Managing Age-Related Macular Degeneration (AMD) Vision Loss

Age-related macular degeneration (AMD) is the most common form of vision loss in adults over age 55 in developed countries. It is a condition that worsens over time. AMD affects the part of the retina that processes what you see in front of you, known as the macula, and causes a gradual loss of central vision or acute vision loss.

AMD vision loss affects your functional vision, impacting activities of daily living like the ability to read, drive, or make out fine details in your central vision.

This article will help you understand AMD vision loss and provide strategies to manage the condition.    

How Soon Does AMD Cause Vision Loss?

There are two types of AMD vision loss—dry and wet—and they cause vision loss at different speeds.

Dry AMD

Dry AMD accounts for 85% to 90% of cases of AMD. It arises from deposits in the macula called drusen. Dry AMD progression depends on the size of the drusen. About 1% to 3% of people with small drusen experience significant vision loss within five years. However, up to 1 in 5 people with medium-sized drusen experience vision problems in the same time frame as their diagnosis. Vision loss is seen in nearly half (47%) of people with large drusen.

Wet AMD

Wet AMD, also known as neovascular AMD, is considered an advanced form of the condition, and vision loss may occur within a few days or weeks of onset. It is more severe than dry AMD and accounts for most cases of AMD-related blindness. It arises due to irregular blood vessel growth in the retina, which leaks blood and affects the macula.

Stages of AMD Vision Loss

While there are individual differences in the progression of AMD, the condition typically passes through three stages, as follows:

• Early: In the early stages of dry AMD, the drusen are small and do not affect vision.
• Intermediate: Intermediate dry AMD may or may not cause some blurry vision.
• Advanced: In advanced dry or wet AMD, the symptoms are pronounced. It affects the clarity of what you see and your ability to see. Advanced AMD can also cause vision distortion (metamorphopsia).

Vision Changes From AMD

Whether wet or dry, AMD can drastically affect your vision, especially if untreated. However, AMD does not impact your peripheral vision (seeing from the side of the eye).

Since this condition affects the macula, it greatly impacts your central vision. AMD signs include:

• Blurriness or lack of focus in the middle of your field of vision
• Loss of ability to make out words on a page or drive safely
• Trouble seeing in low light
• Waviness or crookedness when looking at lines
• Blank spaces and faded color in the center of your vision
• Partial blindness

More often, late-stage AMD affects one eye, though having it in one increases the chances of developing it in the other.   

What Helps With AMD Vision Loss?

AMD vision loss is progressive and chronic, meaning no treatment can reverse it. However, taking certain supplements and making lifestyle changes can slow its progression in the early stages. Medications may also be indicated for advanced and wet AMD.

Lifestyle Changes

If you detect AMD in its early or intermediate stages, adopting preventive strategies and making lifestyle changes will help. While these will not stop the condition from progressing, they can slow it down. Such approaches to prevention include:

• Quitting smoking: Smoking tobacco and using nicotine products increases the risk of developing AMD and can hasten its progression.
• Boosting physical activity: Ensuring enough exercise—at least 150 minutes a week of low to moderate activity—is another way to reduce risk.
• Improving diet: A diet emphasizing fresh fruits and vegetables, lean proteins (e.g., fish), nuts, and seeds, and avoiding high carbohydrate foods, has been shown to help.
• Managing cholesterol and blood pressure: Elevated cholesterol levels and high blood pressure (hypertension) can also increase AMD risk, so managing them is a means to slow the progression of this disease.   

Supplements

Alongside lifestyle changes, taking certain vitamin and mineral supplements can be another way to slow the progression of AMD. Healthcare providers may recommend taking special supplements called AREDS-2 (Age-Related Eye Disease Study 2). These supplements include:

• Vitamin C
• Vitamin E
• Copper
• Zinc
• Lutein
• Zeaxanthin

While AREDS-2 supplements are available in pharmacies, talk to your healthcare provider before trying them or attempting other supplements.

Specialty Glasses

Ultraviolet (UV) rays in light can damage the retinas and spur the progress of AMD vision loss. Wearing specialized glasses can help you manage the condition. Your optometrist or healthcare provider may be able to recommend pairs that can protect from UV rays.

The American Macular Degeneration Foundation (AMDF) recommends sunglasses labeled "UV 400" to protect against UV rays.

Blue-light-blocking glasses have grown in popularity, however, there is no evidence to support the benefit of blue-light glasses for AMD.

Medications

Anti-vascular endothelial growth factor (anti-VEGF) drugs may help slow wet AMD-associated vision loss. However, these medications aren’t effective for advanced dry AMD.

In this procedure, a healthcare provider will numb your eyes and apply anti-VEGF drugs via a very fine needle injection to help stop the bleeding and leaking of the retina that causes the condition. The effects are temporary, so multiple treatments are needed. Anti-VEGF drugs include:

• Beovu (brolucizumab)
• Lucentis (ranibizumab)
• Eylea (aflibercept)
• Avastin (bevacizumab) (an off-label use for this drug)
  

Syfovre Injection

In February of 2023, the Food and Drug Administration (FDA) approved Syfovre (pegcetacoplan), a new therapy for macular degeneration due to AMD. It’s an injection given in a healthcare provider’s office every 25 to 60 days.

This drug is in a class called complement-inhibitors, which work directly on the damaged portion of the macula to preserve vision and stop AMD vision loss from progressing.

Monitoring AMD Vision Loss

Since AMD vision loss is progressive, you should be monitored by a low-vision specialist and vision rehabilitation team of vision loss experts in addition to seeing your treating optometrist (eye doctor) and ophthalmologist (eye specialist). Your team of professionals may include the following:

• Ophthalmologist
• Low-vision optometrist
• Occupational therapist
• Assistive technology instructor
• Orientation and mobility instructor
• Psychologist or psychiatrist.
  

They may use one or more of the following procedures:

• Evaluation of health status: To rule out other causes of vision problems, you'll be asked about your medical history and medications.
• Slit lamp examination: After your eyes are dilated with special eye drops, a provider uses a microscope with a light attached (slit lamp) to examine the retina, macula, and fundus (the part of the eye just behind the lens).
• Visual acuity and refraction: A healthcare provider will assess your visual acuity (how well you see), focusing on your central vision for blurriness or other features of AMD.
• Fluorescein angiography: To help determine how far wet AMD has advanced, a provider may use a type of imaging called fluorescein angiography. The provider injects a contrast dye into a vein in the arm and uses a specialized camera to capture blood flow in the eye.
• Optical coherence tomography (OCT): OCT is noninvasive imaging that uses light waves to examine the ten layers of the retina, distinguish wet from dry AMD, and assess the severity of the condition.     
  

Accommodations for AMD Vision Loss

Since treatment can't reverse AMD vision loss, it's important to understand what you can do to make life with the condition more manageable. Such strategies include:

• Using a magnifying lens to make reading print or seeing images easier
• Trying audio assisted devices, such as OrCam, which are mounted on glasses to provide audio assistance with recognizing objects, faces, and words, and electronic magnification so you can increase size, and change contrast and brightness.
• Enlarging the text on phone, computer, or device screens using the zoom function
• Using other features of devices that assist with visual impairment, such as increasing brightness and enabling dictation
• Choosing large-print books and magazines
• Using high-lumen (high-powered), bright lights in your home or office
• Wearing wraparound sunglasses or wide-brimmed hats or covering shiny surfaces

According to the Americans with Disabilities Act (ADA), employers must provide “reasonable accommodations” for your condition if you can demonstrate disability due to AMD vision loss. These include:

• Providing assistive devices, such as computer screen magnifiers, high-powered lights, and others
• Allowing you to work from home
• Providing software that can read out words on a computer screen
• Providing written materials in larger print or another accessible format
• Arranging for transportation to and from work
• Modifying your work schedule

Your employer may request documentation and proof of your disability. In addition, they can refuse a request for a reasonable accommodation if it causes an “undue hardship” in the workplace.

Summary

Age-related macular degeneration (AMD) is a vision disorder that causes gradual central vision loss. It is a progressive and irreversible condition most prevalent in adults over 55. Treatments focus on slowing the progression of AMD vision loss and include lifestyle changes, supplements, or medication injections. Wearing wraparound sunglasses, increasing text size on screens, and using strong lights are some ways to manage this condition.

If you have AMD, work with a low-vision specialist and vision rehabilitation team of vision loss experts in addition to seeing your treating ophthalmologist.