The macula is a specialized portion of the retina responsible for central vision. Located at the back of your eye in the center of your retina, the macula provides the sharp vision you need to drive, to read and to see details. However, if you’re over the age of 50, age-related macular degeneration (AMD) may affect your ability to see. In fact, among older people, AMD is the main reason for irreversible legal blindness . The disease runs in families and is much more severe in people who smoke. 

There are two types of AMD:

• Dry AMD is the first stage of the disease. It starts slowly, eventually leading to loss of central vision. While the disease affects both eyes and progresses faster in one eye compared to the other, most people eventually lose their central vision in both eyes.
• Wet AMD arises from Dry AMD and is characterized by the growth of abnormal blood vessels in your macula. These abnormal blood vessels leak fluid and blood. If untreated, then this fluid and blood causes a scar to form and significant vision loss occurs. If the Wet AMD is treated, then it can be converted back to Dry AMD.

When Should You See a Doctor?

Dry AMD progresses slowly, but the use of vitamin supplementation and a diet rich in dark-green leafy vegetables can help slow down the vision loss if you catch the problem early.  That’s why regular eye exams matter. If you can’t see people clearly at a distance, have trouble transitioning from dark to bright light, or if you need increasingly brighter light to read by, schedule an appointment with an eye doctor. 

Wet AMD damages the macula much more quickly. Again, if you experience noticeable differences in your sight, especially blurry or distorted vision, then consult an eye doctor as soon as possible. AMD is worrisome for older people, but with proper diagnosis, our experts at Bascom Palmer Eye Institute will help you manage your condition and protect your vision.

Dry AMD Treatment

We have a new revolutionary treatment for dry atrophic age-related macular degeneration (AMD) that was approved by the Food and Drug Administration on February 17, 2023. This new drug, which has been in development for the past 18 years, is known as Syfovre®. Syfovre® slows the progression of geographic atrophy in AMD, which is the major cause of blindness from AMD. AMD, a common cause of vision loss as people age, begins slowly as dry AMD. As AMD progresses, the dry form of AMD progresses to the late-stage known as geographic atrophy or to the late-stage of AMD known as wet AMD. Wet AMD arises from dry AMD and occurs when abnormal blood vessels grow and leak fluid and blood into the central macula. Only about 15% of patients with dry AMD ever progress to wet AMD. 

Wet AMD Treatments

Injections of drugs into the eye that block vascular endothelial growth factor (anti-VEGF injections) prevent the severe vision loss that normally occurs in WET AMD, and in many patients, vision is improved.  If this treatment is recommended, then the injections need to be given every month at first, and then the injections can be spaced out and become less frequent. By stopping or limiting the growth of new blood vessels, this medication helps preserve your vision. Since 2005, we’ve had great treatments for wet AMD, starting with Avastin®, followed by Lucentis®, then Eylea®, and now Vabysmo®. All these treatments are highly effective and convert the wet AMD back to dry AMD, but there has been no treatment for dry AMD until Syfovre® was approved. Now the relentless progression of vision loss from geographic atrophy in dry AMD can be slowed and eventually stopped.

How is geographic atrophy treated?

As AMD progresses, the disease eventually causes geographic atrophy to form, which is the loss of retinal tissue that causes the relentless progression of vision loss. Even before legal blindness occurs, patients with early geographic atrophy can still have good reading vision, but they are aware of significant symptoms such as needing brighter lights to read, having difficulty with glare, losing the ability to drive at night, and complaining that they can’t recognize people in dim light. While Syfovre® isn’t a cure, the drug will slow down the overall vision loss and allow patients to have useful vision for longer resulting in a better quality of life.

Syfovre® won’t improve vision, but it will gradually slow and hopefully stop the progression. However, there is a significant treatment burden. For the first two years, most patients will need monthly injections of Syfovre® into their eyes. However, the eye must first qualify for treatment. To know if an eye qualifies, patients need to be evaluated by a retina specialist. While injections into eyes are routinely performed for wet AMD and everyone is nervous when they get their first injections, the procedure quickly becomes less stressful and well tolerated. The procedure performed by the retina specialist is the same as for wet AMD, but the drug we inject is different. Most patients do experience mild discomfort after the injection, and this discomfort lasts for about one day. Other promising drugs are also being developed for dry AMD

Tests

Comprehensive Eye Exam - The standard way of diagnosing macular degeneration is with a dilated exam. During your examination, your ophthalmologist will search for retinal damage and may perform other tests.

Distance Visual Acuity Measurement - In this test, you cover one eye, read a standard eye chart from a distance and then repeat the process with the other eye. Your eye care professional records how well your eyes see at a distance.

Amsler Grid - In this test, you look at an Amsler grid’s pattern of straight horizontal and vertical lines. If you have AMD, you will see wavy lines, distorted or missing lines or a black spot in the center of the grid.

Optical Coherence Tomography (OCT) - This non-invasive imaging procedure uses dim light and produces a cross-sectional, three-dimensional (3-D) images of the inside of your eyes. By performing OCT imaging, you doctor can determine if your AMD is getting worse and whether you need an injection into your eye.

Fluorescein Angiography - Using this method, your doctor can see changes in the structure or function of your retinal blood vessels. To perform the test, your eye care professional injects dye into a vein in your arm or hand, then photographs your retina as the dye outlines your blood vessels.

Why Choose Bascom Palmer Eye Institute?

#1 in the Nation. Ranked #1 for ophthalmology in the nation by U.S. News & World Report, our retinal specialists offer the most advanced imaging techniques and latest treatments.

Patient-Centered Care and Support. If you’re facing vision loss, you deserve expert care that considers your individual needs. Our low vision support services help you manage AMD and preserve your quality of life.

Research-Driven Medicine. Our physician-researchers continuously study this disease to develop effective treatments. As our patient, you gain access to innovative clinical trials and state-of-the-art treatments.

What this means for you: As an older adult, you may be coping with more than one condition. The world-class specialists within Bascom Palmer can treat any eye condition, from the common to the complex.