In the United States nearly 19 million adults over the age of 50 have some form of macular degeneration, with almost 1.5 million of them with vision-threatening disease[1]. The high prevalence of this condition makes it one of the leading causes of vision loss and blindness as we get older. Most adults will have a friend or a family member who has macular degeneration.
Because of how common macular degeneration is and the consequences of advanced disease, including vision loss, we see and hear advertisements on television, radio ads, on the internet and in social media talking about it.
For you or for a friend or loved one, navigating all the information can be difficult. Let’s address some of the biggest questions I receive from my patients and their family members and make some sense of it all.
My grandmother has macular degeneration – am I going to get it?
Not necessarily. That might offer some comfort to some. Though it is true that macular degeneration can run in families, it is not a guarantee that you will develop it. The inheritability of macular degeneration does not follow simple dominant and recessive genes, like some of our other more common physical traits.
The most common risk factors[2] for developing macular degeneration include:
- Age – generally, the older we are the more likely we are to develop macular degeneration
- Family history – Having a direct relative (parents, siblings) with macular degeneration increases our risks and that we may have a genetic component as a factor. Additionally, people with light colored eyes (blue) and those of Northern European descent have a higher prevalence
- Smoking – a history of smoking in our past for more than 10 years is an independent risk factor for developing macular degeneration. That means that even if we quit decades ago, and even if we don’t have any family history, our risk of developing macular degeneration is higher than if we had never smoked.
Other secondary risk factors can include a fatty diet, sedentary lifestyle, obesity, and high levels of UV light exposure, among others, but their influences are comparatively minor. Of the major risk factors, the only modifiable risk factor is smoking, so if you do smoke you can add macular degeneration to the list of motivations to help you quit. Additionally, keeping your health as good as you can with a good diet (more to come on that later) and exercise can be protective.
What is the macula exactly, and why is it so important?
The macula represents the center of the retina – the light-sensitive tissue deep inside the eye behind our pupils. The retina is like very fine wallpaper made of rods and cones (photoreceptors) inside the eye which lines the inner wall and reacts to light. The very center of the retina in a line behind our pupil contains a very high number and concentration of these special photoreceptor cells to allow for our high-detailed central vision. This area of high concentration is the “macula”.[3]
Because the macula has so many tightly packed photoreceptors and is centered behind the pupil of our eye it is responsible for the center of our vision – the same vision we use to see things clearing and in high detail. A healthy macula is critical to allow us to read, drive safely, and recognize faces.
A macula which is not healthy for any reason can have significant trouble seeing. Untreated, such a sick macula can experience irreversible damage which will permanently affect our vision.
I have macular degeneration – will I go blind?
With rare exception, nearly no one goes black-out blind or completely loses all their vision from macular degeneration. Blindness from macular degeneration is a legal term which describes the amount of visual impairment caused by macular degeneration. If your macular degeneration advances enough to cause your vision to be worse than 20/200 vision[4], then the eye may be considered “blind” even though your peripheral and side vision is completely unaffected. Oftentimes, even in the most advanced cases the central vision may be lost but one can still see enough to know who is in the room, where the furniture is, and what color of clothes they are wearing. But, because the central vision is so poor you may not be able to see well enough to read, may no longer drive if both eyes are affected, or have a hard time seeing faces.
Most people who have mild or even intermediate levels of macular degeneration may not have any significant visual impairment at all. And with careful monitoring and management, and appropriate steps, we may be able to hold on to that vision for a long time.
Okay, then, so what should I do?
Some of what can be done depends on what type of macular degeneration you have and how far along it is. Two broad categories of macular degeneration exist: 1) “dry”; and, 2) “wet”. Both “dry” and “wet” macular degeneration are used as descriptors for the activity level of the macular degeneration and not separate diseases.
Dry macular degeneration is most common and affects approximately 90% of all people with macular degeneration. This is represented as a premature breakdown and wearing away of normal healthy macular tissue. As the macula breaks down, small deposits called “drusen” may be seen along with changes to the normal pigmented layers (called the “RPE” – retina pigment epithelium). In dry macular degeneration these deposits and RPE changes accumulate over time and may affect the function of the macula and the clarity and brightness of vision. These changes may be categorized as early, intermediate or advanced levels. Most of the threat to vision with dry macular degeneration is realized in the advanced stages when the macula can atrophy and scar – it completely wears out. Generally the progression of macular degeneration from early to advanced takes years and there is no guarantee that someone with dry macular degeneration ever gets to an advanced stage.
Wet macular degeneration can include all of the same changes as dry macular degeneration but will have an additional component: the presence of blood or the accumulation of fluid in the macula. Wet macular degeneration affects about 10% of all those with macular degeneration, so it is less common, though vision changes can happen much more quickly, even over a day or two! Wet macular degeneration most typically develops as a consequence of having dry macular degeneration first, though it is possible that someone can develop wet macular degeneration without knowing that they had macular degeneration beforehand.
Whether you have wet or dry macular degeneration the key is early detection and careful monitoring with regular eye examinations. Your eye care professional may recommend seeing an ophthalmologist who specializes in retina care, like me, at Twin Cities Eye Consultants (TCEC).
I recommend taking eye vitamins for those who have at least intermediate levels of dry macular degeneration. A multi-center nationwide study looking at the causes and progression of macular degeneration called the “Age-related Eye Disease Study” (AREDS)[5] found that regular supplementation of vitamins can help reduce the rate of worsening of macular degeneration and reduce the risk of development of wet macular degeneration. These are the popular AREDS-2 multivitamin formula supplements.
If you have advanced dry macular degeneration or if you develop wet macular degeneration regular treatment may reduce your risk of vision loss and help preserve your vision for as long as possible. These treatments include injections of different medications into the eye to prevent or slow down the scarring and atrophy of advanced dry macular degeneration[6] or to reduce swelling and fluid in the macula if it is wet macular degeneration[7]. They can be delivered in the office in a quick, safe and gentle manner with little to no discomfort.
New research and innovation is driving change in care for macular degeneration and future treatments may include implants, new oral medications, new longer-lasting injectable medications, or light therapy treatments. Luckily, here at TCEC we utilize all the currently available treatments and we are participating in development of new treatments as a study site for investigational medications.
These treatments work best when started as soon as they are needed. If you or a friend or loved one would like to learn more or to consult with me – please contact our office and set up a visit. I’d love to be able to help!
Works Cited:
[1] https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2797921#:~:text=Findings%20In%20this%20study%2C%20we,ethnicity%2C%20county%2C%20and%20state
[2] https://pubmed.ncbi.nlm.nih.gov/27125062/
See also: https://www.ncbi.nlm.nih.gov/books/NBK536467/
[3] https://www.brightfocus.org/resource/function-of-the-normal-macula/#:~:text=How%20much%20do%20you%20know,of%20sight%2C%20including%20fine%20details
[4] https://www.ssa.gov/OP_Home/ssact/title16b/1614.htm
[5] https://jamanetwork.com/journals/jama/fullarticle/1684847
[6] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01520-9/abstract
[7] https://www.macularsociety.org/diagnosis-treatment/treatments/#:~:text=Vabysmo%20(Faricimab)%20is%20the%20most,or%2016%20weeks%20between%20injections
