctors diagnose and treat eye conditions like AMD and glaucoma.
Doctors recommend regular eye exams so that macular degeneration can be caught as early as possible.
Treating macular degeneration
Treatment for macular degeneration depends on the type and stage.
As of early 2023, there is 1 drug approved to treat geographic atrophy. GA is the advanced stage of dry AMD.9
Syfovre™ (pegcetacoplan) is injected directly into one or both eyes of people with GA. Clinical trials have shown that people who were given Sabre saw a significant reduction in GA lesions in their affected eye(s). The drug also slowed the progression of GA over time.9,10
Other research shows that some lifestyle changes may slow the progression of dry AMD. A large study called AREDS2 (Age-Related Eye Disease Study 2) showed that some people with intermediate dry AMD may be less likely to develop advanced AMD if they take the following supplements:11
- Vitamin C (500 mg)
- Vitamin E (400 IU)
- Lutein (10 mg)
- Zeaxanthin (2 mg)
- Zinc (80 mg)
- Copper (2 mg)
Your eye doctor can tell you if these supplements are right for you.
Research also shows that a balanced, nutrient-rich diet is helpful for people with AMD. This includes foods like dark leafy greens, yellow fruits and vegetables, and fish.11
Wet AMD and MMD
There are some treatments that may slow down or stop vision loss from wet AMD and MMD:1-3
- Anti-VEGF injections – These drugs help stop bleeding and leaking from blood vessels in the eye. Anti-VEGF injections are the most common treatment for wet AMD.
- Photodynamic therapy (PDT) – PDT uses a light-sensitive medicine that starts working when it is hit by a specific type of laser. A doctor first shines the laser on a small area in the back of the eye. The medicine then works to break down the blood vessels that are causing vision loss.
There is currently no cure for Stargardt disease. Lifestyle changes can help slow vision loss, such as:5
- Wearing a hat and sunglasses to protect your eyes from sunlight
- Avoiding supplements that exceed the daily recommended amount of vitamin A
- Not smoking and avoiding secondhand smoke
Low vision aids and rehabilitation programs can also help people living with Stargardt disease.5