Amsler Grid Chart

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What is Macular Degeneration?

Age-related macular degeneration (AMD) refers to an eye disease that can make your central vision blurry. You can develop it as you age due to macular damage — the area of the eye responsible for sharp, central vision. The macula forms part of the retina where light-sensitive tissue lies.

AMD is a condition that affects many older adults, being the leading cause of vision loss. While AMD will not result in complete blindness, you can lose your central vision. Partial loss of this field of vision could make it more challenging to distinguish faces, read, drive, or do close-up work like cooking or fixing items around the house. 

The severity of AMD can vary from one person to the next. This means that it may develop slowly or fast. If you experience early AMD, you may not even be aware of vision loss for a long time. Because of this, you should undergo regular eye exams to determine if you have this eye condition. 

There are two types of macular degeneration: dry and wet. Dry macular degeneration is more common in people who are 50 years of age or older.

What Causes Macular Degeneration?

AMD is a complex disease. Researchers and doctors still do not know the exact cause of AMD. Some believe that genetic components and environmental factors play a role in your susceptibility to the eye condition. 

The following list details risks for AMD:

  • Age. Aging is a significant risk factor. The majority of AMD cases happen in people over the age of 50. 
  • Family history. There are specific genes related to AMD onset.
  • Race. Caucasian people face an increased risk of AMD. 
  • Smoking. Smoking or exposure to secondhand smoke raises your likelihood of developing AMD.
  • Unhealthy diet. Research suggests that obesity and unhealthy diets may amplify disease severity.
  • Cardiovascular disease. You could have a higher chance of developing the wet form of macular degeneration if you have health issues that involve your heart or blood vessels (e.g., high blood pressure or hypertension).

An estimated 1 in 20,000 children or teenagers will develop AMD, otherwise known as Stargardt disease. Although it is similar to AMD, researchers believe that genetics is the primary cause. 

What are the Symptoms of Macular Degeneration?

If you have macular degeneration, your symptoms may vary according to the disease stage. For example, dry AMD has three stages: early, intermediate, and late. Because AMD is progressive, symptoms will often get worse as time passes. 

Here are the primary symptoms of AMD:

  • People with early cases of dry AMD will not present with symptoms. 
  • Some people with intermediate dry AMD may still not present with symptoms. Others may experience mild blurriness in central vision or have trouble seeing in low-lighting settings.
  • In late AMD (wet or dry type), straight lines appear wavy or crooked. If you are in this stage of the disease, you could also observe a blurry area near the center of your vision. As time progresses, this blurry area could increase in size, or blank spots may appear. You may also notice that colors become dimmer and vision in low-lighting settings weaker.

Macular degeneration takes the lead in the main causes of vision loss, affecting more than 10 million Americans. 

How to Test for Macular Degeneration

If you believe you have AMD, you should visit your local eye clinic and speak with an eye doctor. You will undergo a comprehensive eye examination, including various tests, to rule out or diagnose the condition.

Different testing approaches include:

  • Amsler Grid
  • Retinal examination
  • Fluorescein angiography
  • Optical coherence tomography

What is an Amsler Grid Test?

The Amsler grid test is one of the many standard tools used to perform a diagnosis. The grid consists of a single square composed of a grid pattern and a dot in the middle. The test helps identify problem spots in your field of vision.

You can perform the test at home or in your local eye clinic.  

AmslerGrid

How to Use an Amsler Grid Test

If you want to use the Amsler grid test correctly, follow these steps once a day, every day:

  • Put on your regular reading glasses if you have them. Hold the grid at an approximate distance of 12 to 15 inches away from your face in good light.
  • Then, cover your left eye.
  • With your right eye only (uncovered), look right at the dot in the middle and lock your focus there. 
  • While staring at the center dot, pay attention if all of the grid lines in your peripheral (side) vision appear straight. If you have any lines or areas that look blurry, wavy, dark, or blank, you should speak with your eye doctor. This could indicate that you have AMD.
  • After you have done one eye, switch and perform the same tasks with the other eye. 

What Does the Amsler Chart Look Like if You Have Macular Degeneration? 

A person with AMD will not see the Amsler grid/chart the same way as a person without eye condition. If you have AMD, the grid could appear to have wavy lines or blank sports. 

If this occurs, it is important to speak with an ophthalmologist immediately. Determining if you have AMD (and what stage of the disease) could help your eye doctor establish a treatment regimen immediately. 

How Effective is an Amsler Grid Chart for Testing Macular Degeneration? 

Current best practices will promote the use of an Amsler grid chart to test macular degeneration. However, according to a study, the sensitivity of Amsler Grid Charts can be less than 50%.3 This means that some individuals with macular degeneration may believe they do not have the condition when, in reality, they do.

However, despite this, the Amsler grid chart is a recommended tool to use. It is economical and can be performed at home daily. Until another adequate replacement comes about, the grid plus risk factors and other clinical history features could increase the probability of an accurate diagnosis. 

If you believe you have AMD, you should visit your eye doctor. You can undergo other tests to help establish a proper diagnosis and start treatment, if necessary. 

How to Treat Macular Degeneration

You cannot cure macular degeneration. It is a progressive disease. However, if you begin treatments and seek medical care, you can reduce symptom severity and slow disease progression. 

Disease type and stage will determine the kind of treatment you will receive. In general, though, your healthcare provider may consider the following therapeutic approaches:

  • Nutritional supplements: Clinical trials found that combining vitamin and mineral intake could slow the progression of dry AMD.2 AREDS supplements are vitamins C and E, lutein, zinc, copper, zeaxanthin, and beta carotene (this is not recommendable for smokers due to an increased risk of lung cancer). 
  • Antivascular endothelial growth factor (anti-VEGF): This is a treatment for wet AMD that includes blocking VEGF production, a protein that contributes to the creation of blood vessels. Your eye doctor will inject anti-VEGF into a numbed eye to delay or stop blood vessel development. Vision could improve as a result. 
  • Photodynamic therapy (PDT): A healthcare professional will use both an injectable light-sensitive drug and a laser to eliminate extra blood vessels in the eye. You may undergo a combination treatment with anti-VEGF.
Resources
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Age-Related Macular Degeneration: Symptoms & Treatment.Cleveland Clinic.

AREDS/AREDS2 Frequently Asked Questions.National Eye Institute, U.S. Department of Health and Human Services. 

Boyd, Kierstan. “What Is Macular Degeneration?American Academy of Ophthalmology, 14 June 2021.

Crossland, Michael, and Gary Rubin. “The Amsler Chart: Absence of Evidence Is Not Evidence of Absence.The British Journal of Ophthalmology, BMJ Group, Mar. 2007.

Dry Macular Degeneration.Mayo Clinic, Mayo Foundation for Medical Education and Research, 8 May 2021.

Have AMD? Save Your Sight with an Amsler Grid.American Academy of Ophthalmology, 26 May 2020.

Macular Degeneration.” AOA.org.

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