Age-related macular degeneration (AMD)

Age-related macular degeneration (AMD) is a disease of the middle part of the retina, the yellow spot (macula). The macula contains cones that perceive contrast and colors. They ensure that you see clearly. In age-related macular degeneration, those cones gradually die which causes you to see less sharp and fewer colors. In addition, loss of central vision is the result of changes that occur in response to the deposition of abnormal material (drusen) in the retina which can also cause you to see images distorted.

The rest of the retina that surrounds the macula, provides the complete picture of the environment. Those are the images you see with the corners of your eyes and are called your peripheral vision. Peripheral vision is usually spared in macular degeneration so that you can more or less independently find your way around the house and beyond.

But without a healthy macula, everyday activities such as reading or recognizing faces can become challenging. AMD is the most common cause of irreversible vision loss in the developed world in individuals over 50 years of age - making it a significant medical concern to be aware of and be prepared against.

WHAT ARE THE CAUSES AND RISK FACTORS OF AGE-RELATED MACULAR DEGENERATION?

Macular degeneration is a complex condition of which the exact causes remain largely unknown. It is described as an extreme exaggeration of the ‘normal’ aging progress of the retina. Age itself is the main risk factor. However, research has highlighted also other factors in developing AMD:

• Positive family history of AMD

• Female gender

• Smoking

• Being overweight (obesity)

• High blood pressure (hypertension)

• Hypercholesterolemia

• Cardiovascular disease

WHAT ARE THE STAGES AND TYPES OF AGE-RELATED MACULAR DEGENERATION?

AMD presents itself in various stages. The stages of AMD are determined by changes in the retina. As AMD progresses, two types of macular degeneration may be diagnosed:

NON-EXUDATIVE OR DRY MACULAR DEGENERATION

Dry Macular Degeneration is the most common form of AMD, affecting over 90% of those diagnosed. This slow-progressing condition causes an accumulation of small pale yellow deposits in the macula (drusen). These drusen reduce the number of cones in the macula. This will slowly make your vision worse, usually in both eyes. It can take years for your vision to deteriorate.

EXUDATIVE OR WET MACULAR DEGENERATION

Exudative or Wet Macular Degeneration affects the choroid, a critical layer surrounding the retina. This can lead to abnormal growth of blood vessels that cause bleeding and swelling in subretinal space - ultimately leading to retinal damage, detachment, and potentially blindness if left untreated.

WHAT ARE THE SYMPTOMS OF AGE-RELATED MACULAR DEGENERATION?

Age-related macular degeneration symptoms can occur in one or both eyes and affect your central vision. In the early stages, patients rarely experience symptoms. However, as the condition progresses and depending on the type of AMD, they may experience:

• Impaired central vision; difficulty reading, difficulty recognizing faces, distortion of perceived images (metamorphopsia)

• Positive central scotoma (something obstructing central vision)

• Decreased color brightness

• Loss of color vision

• Difficulty adapting to low light

Pay attention to whether you see distortion in the images of your surroundings. For example, a curve in something that should be straight, such as a curve in a window frame or a line in a text. This may indicate the onset of the more severe form of AMD.

TREATMENT OPTIONS FOR AMD

Depending on the stage of the AMD, there are different treatment options. If you are looking for surgical treatment options for AMD, plan a consultation with Prof. Marco Mura at the Department of Ophthalmology Arcispedale Sant’Anna in Ferrara or at Casa di Cura Toniolo in Bologna, Italy.