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Complications of Macular Degeneration

In medicine, a complication of a disease or condition is usually a secondary condition that might make the initial disease worse, or make things a bit more difficult. Sometimes they are just secondary conditions that coexist with the original condition, and may also need monitoring or treatment. There are various complications that might arise from macular degeneration, including visual hallucinations, depression, falls and fractures. Each of these can be addressed and treated, so if any of these do occur, there is help for it.

Visual hallucinations (Charles Bonnet syndrome)

In Charles Bonnet syndrome (CBS), an individual experiences visual hallucinations, or seeing things that aren’t actually there. The individual knows the images aren’t real, and the hallucinations aren’t caused by dementia or a psychiatric condition. The exact cause of CBS isn’t completely understood, but it’s almost like the brain is still seeing and interpreting images, even though objects are not actually visualized by the eye.1

Treating CBS

Treatment can vary among each person, and there isn’t one accepted treatment that works for everyone. It can include medications, behavioral interventions, reassurance and support, low-vision aids, and regular eye exams.

Depression

Depression, both clinical and sub-clinical (depression that doesn’t meet the exact criteria for major depression) are seen at higher rates in those with AMD than in the general population, but are similar to rates found in other populations who live with chronic disease, such as in those with cancer or diabetes.2 A diagnosis of macular degeneration and the associated vision loss may have profound effects on quality of life, and can seriously impact emotional health and result in depression.

Psychosocial well-being and vision loss

Studies have found that approximately one-third of AMD patients were depressed, and prevalence of depression increased as vision loss became more severe.2 In fact, in individuals with any kind of visual impairment, psychosocial well-being is generally lower.3 This can be especially important to keep in mind in those with macular degeneration, especially because of its progressive nature.

First steps in coping with vision loss

It’s important to diagnose depression in those with macular degeneration, and eye doctors should be aware of this, since they might be the first ones to notice it. Education and psychosocial interventions focusing on how to cope with vision loss have been found to be especially effective in those with macular degeneration.

Falls and fractures

As vision decreases, the risk of falls and fractures increases and can pose a serious health risk.4,5 Older adults also have more complications if they’re injured than younger adults, making falls especially risky. For individuals with AMD, changes in visual acuity, visual field, and decreased ability to see contrast makes the risk of falls particularly concerning.4

Preventing falls

Taking steps at home to prevent falls and subsequent injuries from falls is important for those with macular degeneration. Low-vision specialists and OTs can help you evaluate your surroundings and suggest adaptations to reduce the risk of falls, such as handrails in stairways and in the bathroom or shower, arranging your furniture in a certain way, getting rid of throw rugs or taping them down, and adding more lighting in certain areas.

What can you do?

Living with macular degeneration involves more than just dealing with the actual eye condition. Macular degeneration can affect many aspects of your daily life, and it’s important to be aware of the various complications that can arise from the condition, both directly and indirectly. Talk with your eye doctor about the ways that your condition can impact your life, and the sorts of specialists that can assist you with minimizing complications from macular degeneration, like OTs, low-vision specialists, social workers, therapists, and rehabilitation specialists.

Jaime R. Herndon | December 2018
  1. National Institutes of Health: Genetic and Rare Diseases Information Center. Charles Bonnet Syndrome. 2018. https://rarediseases.info.nih.gov/diseases/10343/charles-bonnet-syndrome. Accessed October 19, 2018.
  2. Casten R & Rovner B. Depression in age-related macular degeneration. J Vis Impair Blind. 2008; 102(10): 591-599. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792986. Accessed October 20, 2018.
  3. Nyman SR, Gosney MA, Victor CR. Psychosocial impact of visual impairment in working-age adults. British Journal of Ophthalmology. 2009; 94(11). Doi: http://dx.doi.org/10.1136/bjo.2009.164814. Accessed February 5, 2019.
  4. Wood JM, Lacherez P, Black AA, et al. Risk of falls, injurious falls, and other injuries resulting from visual impairment among older adults with age-related macular degeneration. Invest Ophthalmol Visl Sci. 2011; 52: 5088-5092. Doi: 10.1167/iovs.10-6644. Accessed October 20, 2018.
  5. Hong T, Mitchell P, Burlutsky G, et al. Visual impairment and the incidence of falls and fractures among older people: Longitudinal findings from the Blue Mountains Eye Study. Invest Ophthalmol Vis Sci. 2014; 55(11): 7589-93. Doi: 10.1167/iovs.14-14262. Accessed October 20, 2018.