As you age, you might notice blurry spots or fuzzy vision. Dry age-related macular degeneration (dry AMD) is the most common cause of gradual central-vision loss in adults over 50 and affects millions around the world.
Fortunately, early detection and lifestyle changes can protect your central vision and preserve your independence. Plus, there are proven supplements and newly approved injections for geographic atrophy.
In this article, weāll go over what dry AMD is and what you can do to protect your eyesight.
How Does Dry Macular Degeneration Occur?
Dry AMD occurs in the macula, a small area of your retina that controls central vision, essential for tasks like reading, driving, and recognizing faces.
In dry AMD, tiny yellow deposits called drusen build up under your retina, between the retinal pigment epithelium (RPE) and Bruchās membrane. Drusen are normal with aging, but can become problematic when they grow larger or cluster.
These yellow deposits disrupt the nutrient flow to the retinal cells, triggering inflammation and damage that thin the RPE layer. Once the RPE cells are damaged, youāll start experiencing blind spots.
How Does it Progress?
This disease progresses through three main stages:
- Early AMD. Small drusen, resulting in minimal vision impact.
- Intermediate AMD. Larger drusen, resulting in slight vision distortion.
- Advanced dry AMD (Geographic Atrophy). Significant loss of central vision due to widespread cell death.
Geographic atrophy involves extensive thinning and loss of the retinal pigment epithelium and retinal cells, severely affecting your visual field.
Although less common, about 10 to 15% of people with dry AMD can sometimes progress to wet AMD, a more aggressive form where abnormal blood vessels leak fluid into the retina.
What Are the Symptoms of Dry Macular Degeneration?
The symptoms of dry AMD vary depending on what stage youāre at. For instance, early AMD usually doesnāt cause any symptoms.
Some people may still have no symptoms for intermediate AMD. However, others may notice mild blurriness in their central vision, while peripheral vision remains the same.
They may also have trouble seeing in low-light conditions. Finally, the symptoms of late-stage dry AMD include:
- Blurry spot in the center of the visual field
- Inability to see fine details
- Trouble seeing in low lightĀ
- Straight lines appear wavy or crooked
- Blind spots in vision
- Colors appear less bright than before
What Are the Potential Effects of Dry AMD?
The potential effects of dry AMD include:
- Straight lines appear wavy, or words fade while reading
- Blurry or missing central vision
- Difficulties in low-light environments
- Visual distortions or black spots
Call your eye doctor immediately if straight lines start to look wavy; this may indicate wet AMD. Those struggling with geographic atrophy may also begin seeing visual hallucinations.
Who is At Risk of Dry Macular Degeneration?
People over the age of 50 have the highest risk of developing dry AMD. However, other factors can increase your risk of developing this condition.
These include:
- Family history or high-risk genes (CFH, ARMS2)
- Smoking
- Uncontrolled blood pressure or high cholesterol
- Poor diet, low in leafy greens and omega-3s
- Excess sun exposure without UV-blocking eyewear
How to Diagnose and Monitor Dry AMD
Routine eye exams are crucial for diagnosing and managing dry AMD. Your ophthalmologist or optometrist will perform a comprehensive evaluation, including:
- Dilated fundus exam. It allows the doctor to visualize the drusen and signs of macular degeneration clearly.
- Optical Coherence Tomography (OCT). This painless imaging test captures detailed cross-sectional images of your retina, helping to track disease progression.
- Fundus photograph and autofluorescence imaging. These tests map the areas of geographic atrophy, enabling precise monitoring of disease changes.
You can also use an Amsler grid test to check for distortions or blurry spots. There are also apps designed for AMD patients to help them monitor visual changes.
How is Dry AMD Treated?
While dry AMD currently has no definitive cure, multiple treatment options exist that can help slow its progression, preserve your sight, and maintain your independence.
For example, AREDS2 supplements are specifically formulated with vitamins C and E, zinc oxide, cupric oxide, lutein, and zeaxanthin. They can significantly slow progression to advanced AMD in people with intermediate AMD.
Treatment Options for Wet AMD
Treatment is different for wet AMD because it involves the growth of abnormal blood vessels. Gold standard wet AMD treatments include:
- Anti-vascular endothelial growth factor (Anti-VEGF) medications. These are injected into the eye to reduce the growth of new blood vessels.
- Laser surgery. To reduce the number of abnormal blood vessels.
- Photodynamic therapy (PDT). A laser with dye to target abnormal blood vessels
Depending on disease progression, these treatments might be administered several times throughout a personās lifetime to help prevent further vision loss.
Treatments for Geographic Atrophy
Recent FDA-approved injections specifically target components of the immune system to slow disease progression. Syfovre treatment involves injections administered every 25 to 60 days.
Clinical trials showed it slowed geographic atrophy lesion growth by about 22% at 24 months. Meanwhile, Avacincaptad Pegol (Izervay) is a monthly injection that targets complement protein C5, reducing GA progression by around 14 to 18%.
It similarly poses a small risk of wet AMD conversion but has shown fewer inflammation-related issues.
Lifestyle Changes to Treat Dry AMD
A healthy lifestyle significantly impacts AMD progression. Adopting a diet rich in vitamins and minerals, particularly leafy greens, fruits, and fish, combined with regular exercise, can support retinal health.
Quitting smoking is also a crucial part of slowing the progression of AMD. Additionally, blue-blocking lenses help reduce harmful blue-light exposure, potentially protecting the retinal cells from oxidative stress.
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