Diagnosed with Age-Related Macular Degeneration? Here’s What You Should Know

Lopez explains there are three stages of AMD: early, intermediate, and advanced. Within advanced, there are two categories: wet and dry.

Wet AMD is a type of advanced AMD where abnormal blood vessels grow underneath or into the retina. These vessels can leak, causing fluid and blood to build up in the retina and lead to potential sudden vision changes or distortion in vision.

Dry AMD is more common, and there is no abnormal blood vessel growth or fluid/blood leakage in the retina. Patients with an early stage of dry AMD may not experience any symptoms, Lopez explains. These cases are typically detected during a routine eye exam by the eye specialist noticing the presence of drusen.

“As we age, deposits called drusen accumulate underneath the retina. Over time, these can damage the retinal cells and supporting tissues,” Lopez says. “In early AMD, we see a few drusen but usually no vision changes. In intermediate, there are larger drusen and some people may start to notice difficulty with low light vision.”

As AMD becomes more advanced, symptoms may include distortion in the central vision, difficulty seeing in dim conditions, and decreased contrast sensitivity. Geographic atrophy is the most advanced form of dry AMD, and it is characterized by permanent central vision loss.

Because AMD is a progressive disease, anyone with an early stage of dry AMD could eventually develop advanced dry or wet AMD, Lopez explains.

Lopez recommends patients with AMD get an exam every six months.

“It’s very important. Sometimes, we can see changes in the retina that the patient may not notice,” she says. “It’s also helpful because we know of newer medications and clinical trials that patients may qualify for.”

Patients should also be monitoring their symptoms at home. Lopez recommends daily use of an Amsler grid, a tool that helps assess a person’s field of vision.

“I’ll ask patients to put the grid on their fridge so they remember to do it daily. You cover one eye at a time, look at the lines on the grid, and assess how distorted your vision is and if there are any black spots,” she says. “I always tell patients that if they notice any big changes, give us a call so we can evaluate them sooner.”

AMD does not typically put a patient at risk for other eye diseases, Lopez says. However, advanced AMD can be associated with an increased risk of depression and loss of independence.

If it appears that a patient may be developing a cataract (a condition that predominantly affects older adults and can cause cloudy and blurry vision), Lopez will proactively send them for evaluation sooner than she otherwise would to ensure they have as much visibility in their eyes as possible.

Yes. AMD is affected by aging, genetics, and environment, Lopez explains. People with a first-degree relative who has AMD (such as their biological mother or father) will face a higher risk of developing AMD themselves. For those individuals, Lopez recommends they continue to get annual eye exams to monitor their ocular health.

Other factors can influence the risk of developing AMD. Research shows AMD is more common in white people, and smoking significantly increases the risk of development and progression of AMD, she notes.

In general, Lopez encourages patients who smoke to stop immediately. Some studies also suggest that eating a Mediterranean-style diet, with leafy greens and fish, may help.

For patients with an intermediate stage of dry AMD, Lopez recommends they take AREDS 2 supplements, because studies show that these supplements may slow or decrease the progression of AMD. These supplements are available over the counter.

Current treatment options are mostly limited to patients with advanced AMD, Lopez explains.

Patients with wet AMD are typically treated with intravitreal anti-vascular endothelial growth factor injections, which aim to stop abnormal blood vessel growth and reduce fluid leakage. Ophthalmologists like Lopez will give patients anesthetic drops in their eyes before then injecting the medicine into the eyeball with a needle.

“Once we see that a patient has converted to the wet form of macular degeneration, we'll start injections every four weeks or so,” she says. “If the patient’s fluid in their retina resolves, then we’ll extend the amount of time between injections to six weeks, then eight weeks, and so on.”

“The goal is to extend the time between injections as much as we safely can,” she adds. “There are a lot of different medications that we can use depending on the patient’s response to the medication as well.”

There are a few new drugs available to treat geographic atrophy, Lopez explains. The drugs Syfovre and Izervay are intravitreal complement inhibitors that are approved by the Food and Drug Administration to slow down disease progression. These drugs are typically injected every other month.

“I tell patients that these drugs won’t reverse anything or bring vision back, but it potentially will slow down progression. There are risks associated with them, so I discuss with each patient whether this is a good fit,” Lopez says.

One of the most common concerns patients bring up to Lopez is what they can expect for the future.

“I always tell patients that I can’t predict how quickly the condition will progress, because it’s different for every person,” Lopez says.

This condition typically affects central vision, potentially limiting a person’s ability to do tasks like reading or driving. However, even when AMD is advanced, the patient’s peripheral vision should remain intact if they do not have any other eye conditions, she explains.

“It can be helpful for patients to ask their retina specialist what changes they have seen over time, because their observations may help indicate how quickly the disease is progressing,” Lopez says.

In addition to their regular eye specialist, such as an optometrist, Lopez recommends patients work with a retina specialist like herself to help manage the condition. Patients may also work with low vision specialists to adapt to vision changes.

For patients who are dealing with vision loss, Lopez will refer them to the low vision rehabilitation team at CU Anschutz. She says these specialists are great at helping patients cope with the vision they have and learn how to use assistive devices. These tools may include optical devices such as telescopic glasses or magnification tools, or non-optical tools such as cutting boards or measuring cups designed specifically for people with low vision.

Patients will also be connected to other resources, such as transportation or mental health resources, when appropriate. Caretakers of people with AMD are also important, Lopez notes, especially if a patient’s vision has changed to the point that they can no longer drive or do other daily tasks on their own.

“Adapting to life with AMD can be hard, so supporting these patients in any way where they can still feel like they are able to do things on their own is helpful, especially for mental health,” Lopez says.