Age-Related Macular Degeneration (ARMD)

What is age-related macular degeneration (ARMD)?

Age-related macular degeneration (ARMD) is a degenerative disease that affects the macular of the eye. The macular is a part of the central area of the retina and allows the eye to be able to view objects close up, to enable us to read and write and it also allows us to be able to see all the different colours.

If the cells of the macular become damaged and stops working properly, then the macular degenerates and it can cause blindness. If caught early, the progression of the disease can be slowed down.

Since AMD starts in one eye before it affects the other eye, it can sometimes make it more difficult to detect as the “good” eye often compensates for the vision difficulties in the “bad” eye.

AMD is the form of macular degeneration which occurs as a result of ageing. Macular degeneration is a broad term which described any type of degeneration of the macular due to any reason.

There are two types of macular degeneration (MD), which are defined by how the macular appears to the ophthalmologist (eye specialist) viewing it the macular through their equipment:

• Dry (atrophic) – most common form of MD; causes gradual loss of central vision
• Wet (exudative) – least common form of MD; causes bleeding and scarring behind the retina (a leaking of the blood vessels), which can lead to loss of vision

Age-related macular degeneration is also shortened to AMD (or ARMD).

Facts about ARMD

• Some people’s vision deteriorates really slowly over a long time, so they may not even realise their macular is degenerating and that they are slowly going blind
• Degeneration of the macular can cause vision loss
• One in seven Australians over 50 years will develop age-related macular degeneration
• Having any type of macular degeneration does not normally hurt, so that could be why most people do not even realise it is happening until it is almost too late (when they start to go blind)
• Regular eye examinations can detect age-related macular degeneration before it causes vision loss
• Wet AMD is more treatable than dry AMD before it progresses to an advanced stage
• An important study has shown that certain antioxidants such as vitamin A, betacarotene, vitamin C, vitamin E, selenium and zinc appear to have a beneficial effect on dry AMD and specifically on halting progress of vision loss
• Age-related macular degeneration is also known as AMD.

Symptoms of ARMD

General symptoms of dry macular degeneration

The symptoms of dry macular degeneration generally develop very slowly and not very noticeable. Main symptoms are:

• Blurry or blind spot in centre of vision, together with a decrease in the sharpness of central vision
• Blurriness of printed words when reading
• Decreased ability to see the intensity or brightness of colours
• Difficulty reading, writing, embroidery, sewing or anything else that requires close-up work
• Difficulty seeing properly when lights are dimmed
• Haziness in vision which increases gradually (but continues to get worse)
• Inability to distinguish different people
• Require a lot of bright light when reading, writing, embroidery, sewing or anything else that needs close-up work
• Vision loss (final symptom)

General symptoms of wet macular degeneration

The symptoms of wet macular degeneration happen quite abruptly and normally worsen very quickly:

• Blurriness or blind spot in field of vision
• Decreased central vision
• Decreased ability to see the intensity or brightness of colours
• Distortion in vision – seeing straight lines as looking wavy, lopsided or bent
• Hallucinating – seeing objects that are not there
• Objects appearing smaller or further away than they are
• Vision loss (final symptom)

Causes of ARMD

Science does not know why some people develop macular degeneration and others do not.

A few theories have been proposed on possible causes:

Age

The only known cause of age-related macular degeneration is the age of the individual. The older that people get, the more likely it is that the macular in the eye can become damaged or degenerate in some way.

Other factors

The other factors that may play a role in the development of age-related macular degeneration are: gender (female), obesity, smoking and family history of this condition.

Prevention of ARMD

Unpreventable risk factors

Age-related macular degeneration may be unpreventable in certain circumstances:

• Age – people who are over 65 may develop this condition as their eyes are not functioning as well as they were when they were younger as scientists think this condition occurs more frequently in older people due to the degeneration of the eyes as people age
• Certain eye colours – people with certain eye colours are at a greater risk of developing age-related macular degeneration. The eye colours most at risk: blue, green and hazel
• Gender – research shows that women more often develop age-related macular degeneration than men and which this is a known statistics, researchers are yet to understand why this is a risk factor
• Genetic – people who have family members that have age-related macular degeneration may be at a higher risk for developing it too, especially if they engage in lifestyle choices which are not healthy for the eyes

Preventable risk factors

There may be ways to prevent age-related macular degeneration from occurring:

• Exercise regularly – people who exercise regularly have a much lower risk for developing age-related macular degeneration because they have better body circulation (including to the eyes) and better heart health. In addition to this, exercise ensures that healthy body weight is maintained, which reduces another risk factor (obesity) for developing this condition
• Healthy diet – a healthy diet that includes foods rich in the antioxidants and vitamin A, are especially useful in reducing the risk of developing this disease, because these antioxidants are vital to the healthy functioning of the eyes
• High blood pressure – the reasons most people have high blood pressure is due to poor diet (improper nutrition due to eating too much processed and take-away food that is high in saturated fat and sugar) and lack of exercise, so it can be almost entirely prevented. High blood pressure is a known risk factor for age-related macular degeneration because it is known that high pressure in the eye can cause damage to the retina and macular
• Nutrition – studies have shown that deficiencies of certain important nutrients (especially the antioxidants lutein, zeaxanthin, vitamin A and betacarotene) may be a major factor in the development of age-related macular degeneration because these nutrients actually exist in the eye in the retina and macular and dietary intake needs to be adequate to ensure the proper health of the eye
• Obesity – studies have shown that being obese can lead to age-related macular degeneration progressing to a more severe level much more quickly
• Smoking – several studies have shown that smoking is implicated in the development of age-related macular degeneration. Smokers seem to be at a higher risk for developing age-related macular degeneration than non-smokers. This is due to the way smoking damages the blood vessels and depletes the body of many antioxidants, especially vitamin C. In addition to not smoking, also keep away from other people’s second hand smoke too

Complications of ARMD

The main and most serious complication of age-related macular degeneration is permanent vision loss (blindness), which can be very debilitating as it occurs slowly and over a long time and is not noticeable until it is too late and vision has deteriorated beyond repair.

If the age-related macular degeneration can be diagnosed and treated early in the disease progression, there is much better prognosis for reducing the likelihood of vision loss (through appropriate treatment, medication or surgery, or both).

If you have any type of changes in your vision, always see your eye specialist to get a check-up.

When to see a doctor about ARMD

You need to make an appointment to see your doctor if you experience any of the symptoms listed for age-related macular degeneration, especially if you are over 50 and experience the following two symptoms:

• You experience any changes in your central vision
• You start to be unable to see colours or fine detail properly

People who have been diagnosed with age-related macular degeneration need to see their doctor on a regular basis. Your eye specialist will recommend you have a comprehensive dilated eye exam at least once a year to monitor your condition and to check for any other eye conditions that may emerge.

Diagnosis of ARMD

Once you have seen your regular doctor, you will be referred to an eye specialist (ophthalmologist) who will examine both the eyes for any signs of age-related macular degeneration through the following:

• Eye chart testing – to determine how well you can view the letters in the eye chart from each eye and at different distances; this test shows how clear vision is and at which distance vision becomes distorted
• Eye exam – special eye drops will be administered to each eye (which do not normally cause any pain) which widen the pupil to allow the eye specialist to view your eyes through a magnifying lens machine for signs of age-related macular degeneration; vision may stay blurry after the eye exam, due to the effects of the eye drops, but this effect is temporary (although it is recommended to have someone take you home after the test)

If the preliminary tests show that there could be a problem of if they are inconclusive, further, more comprehensive tests can be done that will give better results:

• Fluorescein angiogram – in this test, a special dye is injected into a vein in the arm (fluorescein), which soon arrives in the vessels of the eye; this test is performed to look at the circulation of blood in the blood vessels of the retina; the dye highlights any abnormalities or damage to the macular or retina; as the dye passes through the retina, a special camera takes a series of images
• Indocyanine green (ICG) angiogram – in this test, another special dye is injected into a vein in the arm (indocyanine green) which soon arrives in the vessels of the eye; this test is performed to highlight the deeper layers of the retina and makes visible the source of the abnormal blood vessels (this dye may cause the skin and eyes to stay yellow for up to 24 hours after it is administered)
• Optical coherence tomography – this non-invasive imaging test is used identify and display areas where the retina is damaged (either too thin or too thick) or any other changes which are associated with damage to the macular. This test is often used to monitor the response of the macular to treatment

Note: a very small percentage of people may react to the dye used in the angiogram tests. You should discuss any concerns about the dye with your doctor prior to having the test done.

Conventional treatment of ARMD

Conventional treatment depends on the type of age-related macular degeneration:

Dry ARMD

The US National Eye Institute’ s Age-Related Eye Disease Study (AREDS) has shown that taking certain antioxidants significantly reduces the progression of dry AMD to an advanced stage.

Proven treatments for dry ARMD

A large US study conducted by the National Eye Institute has confirmed that antioxidants can significantly reduce existing symptoms and prevent worsening of the condition in those people with dry ARMD (to a more worse wet macular degeneration). The study suggested that certain supplements may be of use to people with mild to moderate ARMD.

The antioxidants supplements recommended are:

• Betacarotene
• Selenium
• Vitamin A
• Vitamin C
• Vitamin E
• Zinc

Once dry AMD reaches an advanced stage it does not respond well to any type of treatment and vision loss ensues. This is why early treatment is vital to prevent deterioration of vision.

Wet ARMD

There are four proven and two experimental treatments used to treat wet ARMD. Proven treatment means there is proven scientific backing through research, whereas experimental means that the treatment is not yet proven through comprehensive scientific studies and the dosage is not yet determined or it has too many side effects.

Proven treatments for wet ARMD

• Lucentis – this is a medication with proven results where 70-80% of people injected had improvement of symptoms, or at least no deterioration; this medication must be injected into the eye at regular intervals; this treatment is available through the PBS in Australia; vision is maintain in the large percentage of people taking this drug
• Photodynamic Therapy (PDT) / Visudyne Therapy – this is a combined medication and laser treatment therapy, which uses a laser to activate the medication Visudyne which closes leaking blood vessels and stops progression of Wet AMD; a course of treatments is required with close monitoring of symptoms; AMD patients usually still have vision loss for up to 6 months after treatment, after which vision usually stabilises and does not deteriorate any further
• Laser photocoagulation – this treatments consists of a high energy thermal light (laser) directed into the affected eye(s) which seals and destroys the damaged blood vessels; this is not a painful procedure; close monitoring is require after the procedure as re-occurrence of AMD occurs in about 50% of people
• Retaane – this is an angiostatic cortisone derived from a steroid, but modified so that it causes less side effects; this medication is inserted into the back of the eye through a small tube but it needs to be repeated every 6 months; as this is not yet on the PBS and has a high cost associated with it

Experimental treatments

• Avastin – this medication has similar effect to Lucentis; it is regularly injected into the eye (after it has been prepared and numbed) but there is not enough research to prove how safe or effective it is and how long treatment must be given; it was originally used as a cancer treatment and discovered to have some benefits for AMD
• Triamcinalone – this medication is a slow release steroid which has been used experimentally in conjunction with other proven treatments; it needs to be injected into the eye and its effects last for several months; it appears to increase the risk of glaucoma development and other side effects with repeated use

Alternative / complementary treatment of ARMD

Alternative / complementary treatment of age-related macular degeneration (ARMD) centres on treating the symptoms and prevention of this condition from occurring in the first place, through proper nutrition and supplementation.

Herbs

There are a number of herbs which are very beneficial in reducing symptoms or may even prevent this condition from developing in the first place:

• Bilberry – the herb bilberry has been used for centuries to treat eye conditions. Bilberries have a high level of anthocyanosides, an antioxidant, which is the active component of the berry. Studies on animals have shown that bilberry can prevent age-related macular degeneration from developing in the first place. People with diabetes should be careful using this herb as there may be issues with glucose and insulin
• Ginkgo biloba – studies show that people who are supplemented with ginkgo biloba may have less deterioration of vision and it may even prevent vision loss. Ginkgo biloba works to stimulate proper circulation and this helps to ensure that enough blood and nutrients are reaching the eyes

Vitamins

There are a number of vitamins which are very beneficial in reducing symptoms or even preventing this condition from developing in the first place:

• Betacarotene – this is the precursor to vitamin A and is often used instead of vitamin A, as it has less toxicity when used in higher doses. Betacarotene is a potent antioxidant which acts to prevent free radical damage to the macular (as well to every other cell in the body) and has been shown in major studies (along with other antioxidant vitamins) to slow the progression of ARMD. Betacarotene supplements should not be used by those people who are current or previous heavy smokers or alcohol drinkers as a large recent study implicated a higher incidence of cancer in those people taking this supplement, but the study also recommended getting betacarotene from the food in the diet for these groups of people was safe and did not increase risk for cancer
• Vitamin A – several large studies have shown that the antioxidant vitamin A may be useful in preventing free radical damage to the macular (as well to every other cell in the body) and has been shown to slow the progression of ARMD, especially when it is taken with the other antioxidant nutrients (vitamin C, vitamin E, zinc and selenium)
• Vitamin C – studies show that vitamin C is a major antioxidant which acts to prevent free radical damage to the macular (as well to every other cell in the body) and has been shown in major studies (along with other antioxidant vitamins) to slow the progression of ARMD
• Vitamin E – studies show that vitamin E is a major antioxidant which acts to prevent free radical damage to the macular (as well to every other cell in the body) and has been shown in major studies (along with other antioxidant vitamins) to slow the progression of ARMD

Minerals

There are a number of minerals which are very beneficial in reducing symptoms or even preventing this condition from developing in the first place:

• Selenium – the mineral selenium is a potent antioxidant which acts to prevent free radical damage to the macular (as well to every other cell in the body) and has been shown in major studies (along with other antioxidant vitamins) to slow the progression of ARMD
• Zinc – the mineral zinc is a major antioxidant which acts to prevent free radical damage to the macular (as well to every other cell in the body) and has been shown in major studies (along with other antioxidant vitamins) to slow the progression of ARMD

Other nutrients

There are a number of nutrients which are very beneficial in reducing symptoms or even preventing this condition from developing in the first place:

• Coenzyme Q10 – a large study showed that when the mitochondria were supported with coenzyme Q10 (together with acetyl-n-carnitine and omega 3 fatty acids) this decreased symptoms and slowed degeneration of the macular by over 20% in the group trialling the supplements, while the group receiving no vitamins had 10% degeneration in symptoms
• Lutein – studies show people who have a diet rich in foods high in the antioxidant lutein have a lowered risk for developing age-related macular degeneration. Lutein acts as a potent antioxidant preventing the retina and macular from getting damaged by free radicals. Lutein is one of the natural pigments that colours the eye and is found in broccoli, corn, egg yolks, grapes, oranges, spinach
• Omega 3 fatty acids – several studies have shown that those people with a health level of omega 3 fatty acids in their diet (from consuming oily fish such as salmon, tuna) have a lower risk for developing AMD; other studies also found that a healthy balance of omega 3 to omega 6 fatty acids was also a factor in reducing risk for AMD; a new study showed that omega 3 fatty acids should be obtained from DHA and EPA and not ALA, as ALA seemed to increase risk for developing AMD
• Zeaxanthin – studies also show that people who eat foods high in zeaxanthin also have a much lowered risk for developing age-related macular degeneration. Zeaxanthin is one of the natural pigments that colours the eye and is found in retina and macular, so levels of this nutrient need to be optimal levels to ensure proper working and health of the macular

Dietary modifications

Changes in the diet can help reduce symptoms or even prevent this condition from developing in the first place:

• Eat more fish – increasing intake of oily fish such as salmon, trout, mackerel, tuna, sardines, will help to increase levels of omega 3 fatty acids in the body and this may help reduce inflammation and help symptoms
• Eat more leafy green vegetables – such as kale, spinach, collard, mustard greens to help boost the levels of lutein, zeaxanthin and betacarotene in the body and reduce risk of age-related macular degeneration developing in the first place, but if it is in progression, then they may be able to reduce further degeneration
• Eat more orange coloured vegetables – such as carrots, pumpkin, sweet potato to help boost the levels of lutein, zeaxanthin and betacarotene in the body and reduce risk of age-related macular degeneration developing in the first place, but if it is in progression, then they may be able to reduce further degeneration
• Eat more orange coloured fruits – such as apricots, oranges, peaches, nectarines to help boost the levels of lutein, zeaxanthin and betacarotene in the body and reduce risk of age-related macular degeneration developing in the first place, but if it is in progression, then they may be able to reduce further degeneration
• Eat more zinc rich foods – the foods rich in zinc may somewhat help reduce the amount of degeneration in the eye by releasing more antioxidants in the area, to reduce the degeneration. The foods with the highest levels of zinc are oysters

Lifestyle modifications

There are certain lifestyle modifications that should be adhered to as they greatly reduce risk of age-related macular degeneration occurring in the first place and they also prevent further worsening of symptoms in people who already have the condition:

• Exercise – people with age-related macular degeneration are recommended to incorporate some exercise in their day (at least 30 minutes per day), to ensure there is good blood flow to the eyes
• Stop smoking – studies have shown that smoking is a definite risk factor which is implicated in the development of age-related macular degeneration

Alternative treatments

• Acupuncture – two older studies have suggested that a course of acupuncture may be useful in relieving some of the symptoms of eye disease, including age-related macular degeneration

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with ARMD

People who have any type of age-related macular degeneration can try to cope with their condition (and try to reduce worsening of symptoms) through the following strategies:

• Caution when driving – age-related macular vision causes blindness in central vision, so it may impair your ability to drive, if your symptoms are severe. Check with your doctor if you can drive and ensure you don’t drive in poor weather, at night or when it is raining, because your vision will not be very good in these conditions
• Depression– there is a great deal of evidence that shows that people with age-related macular degeneration, who are losing their vision, may develop depression, due to their feelings becoming quite intense about their loss of vision, loss of autonomy and other issues related to this condition. If your feelings start to overwhelm you and especially if they are negative and pessimistic (and not normal for you), do see your doctor to get some advice about your treatment options
• Eye specialist – ensure you see your eye specialist on a regular basis (as often as required) and make sure you know how much of the medication (or supplements) you have been given to take and always let your eye doctor know if your symptoms are getting worse, of if the medications (or supplements) are causing any side effects, as they may need to adjusted. Your eye specialist can also advise if you are a suitable candidate for eye surgery to correct your vision problems or not
• Glasses – ensure you have the right prescription glasses for your eyes, to help you see a little better
• Healthy diet – you must eat healthy food, such as fresh fruit (2-3 per day) and vegetables (5-7 portions a day), but especially leafy green, orange and red fruits and vegetables as they are full of the nutrients vital for eye health (lutein, zeaxanthin, betacarotene), nuts and seeds, oily fish about 2-3 times a week (mackerel, salmon, sardines, trout, tuna), legumes most days, wholegrains, some low fat dairy, poultry and some red meat 2-3 times a week. Always try to use fresh produce and organic is better as it has more of the nutrients available in the food than non-organic
• Help from family and friends – you may need help with shopping, with housework and paying bills (and other home maintenance), so if you have any family or close friends living near you, it would be very helpful for you, if you could ask them for their help

• Make your home clutter free – you will need to remove any clutter around your home, or anything on the floor that may make it easy for you to trip and fall
• Maintain normal blood pressure – if you have high blood pressure, you need to make sure it is reduced so that it is normal. High blood pressure is implicated both in the development of and in worsening the symptoms and progression of age-related macular degeneration due the the increased blood pressure in the eyes, which can damage the macular
• Proper lighting – make sure you have proper lighting in your home so that you can see better
• Special large letter appliances – you may be able to purchase some special large lettering appliances (clocks, telephones, radios) which have extra large lettering to help you read them better
• Stop smoking – if you smoke cigarettes, you have to give them up, because cigarette smoking is implicated as a risk factor for age-related macular degeneration. Smoking damages the fine blood vessels in the retina and macular and it also robs the body of a number of the antioxidant vitamins (such as vitamin C), which are vitally necessary for the health of the eye, so if you have been diagnosed with age-related macular degeneration, you must stop smoking, to reduce any further damage to the eye and worsening of symptoms and disease progression
• Travel with other people – if your central vision is no longer clear, try to get your friends and family to take you out when you need to do your errands, or use a bus (or other public transport), or even find a community bus which can take you from door to door and help you too
• Use a magnifying glass to read – a good magnifying glass can help to enlarge letters so that they do not appear fuzzy, which makes them easier to read

Caring for someone with ARMD

Partner

If you have a partner with age-related macular degeneration, there are a number of useful strategies you can use to help them:

• Cleaning – your partner may not be able to perform much of the cleaning duties in the house, so either you will need to do most of them, you can try to enlist family and friends to help, you can employ a cleaner or a combination of all of these. Just make sure you and your partner are agreed about the way forward
• Depression – people with any type of degenerative condition can easily become depressed, due to many factors and if you notice your partner’s mood has changed, you could suggest a visit to the doctor just as a precaution to make sure it is not depression, but if it is, your partner’s doctor can make some suggestions for treatment
• Healthy diet – your partner must eat healthy food, such as fresh fruit (2-3 per day) and vegetables (5-7 portions a day), but especially leafy green, orange and red fruits and vegetables as they are full of the nutrients vital for eye health (lutein, zeaxanthin, betacarotene), nuts and seeds, oily fish about 2-3 times a week (mackerel, salmon, sardines, trout, tuna), legumes most days, wholegrains, some low fat dairy, poultry and some red meat 2-3 times a week. Always try to use fresh produce and organic is better as it has more of the nutrients available in the food than non-organic
• Support – your partner needs your love and support and to know that you are there for them if they need you. Try to be there to listen to their concerns and worries and if you cannot manage everything, talk to your doctor about other support options (including from family and friends)

Friends

If you have a friend with age-related macular degeneration, there are a number of useful strategies you can use to help them:

• Driving – your friend may not be able to drive themselves to visit you or go shopping, so you may be able to help them out when you can
• Support – your friend needs your love and support and to know that you are there for them if they need you. Try to be there to listen to their concerns and worries and let them know you are available for support

Family member

If you have a family member with age-related macular degeneration, there are a number of useful strategies you can use to help them:

• Driving – your family member may not be able to drive themselves to visit you or go shopping, so you may be able to help them out when you can
• Support – your family member needs your love and support and to know that you are there for them if they need you. Try to be there to listen to their concerns and worries and let them know you are available for support

References

Last reviewed and updated: 14 May 2024