What is Macular Degeneration?
Age-related macular degeneration (AMD) is a chronic, degenerative disease that affects the macula — the small, central area of the retina responsible for sharp, detailed vision needed for activities such as reading, driving, and recognizing faces. AMD is classified into two main forms. Dry (atrophic) AMD, accounting for approximately 85-90% of cases, is characterized by the accumulation of drusen (yellow deposits beneath the retina) and progressive thinning and atrophy of the retinal pigment epithelium (RPE) and photoreceptors. Wet (neovascular or exudative) AMD, though less common, is more aggressive and involves the growth of abnormal blood vessels (choroidal neovascularization) beneath the retina that leak fluid and blood, causing rapid and severe central vision loss. AMD affects central vision while peripheral vision typically remains intact, meaning patients do not go completely blind but may lose the ability to perform detailed visual tasks.
Symptoms
- Gradual blurring of central vision
- Distortion of straight lines (metamorphopsia) — a key warning sign of wet AMD
- A dark or empty spot (scotoma) in the center of vision
- Difficulty reading, even with glasses
- Decreased brightness or intensity of colors
- Difficulty recognizing faces
- Need for brighter light for close-up tasks
- Slow adaptation to low light levels
Symptoms may develop gradually in dry AMD or suddenly in wet AMD. Any sudden distortion or loss of central vision should be treated as urgent.
Causes and Risk Factors
The exact cause of AMD is not fully understood, but it involves a combination of genetic predisposition, oxidative stress, and chronic inflammation at the level of the RPE and Bruch's membrane. Risk factors include:
- Age — the strongest risk factor; prevalence increases significantly after age 60
- Smoking — doubles the risk of AMD and accelerates progression
- Family history and genetic factors (CFH, ARMS2/HTRA1 gene variants)
- Caucasian ethnicity
- Cardiovascular disease and hypertension
- Obesity and high-fat diet
- Prolonged UV light exposure
- Female sex (slightly higher prevalence)
Diagnosis
A comprehensive ophthalmic examination is essential for diagnosing and staging AMD. Dilated fundoscopy reveals drusen, pigmentary changes, atrophy, or signs of neovascularization. Optical coherence tomography (OCT) provides high-resolution cross-sectional images of the retina to detect fluid, drusen, and atrophic changes. OCT angiography (OCTA) can non-invasively detect choroidal neovascularization. Fluorescein angiography (FA) remains the gold standard for confirming wet AMD and characterizing the type of neovascular membrane. The Amsler grid — a simple home-monitoring tool — helps patients detect early metamorphopsia. Fundus autofluorescence (FAF) imaging is useful for monitoring geographic atrophy progression in dry AMD.
Treatment
Treatment depends on the type and stage of AMD:
- Dry AMD — Valeda® Light Delivery System: a non-invasive, safe, and painless treatment that uses a precisely controlled combination of red, near-infrared, and yellow light to stimulate cellular activity in the retina and improve its function. The therapy is based on photobiomodulation — a process in which specific wavelengths of light activate the cells' natural repair mechanisms, improve their energy balance, and reduce inflammation and oxidative stress. This improves cellular health and may help slow the progression of degenerative changes in the macula.
- Wet AMD — intravitreal anti-VEGF injections are the standard of care (ranibizumab, aflibercept, brolucizumab, faricimab); these drugs block the growth factor responsible for abnormal blood vessel formation and reduce fluid leakage
- Low-vision rehabilitation — magnifying devices, adaptive technology, and occupational therapy for patients with significant vision loss
Prevention and Recommendations
- Stop smoking — this is the single most modifiable risk factor
- Eat a diet rich in leafy green vegetables (lutein and zeaxanthin), oily fish (omega-3 fatty acids), and colorful fruits
- Take AREDS2 supplements if recommended by your ophthalmologist
- Exercise regularly and maintain a healthy body weight
- Protect your eyes from UV radiation with quality sunglasses
- Monitor your central vision regularly with an Amsler grid at home
- Schedule regular eye examinations, especially after age 50
- Seek immediate evaluation if you notice sudden distortion or a blind spot in your central vision