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What Is Age-Related Macular Degeneration?
Interviewer: If you've had a relative with macular degeneration, you know how heartbreaking it can be to watch them lose their sight, and a little terrifying for you, too, because you've got to wonder if you're next.
What are the risk factors that could help you get it, what you can do to prevent it, and some possible treatments? We're with Dr. Paul Bernstein at Moran Eye Center.
First of all, macular degeneration, also called AMD, what's going on? There are two different types, if I understand correctly.
Dr. Bernstein: Yes, age-related macular degeneration is the leading cause of blindness in the developing world. There are two types, and they affect the central part of vision called the macula. The macula is the area of the eye that is responsible for reading, driving, and recognizing faces.
What Happens Inside the Eye During Dry and Wet AMD
In age-related macular degeneration, there is a dry form, which is a slow form that progresses slowly over years, if not even decades, it can eventually lead to central blindness in the eye.
And there is the wet form, which involves the growth of new blood vessels under the retina, and this can have a much more rapid course and lead to loss of vision in a matter of days or weeks.
Interviewer: So the dry form, what exactly is happening in the eye?
Dr. Bernstein: In the dry form, initially it starts with deposits forming underneath the retina; something that we call drusen, which are yellowish spots under the retina. The patient may have completely normal vision and not have any symptoms. But eventually, there is more malfunction of the cells of the retina, and some of them begin to die in the center of the macula, and that is why the center of the retina no longer senses light properly, and that can lead to blindness.
Interviewer: So it's like a camera not being able to sense light?
Dr. Bernstein: That's correct; it's a problem of a camera with bad film.
Interviewer: And in the wet, you're actually getting some growth back there, and that's blocking your vision?
Dr. Bernstein: That is disturbing the vision. It's interrupting the retina from having contact with its supporting cells, and eventually this can damage both types of cells, as these blood vessels get in between these two layers, and they can bleed. They can leak fluid, and eventually they can form scars, and that's what leads to loss of vision there.
The Underlying Causes of AMD-Related Damage
Interviewer: What's going on? Why are those starting to grow there?
Dr. Bernstein: We don't know completely, but we understand that with age, there is some malfunction of the cells, and they, for reasons that we don't completely understand start sending out signals and that seems to be an important factor for causing these blood vessels to start to grow underneath the retina.
Interviewer: So it's kind of a malfunction; it's the wrong signals being sent out.
Dr. Bernstein: That's correct.
Who's at Risk for Macular Degeneration?
Interviewer: All right, so who is at risk for age-related macular degeneration? I think the name kind of gives you some sort of an indication.
Dr. Bernstein: Yes, there are many risk factors, and certainly age is one of the most important ones. We know that age-related macular degeneration is not very common in people in the 50 to 60-year-old range. Only a couple of percent of people show the signs, but as we age, it rises almost exponentially, so that over age 75, at least 30% to 35% of people show at least some signs of age-related macular degeneration.
Interviewer: So it's hereditary, so if you get old enough, you're just going to get it?
Dr. Bernstein: Well, there are a number of important risk factors for age-related macular degeneration. And these genes are risk factors, and we know of two very important ones; one on chromosome 1 related to complement and inflammation. And another one on chromosome 10 that we still don't quite understand, but if you have the wrong combination of genes that you've inherited from your parents, it can put you at much, much higher risk. It can raise your risk three, five, or even tenfold higher than the average population.
Other things that we also know as risk factors include being Caucasian; it is much more common in light-skinned populations to have age-related macular degeneration.
And we also know in terms of modifiable risk factors that smoking is the number one modifiable risk factor. If you are a smoker, it increases your risk of developing the wet form of macular degeneration manyfold, and we certainly encourage our patients not to smoke.
The Role of Nutrition in AMD Prevention and Eye Health
And then the other area that I'm quite interested in is nutrition. We've learned that nutrition is very important in helping to prevent age-related macular degeneration; specifically, dark green leafy vegetables, orange and yellow fruits and vegetables, and cold water fish are certainly things that we recommend even in children at risk for age-related macular degeneration because their parents have macular degeneration. And in the patients with macular degeneration, we often recommend that they take supplements because it's often hard to change diet late in life.
How AREDS Research Shaped Supplement Recommendations
Interviewer: How much do you know about the direct causation of diet?
Dr. Bernstein: We know that diet is very important. And there is accumulating research that modifying diet can change the levels of the lutein and zeaxanthin, which are from dark green leafy vegetables and are actually accumulated in the eye. So we know that diet can make a difference, but as I said, when people are older, changing their diet is difficult, and that's why through the AREDS 2 Study...
Interviewer: And what does AREDS stand for?
Dr. Bernstein: AREDS stands for Age-Related Eye Disease Study. And that most recently specifically looked at adding lutein and zeaxanthin, and omega-3 supplements to the vitamins that we already knew were effective against age-related macular degeneration.
Everyday Habits That Can Help Protect Your Vision
Interviewer: So, what are some other things that you can do then? So you have these supplements, and do you really feel they are effective from what you've seen?
Dr. Bernstein: I think they are, and I certainly . . . it's a big part of my practice, encouraging patients to take these supplements, because often my patients present they've lost vision in one eye, and they are very concerned that it's going to affect their other eye, because you can get by with good vision as long as you have good vision in one eye. But if you have age-related macular degeneration that's significant in both eyes, it can be devastating to these otherwise well-functioning patients.
We encourage them not to smoke. We also think that there is a negative role for excessive sunlight, so we encourage patients to wear sunglasses on bright sunny days. That's an easy thing to do.
Interviewer: And it sounds like all of these things that you're currently recommending are really pretty low impact? It's not like anything too serious. What's the risk of taking a few vitamins?
Dr. Bernstein: We think that lutein, zeaxanthin, and the basic AREDS vitamins are very safe, and few patients complain of side effects.
Monitoring Vision and Recognizing Early Signs of Trouble
The other thing that I encourage my patients to do is to monitor their vision and to learn the early signs of age-related macular degeneration, especially the conversion from the dry form to the wet form. With the wet form of macular degeneration, we have developed very effective treatments now for this once almost universally blinding form of macular degeneration.
Current Treatments for Wet AMD and Why Timing Matters
Interviewer: The wet form is actually treatable; the dry form, once it's started, not so much. Is that correct?
Dr. Bernstein: That's correct. We are certainly looking at new treatments for the dry form, but currently, the standard of care is just antioxidant vitamins and a good diet.
Interviewer: Does the wet form always come before the dry form, or the dry form before the wet form?
Dr. Bernstein: The dry form comes before the wet form. So, they almost always start with the dry form of macular degeneration, the slow form. The wet form can then rear its ugly head, and we have to treat it, and sometimes we get it back under control, and still the dry form slowly progresses over time. Macular degeneration is a manageable Сòòò½APP; we'd like to make it a curable and preventable Сòòò½APP, and that's what we're working on here.
The Evolving Role of Genetic Testing in AMD Risk Assessment
Interviewer: If I have a family history of it, can I get a genetic test, and can you actually see if I have the gene mutations you were talking about?
Dr. Bernstein: As a research tool, yes. We can, and there are models that can predict that you have an increased risk. But it is I would caution a risk assessment, so not everyone, even with the relatively high risk, develops macular degeneration, and other people develop macular degeneration for reasons that we don't completely understand. We are trying to figure out the role of the test still in clinical practice and in helping counsel people, and that's part of further research that we will be conducting.
updated: June 24, 2025
originally published: April 18, 2014
