Macular Degeneration: Causes, Symptoms and Treatments

Stages of age-related macular degeneration 

Dry AMD happens in three stages — early, intermediate and late — and usually progresses slowly over years. Any stage of dry AMD can turn into wet AMD, but the reverse isn’t true; wet AMD is always late-stage.​

When to see a doctor for age-related macular degeneration

It’s important to see your ophthalmologist for a comprehensive dilated eye exam every year or two — how often depends on your overall health — beginning at age 60. During the exam, your doctor will inspect the macula for drusen, yellowish deposits about the width of a human hair, and for pigment changes under the retina. ​

Treatment options for age-related macular degeneration

An essential part of any treatment plan — no matter the stage or form of AMD — is a healthy lifestyle, including regular exercise and a diet that incorporates plenty of fish and leafy green vegetables. A review of studies published in 2016 in the journal Nutrients showed that eating fish, especially tuna, regularly can reduce your risk of developing AMD. A study published in 2022 in JAMA Ophthalmology found that eating vegetables rich in nitrates — such as beetroot, spinach, kale, collard greens and arugula — may help. 

Although there’s no cure for macular degeneration, there are things you can do to slow its progression.​

• Vitamins and minerals. Research, including a recent review of studies published in the journal Ophthalmology, shows that taking high-dose vitamins and minerals — specifically, vitamins C and E, zinc, lutein, zeaxanthin, beta-carotene and copper — slows progression of the disease in people with intermediate AMD and those with late-stage dry AMD. That’s not to say you should load up on these vitamins and minerals willy-nilly. Supplements known as AREDS2 are sold over the counter in specific quantities. Talk with your eye doctor before taking such high-dose supplements. 
• Injections. Wet AMD “is treated with the same AREDS2 vitamins as dry AMD but also with injections of medications into the eye to treat the leaking blood vessels,” Andreoli says. These medications help reduce the number of abnormal blood vessels in your retina. They also slow leakage. “Currently, these treatments are focused on stopping progression of disease, but good treatments that reverse damage are still in the works,” she says. In the absence of a cure for AMD, “the pharmacologic industry is continuing to modify and expand the medications that are being used for dry and wet AMD,” Andreoli says. “The medications that are currently being injected for wet AMD are numerous and ever evolving.” 
• Surgery. Laser photocoagulation is a form of surgery in which an eye care provider uses a special lens to focus an intense beam of light to seal off leaky blood vessels in the eyes. This can prevent more vision loss. The procedure is only done for wet AMD and is not appropriate for all patients.​

As always, “the best choice for any given patient is decided by the physician and patient as a team and depends on the individual patient’s eyes,” Andreoli says. “The best plan is to consult your local ophthalmologist to see what might be best for you.” 

For those who have been diagnosed with AMD, reducing exposure to sunlight by wearing sunglasses, avoiding cigarette smoke, eating a healthy diet and getting annual eye exams can help lower the risk that a patient develops vision loss from AMD as they get older, Sodhi says.​

​Causes, risk factors and prevention tips for age-related macular degeneration

“Age-related macular degeneration is a complex condition involving multiple genes, pathways and environmental factors,” says T.Y. Alvin Liu, M.D., director of the Wilmer Precision Ophthalmology Center of Excellence at Johns Hopkins Medicine. There’s no single, direct cause of AMD, but you’re at risk for the disease if you are:​

• Over age 55. As we age, “the cumulative exposure to oxidative stress can affect the health of the retina and, in particular, the macula,” Sodhi says. “The blood flow to the outer retina is reduced, the delivery of oxygen to the retina can be compromised, and the ability of the retina to tolerate the additional burden of oxidative stress declines.”
• Regularly exposed to cigarette smoke. Research shows that not only smokers but also people who are regularly exposed to cigarette smoke are at greater risk for AMD. That’s because smoking speeds up the deterioration of the macula by increasing the number of damaging chemical compounds and reducing blood and oxygen to the eye. The good news? A review of research published in Clinical Interventions in Aging found that stopping smoking can reduce your risk of AMD; the risk for former smokers who hadn’t smoked for more than 20 years was the same as for nonsmokers.
• In a family with a history of AMD. If your parents, siblings or children have AMD, you have a higher risk for getting it too.
• Obese. A body mass index over 30 (obesity) is associated with the progression of AMD. One review of studies, published in Investigative Ophthalmology & Visual Science, found that obese people had a 32 percent greater risk of developing late AMD. Read more on losing weight and maintaining a healthy weight.