Macular Degeneration (Dry & Wet)

Age-Related Macular Degeneration (AMD or ARMD)


Age-related macular degeneration (AMD or ARMD) is one of the most common causes of poor vision after age 60. ARMD is a deterioration or breakdown of the macula. The macula is a small area at the center of the retina in the back of the eye that allows us to see fine details clearly and perform activities such as reading and driving.
The visual symptoms of ARMD involve loss of central vision. While peripheral (side) vision is unaffected, with ARMD, one loses the sharp, straight-ahead vision necessary for driving, reading, recognizing faces, and looking at detail.

Although the specific cause is unknown, ARMD seems to be part of aging. While age is the most significant risk factor for developing ARMD, heredity, blue eyes, high blood pressure, cardiovascular disease, and smoking have also been identified as risk factors. ARMD accounts for 90% of new cases of legal blindness in the United States.

Nine out of 10 people who have ARMD have atrophic or “dry” ARMD, which results in thinning of the macula. Frequently deposits called drusen may develop as seen in the picture below.  Dry ARMD takes many years to develop. A specific vitamin regimen has been shown to slow progression of dry ARMD.  If you are a smoker, however, you need to modify these vitamins slightly as the high percentage of beta-carotene (vitamin A) in these compounds could potentially increase your risk of death due to lung cancer.

Dry ARMD with drusen:          


Exudative or “wet” ARMD is less common (occurring in one out of 10 people with ARMD) but is more serious. In the wet form of ARMD, abnormal blood vessels may grow in a layer beneath the retina, leaking fluid and blood and creating distortion or a large blind spot in the center of your vision. This change can happen rapidly.  Researchers have found that a chemical called vascular endothelial growth factor, or VEGF, is critical in causing abnormal blood vessels to grow under the retina. Scientists have developed several new drugs that can block the trouble-causing VEGF. These are referred to as “anti-VEGF” drugs, and they help block abnormal blood vessels, slow their leakage, and help reduce vision loss.

Treatment with the anti-VEGF drug is usually performed by injecting the medicine with a very fine needle into the back of your eye.  Usually, patients receive multiple anti-VEGF injections over the course of many months. There is a small risk of complications with anti-VEGF treatment, usually resulting from the injection itself. However, for most people, the benefits of this treatment outweigh the small risk of complications.

Anti-VEGF medications are a step forward in the treatment of wet ARMD because they target the underlying cause of abnormal blood vessel growth. Unfortunately we do not yet have a cure.  This treatment offers new hope to those affected with wet ARMD. Although not every patient benefits from anti-VEGF treatment, a large majority of patients achieve stabilized vision, and a significant percentage can improve to some degree.

Promising ARMD research is being done on many fronts. In the meantime, high-intensity reading lamps, magnifiers, and other low vision aids help people with ARMD make the most of their remaining vision.

Wet ARMD with central scarring: