Frequently Asked Questions

Yes, for the WET form of the disease. Some common treatments that can help control the abnormal blood vessel growth and bleeding in the macula for those with wet macular degeneration include injections, laser photocoagulation, and photodynamic therapy. The FDA-approved injectable medications, such as EYLEA™ (aflibercept), Lucentis® (ranibizumab) and Macugen® (pegaptanib sodium), stabilize or effectively reduce damage from wet AMD.

The safety and effectiveness of EYLEA was evaluated in two clinical trials involving 2,412 adult patients. People in the study received either EYLEA or Lucentis (ranibizumab injection). The primary endpoint in each study was a patient’s clearness of vision (visual acuity) after one year of treatment. In comparison to Lucentis, all EYLEA treatment groups had a similar, consistent mean improvement in visual acuity (lost no more than 15 letters or 3 lines on a vision chart), and a similar, generally favorable safety profile. Importantly, EYLEA dosed 2 mg every two months was demonstrated similar in efficacy and safety to Lucentis dosed monthly.

The efficacy of Lucentis depends on a number of factors and is different for every patient. However, in a clinical trial where 800 patients were treated over two years, 90 percent of patients saw their vision stabilize, while 40 percent saw their vision improve (gained up to three lines on a vision chart). The definition of "stabilization of vision" here does allow for some vision loss (accountable to age, testing conditions, and other factors), where patients could lose up to 15 letters on the vision chart (or three lines).

Physicians have also used Avastin® (bevacizumab injection) as an “off-label” treatment for wet macular degeneration, and several other prospective treatments are in various stages of development. The National Eye Institute of the National Institutes of Health conducted clinical trials (Comparison of Treatments Trials or CATT) to study the relative efficacy and safety of Avastin and Lucentis. In May 2011, it was reported that Avastin and Lucentis were found to be nearly equally effective in treating AMD. In April 2012, CATT findings showed that the best results for maintaining visual acuity are achieved with injections every four weeks, with comparable results for either Avastin or Lucentis injected monthly. The report showed that receiving doses of either drug “as needed” was less effective for maintaining visual acuity than with monthly dosing. Although Avastin was associated with a greater number of serious adverse events than Lucentis, the researchers could not determine whether these differences were due to statistical chance or to real differences between the safety profiles of the two drugs. Results from ongoing clinical trials worldwide may provide more information about the risks of taking Avastin relative to Lucentis for wet AMD.

Currently, there is no treatment or cure for advanced DRY macular degeneration that will prevent or slow vision loss. However, a specific high-dose formula of antioxidant vitamins and zinc—colloquially called the AREDS formula—may delay or prevent intermediate macular degeneration from progressing to the advanced stage.

The AREDS formula is based on results of the National Eye Institute’s Age-Related Eye Disease Study (AREDS). Products with this formulation are available over the counter (non-prescription) at places such as drug stores, supermarkets, and health food stores.

The National Eye Institute’s (NEI) Age-Related Eye Disease Study (AREDS) found that taking a specific high dose formula of antioxidants and zinc (500 milligrams of vitamin C, 400 International Units of vitamin E, 15 milligrams of beta-carotene, 80 milligrams of zinc as zinc oxide, and two milligrams of copper as cupric oxide) may delay or prevent intermediate age-related macular degeneration from progressing to the advanced stage. The antioxidant vitamins and minerals in the AREDS formula help maintain healthy cells and tissues and may prevent damage in the macula. There is no evidence, however, that the AREDS formula provided any benefit to people with early stage age-related macular degeneration. Patients with intermediate macular degeneration in one or both eyes or advanced macular degeneration (dry or wet) in one eye but not the other eye should consider taking the formula. Always consult a doctor before taking any supplements. The AREDS formula may be contra-indicated due to other medical conditions or other medications.

The NEI is conducting the AREDS-2 clinical trials focused on the addition of lutein, zeaxanthin, and omega-3 fatty acids to the original AREDS formula. Researchers are interested in the effect these supplements have on the progression to advanced age-related macular degeneration and/or moderate vision loss in those at risk of progression. Participants will also be offered variations on levels of beta-carotene and zinc that were included in the original AREDS formula. The reasons for this adjustment is that the zinc was thought to cause genitourinary problems that required hospitalization in a small percentage of the original AREDS trial participants, and beta-carotene supplementation is not recommended for consumption by smokers or ex-smokers due to the increased risk of lung cancer. The estimated AREDS-2 trial data collection and primary outcome measure completion date is December 2012. Scientists will follow up with trial participants for at least five years.

There are a great many resources available to people with low vision and their caregivers. For instance, every state has an agency on aging. You may find it in the phone book, online, or with the help of a librarian or friend. Professional low-vision therapists at eye clinics or other organizations can assist you. Let your eye doctor know what kind of limitations you are experiencing due to vision loss. He or she can then refer you to a vision rehabilitation center, where a low-vision therapist can work with you to help you adapt and resolve specific problems.

You can also modify your environment, use low-vision aids, develop your senses of hearing and touch, and practice using peripheral vision. Your doctor can prescribe optical devices such as magnifiers. Many non-prescription magnifying glasses and devices are also available to assist with reading and other close work, such as sewing or model-building. These devices range from the simple and inexpensive to more expensive high-tech products that can aid in using computers and watching television.

Many styles of magnifiers, including discreet ones, can be found at drug and medical supply stores, or may be ordered online or by phone through low-vision product catalogs. A hand-held magnifying glass can help with reading medicine bottle labels, mail, price tags in stores, and restaurant menus. Other magnifiers come in the form of eyeglasses or clip onto glasses to free your hands for other activities.

Commonly used household items with large numbers and letters, and others that “talk,” are also available. There are many sources for large-print books and audio materials, as well as services that read newspapers and magazines by phone or over the radio.

Electronic reading aids are proliferating, such as: computer programs that magnify the computer screen and/or read screen text out loud; special scanners to carry while shopping that read out prices, sizes, and colors; web browser plug-ins; and smartphone applications. One specialized device can take pictures of signs or menus and read the words in the pictures aloud.

To discover any changes to your vision as early as possible, your eye care professional will probably have you test your own vision on a regular schedule using a small, hand-held Amsler grid.  He or she may also do this at the office. At home, you will hold the chart at reading distance in good light, cover one eye, and focus on a black dot in the middle of the grid, then repeat with the other eye. If the lines of the grid appear dim, irregular, wavy, or fuzzy, you should schedule an eye exam immediately.

You can download an Amsler grid at www.ahaf.org/amsler.

• More light is needed for tasks such as reading
• A blurry spot appears in the center of the visual field
• A blurry spot becomes larger and darker
• Straight lines may appear wavy
• Straight-ahead vision becomes distorted or lost entirely in a short period of time

• Do I have wet macular degeneration or dry?
• Do I have it in one eye or both eyes?
• What stage of the disease do I have?
• How often should I come in for check-ups?
• What is the Amsler grid and how often should I perform a test with it at home?
• Are there things that I can do to delay disease progression?
• What are the current treatments for macular degeneration?
• Are there lifestyle changes that I should make?
• Should I alter my diet?
• Do my current medications affect disease progression?
• Should I begin to take vitamin supplements?
• Will vitamin supplementation interfere with medications, or vice versa?
• Are there any experimental treatments for macular degeneration?

It is possible to develop AMD in only one eye. However, as the disease progresses both eyes may become affected. If an individual has macular degeneration in one eye, he or she is more likely to develop it in the other eye than someone who does not.

There are two forms of AMD: dry and wet. It is possible for a person to suffer from both forms and for the disease to progress slowly or rapidly.

Dry macular degeneration is the most common type of AMD. This form, in which the photosensitive cells of the macula slowly break down, is diagnosed in 85 to 90 percent of cases. Yellow deposits called drusen (waste products from metabolism) form and accumulate under the retina, between the retinal pigmented epithelium (RPE) layer and the Bruch's membrane, the blood-retina barrier which supports the retina. Drusen are often found in the eyes of older people, but an increase in the size and number of these deposits is frequently the first sign of macular degeneration. Over time, drusen are associated with deterioration of the macula and the death of RPE and photoreceptor cells, resulting in blurring or a spotty loss of clear, straight-ahead vision.

Dry AMD may advance and cause loss of vision without turning into the wet form of the disease. It is also possible for early-stage dry AMD to change into the wet form of the disease.

Wet macular degeneration is usually preceded by the dry form of the disease. This wet form occurs when the Bruch's membrane begins to break down, usually near drusen deposits, and new blood vessels grow. This growth is called neovascularization. These vessels are very fragile and can leak fluid and blood, resulting in scarring of the macula and the potential for rapid, severe damage. The neovascularization disturbs the natural organization of the light-detecting photoreceptor cells and their associated RPE cells, eventually leading to their death. Straight-ahead vision can become distorted or be lost entirely in a short period of time, sometimes within days or weeks. The wet form accounts for approximately 10 percent of all cases of AMD, but it results in 90 percent of the cases of legal blindness. All wet AMD is considered advanced.

The AHAF Macular Degeneration Research website goes into greater depth on many of the above topics and covers additional areas of concern, both medical and social. You can learn where to get help and access to resources, as well as download free publications. And explore our Ask an Expert section where you can read or post queries to doctors.

Visit www.childrenscorner.org for information for all members of the family, with stories, games, and other interactive learning tools.

For more information dealing with the topics below, please visit the helpful organizations section of our website. 

• Clinical Trials
• Organizations of Eye-care Professionals
• Federal Government Programs and Services
• General Information, Resources and Referrals
• Legal Assistance
• Low Vision Aid Resources
• Low Vision Organizations
• Print and Audio Materials for the Visually Impaired
• Senior Housing
• State and Local Resources