Diagnosis
Drusen
Drusen
The presence of drusen, which are yellow deposits, observed in retinal color photographs signifies the onset of early-stage dry macular degeneration (left image). As the condition progresses to its advanced stage (right image), there can be a loss of light-sensitive cells in the macula, leading to atrophy. Recognizing drusen is a key step in Macular Degeneration Diagnosis.
Amsler grid
Amsler grid
When viewing an Amsler grid in an advanced stage of macular degeneration, individuals may notice distorted grid lines or a blank area near the grid’s center (right image). This simple test is valuable in macular degeneration diagnosis and monitoring vision changes.
To achieve an accurate macular degeneration diagnosis, particularly for wet macular degeneration, an ophthalmologist typically begins with a thorough review of the patient’s medical and family history, followed by a comprehensive eye examination. To definitively diagnose macular degeneration, several diagnostic tests may be recommended, including:
-
Examination of the Back of the Eye: During this examination, the eye doctor will administer eye drops to dilate the pupils, allowing for a better view of the retina. Using specialized instruments, the doctor will inspect the back of the eye for any signs of macular degeneration. A key indicator is a mottled appearance caused by drusen, yellowish deposits that form beneath the retina. The presence of numerous drusen is often a significant factor in macular degeneration diagnosis.
-
Visual Field Test with Amsler Grid: An Amsler grid is a tool used to detect alterations in the central visual field. This test is crucial in macular degeneration diagnosis as it helps identify early changes. Patients with macular degeneration might perceive the straight lines of the grid as wavy, broken, or faded, indicating distortions in their central vision.
-
Fluorescein Angiography: This diagnostic procedure involves injecting a fluorescent dye into a vein in the arm. As the dye circulates through the body, it reaches the blood vessels in the eye. A specialized camera captures images as the dye passes through these vessels. Fluorescein angiography is particularly useful in wet macular degeneration diagnosis, as it can reveal leaking blood vessels or other retinal abnormalities characteristic of the condition.
-
Indocyanine Green Angiography: Similar to fluorescein angiography, indocyanine green angiography utilizes an injected dye. It may be employed to corroborate the findings of a fluorescein angiography or to visualize blood vessels situated deeper within the retina. This test aids in a more detailed macular degeneration diagnosis, especially when complex cases are suspected.
-
Optical Coherence Tomography (OCT): Optical coherence tomography is a non-invasive imaging technique that provides detailed cross-sectional images of the retina. OCT scans are instrumental in macular degeneration diagnosis as they can identify areas of retinal thinning, thickening, or swelling. Furthermore, OCT is used to monitor the retina’s response to macular degeneration treatments over time.
-
Optical Coherence Tomography Angiography (OCT-A): This advanced, non-invasive imaging test also provides detailed cross-sectional views of the retina, similar to OCT. OCT angiography is valuable in macular degeneration diagnosis, particularly in identifying fluid buildup caused by leaking blood vessels in and under the retina. This is especially important for diagnosing wet macular degeneration and differentiating it from the dry form.
Care at Mayo Clinic
Seeking expert care for macular degeneration? Connect with Mayo Clinic specialists today.
Treatment
While there is currently no cure for macular degeneration, effective treatments are available that can help slow down the progression of the disease and preserve existing vision. Early intervention and treatment may even lead to the recovery of some lost vision.
Medicines
Anti-VEGF (Vascular Endothelial Growth Factor) drugs are a class of medications that can effectively halt the growth of new, abnormal blood vessels in the eye, which is a hallmark of wet macular degeneration. These drugs work by blocking the signals that the body sends to stimulate new blood vessel growth. Anti-VEGF drugs are considered the primary treatment approach for all stages of wet macular degeneration.
Commonly used anti-VEGF medications for wet macular degeneration treatment include:
- Bevacizumab (Avastin)
- Ranibizumab (Lucentis)
- Aflibercept (Eylea)
- Brolucizumab (Beovu)
- Faricimab-svoa (Vabysmo)
These medications are administered through injections directly into the affected eye by an eye doctor. To maintain the therapeutic benefits, injections are typically required every 4 to 6 weeks. In some cases, as the abnormal blood vessels shrink and fluid under the retina is absorbed by the body, partial vision recovery may be possible.
Potential risks associated with these eye injections include:
- Conjunctival hemorrhage (bleeding under the conjunctiva)
- Elevated intraocular pressure (increased eye pressure)
- Eye infection
- Retinal detachment
- Eye inflammation
Therapies
-
Photodynamic Therapy (PDT): Photodynamic therapy is a treatment option for wet macular degeneration that targets the abnormal blood vessel growth. However, it is less frequently used compared to anti-VEGF injections.
During PDT, a medication called verteporfin (Visudyne) is injected into a vein in the arm. This drug then travels to the blood vessels in the eye. The eye doctor then directs a focused light from a special laser onto the affected blood vessels. This laser light activates the verteporfin, causing the abnormal blood vessels to close and stop leaking.
Photodynamic therapy can help improve vision and reduce the rate of vision loss progression. However, repeated treatments may be necessary over time as the treated blood vessels can sometimes reopen.
Following photodynamic therapy, it is crucial to avoid direct sunlight and bright lights until the verteporfin has been cleared from the body, which may take a few days.
-
Photocoagulation Therapy: In photocoagulation therapy, a high-energy laser beam is used to seal off problematic blood vessels beneath the macula. This procedure aims to stop the bleeding from these vessels, thereby minimizing further damage to the macula. Despite treatment, there is a possibility of blood vessels regrowing, necessitating further treatments. Furthermore, the laser treatment can cause scarring, potentially leading to a blind spot.
Photocoagulation is less commonly used for wet macular degeneration treatment today. It is generally not suitable if the problematic blood vessels are located directly under the center of the macula. Additionally, the success rate diminishes with increased macular damage.
-
Low Vision Rehabilitation: Macular degeneration primarily affects central vision, but typically does not impact peripheral vision or cause complete blindness. However, the loss of central vision can significantly impair daily activities such as reading, driving, and facial recognition. Low vision rehabilitation services, provided by specialists, occupational therapists, and eye doctors, can be invaluable in helping individuals adapt to vision changes and maintain independence.
More Information
Request an eye appointment for macular degeneration concerns.
Lifestyle and Home Remedies
Even after receiving a macular degeneration diagnosis, certain lifestyle modifications can play a role in slowing down vision loss progression.
-
Smoking Cessation: Smoking is a significant risk factor for macular degeneration. If you smoke, seeking professional help to quit is highly recommended.
-
Healthy Dietary Choices: A diet rich in antioxidant vitamins found in fruits and vegetables is beneficial for eye health. Leafy green vegetables like kale, spinach, and broccoli, as well as squash and other vegetables, are excellent sources of antioxidants, including lutein and zeaxanthin, which may benefit individuals with macular degeneration.
Foods rich in zinc, such as high-protein foods like beef, pork, and lamb, as well as non-meat sources like milk, cheese, yogurt, whole-grain cereals, and whole-wheat bread, may also be helpful.
Incorporating healthy unsaturated fats, such as olive oil, into the diet is advisable. Research suggests that a diet high in omega-3 fatty acids, found in fish like salmon and tuna, and walnuts, may reduce the risk of advanced macular degeneration. However, omega-3 supplements like fish oil pills have not shown the same benefit.
-
Management of Other Medical Conditions: If you have conditions such as cardiovascular disease or hypertension, adhering to your prescribed medications and following your healthcare team’s guidance for managing these conditions is important for overall health, including eye health.
-
Maintaining a Healthy Weight and Regular Exercise: If weight loss is recommended, reducing calorie intake and increasing daily exercise is advised. Regular physical activity and a healthy weight contribute to overall well-being and may indirectly benefit eye health.
-
Routine Eye Examinations: Regular eye exams are crucial for monitoring macular degeneration and overall eye health. Consult your eye doctor to determine the recommended schedule for follow-up examinations. Between checkups, self-monitoring of vision using an Amsler grid can be a proactive measure.
Vitamin Supplements
For individuals diagnosed with intermediate or advanced macular degeneration, taking a high-dose formulation of antioxidant vitamins and minerals may help lower the risk of further vision loss. The Age-Related Eye Disease Study 2 (AREDS2) research demonstrated the benefits of a formulation containing:
- 500 mg of vitamin C
- 400 IU of vitamin E
- 10 mg of lutein
- 2 mg of zeaxanthin
- 80 mg of zinc as zinc oxide
- 2 mg of copper as cupric oxide
Consult your eye doctor to determine if vitamin supplements are appropriate for your specific situation.
More Information
Learn more about lifestyle adjustments for macular degeneration.
Coping and Support
Vision loss resulting from macular degeneration can impact various aspects of daily life, including reading, facial recognition, and driving. The following strategies may help in coping with changing vision:
-
Regular Eyeglass Prescription Checks: If you wear eyeglasses or contact lenses, ensure your prescription is up-to-date. If new glasses do not provide sufficient improvement, seek a referral to a low vision specialist.
-
Utilizing Magnifiers: Various magnifying devices can aid with reading and close-up tasks like sewing. These include handheld magnifying lenses and spectacle-mounted magnifiers. Closed-circuit television systems that use a video camera to magnify reading material and display it on a screen are also available.
-
Computer Display and Audio System Adjustments: Adjusting font size and contrast settings on your computer monitor can improve readability. Speech-output systems and other assistive technologies can also be beneficial.
-
Electronic Reading Aids and Voice Interfaces: Explore large-print books, tablet computers, and audiobooks. Many tablet and smartphone apps are designed to assist individuals with low vision. Voice recognition features on these devices can also enhance accessibility.
-
Specialized Low Vision Appliances: Clocks, radios, telephones, and other appliances with extra-large numbers are available. Consider using a larger, high-definition television screen or sitting closer to the screen for better viewing.
-
Improved Home Lighting: Brighter lighting throughout your home can facilitate reading and daily activities and may also reduce the risk of falls.
-
Transportation Options: If you drive, consult your doctor to assess driving safety. Exercise extra caution in challenging driving conditions such as nighttime, heavy traffic, or inclement weather. Explore alternative transportation options like public transportation, rides from friends or family, volunteer driving networks, or ride-sharing services, especially for night driving.
-
Seeking Support: Adjusting to macular degeneration can be emotionally challenging and may necessitate lifestyle changes. Consider talking to a counselor or joining a support group to connect with others facing similar experiences. Spending time with supportive family members and friends is also crucial.
Preparing for Your Appointment
A dilated eye exam is typically necessary to check for macular degeneration. Schedule an appointment with an eye care professional, such as an optometrist or ophthalmologist, for a comprehensive eye examination.
What You Can Do
Prior to your appointment:
- Inquire when scheduling if any specific preparation is needed.
- Compile a list of any symptoms you are experiencing, even if seemingly unrelated to your vision.
- Create a list of all medications, vitamins, and supplements you are currently taking, including dosages.
- Arrange for a family member or friend to accompany you, as pupil dilation during the eye exam may temporarily affect your vision, potentially requiring assistance with driving or navigation afterward.
- Prepare a list of questions to ask your eye care professional.
For macular degeneration, consider asking the following questions:
- Do I have dry or wet macular degeneration?
- How advanced is my macular degeneration?
- Is it safe for me to continue driving?
- Will I experience further vision loss?
- Is my condition treatable?
- Will vitamin or mineral supplements help prevent further vision loss?
- What is the best way to monitor my vision for changes?
- What symptom changes should prompt me to contact you?
- What low vision aids might be beneficial for me?
- What lifestyle modifications can I make to protect my vision?
What to Expect From Your Doctor
Your eye doctor is likely to ask you several questions, such as:
- When did you first notice your vision problem?
- Does the condition affect one or both eyes?
- Do you have difficulty seeing objects up close, at a distance, or both?
- Do you smoke or have you smoked in the past? If so, how much?
- What is your typical diet?
- Do you have any other medical conditions, such as high cholesterol, hypertension, or diabetes?
- Is there a family history of macular degeneration?
Macular degeneration, wet care at Mayo Clinic
Symptoms & causes
Doctors & departments
Dec. 11, 2024
- Age-related macular degeneration (AMD). National Eye Institute. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/age-related-macular-degeneration. Accessed Sept. 17, 2024.
- What is macular degeneration? American Academy of Ophthalmology. https://www.aao.org/eye-health/diseases/amd-macular-degeneration. Accessed Sept. 17, 2024.
- AskMayoExpert. Age-related macular degeneration. Mayo Clinic; 2024.
- What is macular degeneration? American Macular Degeneration Foundation. https://www.macular.org/about-macular-degeneration/what-is-macular-degeneration. Accessed Sept. 17, 2024.
- Heesterbeek TJ, et al. Risk factors for progression of age-related macular degeneration. Ophthalmic and Physiological Optics. 2020; doi:10.1111/opo.12675.
- Charles Bonnet syndrome. American Society of Retina Specialists. https://www.asrs.org/patients/retinal-diseases/38/charles-bonnet-syndrome. Accessed Sept. 17, 2024.
- Yanoff M, et al., eds. Age-related macular degeneration. In: Ophthalmology. 6th ed. Elsevier; 2023. https://www.clinicalkey.com. Accessed Sept. 17, 2024.
- Low vision. National Eye Institute. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/low-vision. Accessed Sept. 17, 2024.
- Van Nispen R, et al. Low vision rehabilitation for better quality of life in visually impaired adults. Cochrane Database of Systematic Reviews. https://www. cochranelibrary.com. Accessed Sept. 17, 2024.
- Preferred practice pattern: Age-related macular degeneration. American Academy of Ophthalmology. 2019; doi:10.1016/j.ophtha.2019.09.024.
- Vision rehabilitation. American Optometric Association. https://www.aoa.org/practice/specialties/vision-rehabilitation?sso=y. Accessed Nov. 3, 2022.
- Ami TR. Allscripts EPSi. Mayo Clinic. Oct. 3, 2022.
- Bakri SJ (expert opinion). Mayo Clinic. Nov. 11, 2020.
- Chodnicki KD (expert opinion). Mayo Clinic. Nov. 6, 2022.
- Nair AA, et al. Spotlight on faricimab in the treatment of wet age-related macular degeneration: Design, development and place in therapy. Drug Design, Development and Therapy. 2022; doi:10.2147/DDDT.S368963.
