Age-Related Macular Degeneration (AMD)
AMD is a leading cause of irreversible central vision loss in adults over 50. It affects the macula, responsible for high-acuity vision. AMD progresses from early dry disease to advanced dry (geographic atrophy) or wet (neovascular) forms.
Types
- Dry (nonexudative): Drusen deposits, retinal pigment epithelium (RPE) changes, geographic atrophy
- Wet (exudative): Choroidal neovascularization causing leakage, hemorrhage, scarring
Risk Factors
- Age > 50, female sex
- Family history, genetic variants (CFH, ARMS2/HTRA1)
- Smoking (major modifiable risk), obesity, hypertension
- Low intake of antioxidants/omega-3s
- Excessive UV exposure
Symptoms
- Blurred or distorted central vision (metamorphopsia)
- Difficulty reading, recognizing faces
- Dark/empty area in center of vision (scotoma)
- Colors appear dull
- Wet AMD can cause rapid vision loss; prompt evaluation is critical
Diagnosis & Monitoring
- Dilated fundus exam showing drusen, pigment changes
- Optical coherence tomography (OCT) to visualize retinal layers, detect fluid
- OCT angiography or fluorescein angiography for neovascularization
- Amsler grid self-monitoring at home for metamorphopsia
- Genetic testing/guided counseling available but not routinely required
Treatment & Management
Dry AMD
- Lifestyle: smoking cessation, Mediterranean diet, exercise, BP/lipid control
- AREDS2 supplements (vitamins C/E, lutein, zeaxanthin, zinc, copper) slow progression in intermediate/advanced disease
- Low-vision aids, occupational therapy for daily adjustments
- New complement inhibitors (pegcetacoplan, avacincaptad) for geographic atrophy slow lesion growth
Wet AMD
- Anti-VEGF injections: ranibizumab, aflibercept, brolucizumab, faricimab, bevacizumab (off-label) given monthly or treat-and-extend
- Photodynamic therapy (verteporfin) rarely used today
- Thermal laser reserved for extrafoveal lesions
- Manage cardiovascular risk factors to reduce recurrence risk
Living with AMD
- Use adaptive devices (magnifiers, high-contrast reading materials, text-to-speech apps)
- Keep home well-lit and decluttered
- Regular follow up with retina specialist; self-monitor with Amsler grid weekly
- Address depression/anxiety—vision loss impacts independence
Complications
- Irreversible central vision loss, reduced driving/reading ability
- Falls, fractures due to poor vision
- Social isolation, depression
Research & Future Directions
Active areas include gene therapy, stem cell/RPE implants, sustained-release anti-VEGF delivery, and neuroprotective agents.
Experimental & Emerging Treatments
- Gene Therapy (RGX-314, ADVM-022): AAV vectors deliver sustained anti-VEGF expression to reduce injection burden.
- RPE Stem Cell Patches: Transplanted cells aim to regenerate damaged macula in advanced dry AMD.
- Complement Inhibitors: C3/C5 blockers (pegcetacoplan, avacincaptad) recently approved and new agents (IONIS-FB-LRx) in trials.
- Subretinal Nano-Port Delivery Systems: Refillable reservoirs providing steady anti-VEGF dosing.
Track AMD with Diagnoza.care
Preserve Your Vision with Insight – Log injection dates, OCT findings, Amsler grid changes, supplements, lifestyle habits, low-vision aids, and retina appointments; capture side effects; and let the AI companion remind you of monitoring and adaptive strategies.
Medical Disclaimer: Informational only. Work with your ophthalmologist/retina specialist for individualized treatment, imaging schedules, and vision rehabilitation.
Sources: American Academy of Ophthalmology, National Eye Institute, Macular Degeneration Association