Macular degeneration is a painless, degenerative eye disease that affects more than 10 million Americans. It is the leading cause of legal blindness in persons over the age of 55 in the United States. While complete blindness does not occur in most people with the disorder, macular degeneration often interferes with reading, driving, or performing other daily activities.
There are two forms of macular degeneration. Dry macular degeneration affects about 90% of those with the disease and causes gradual loss of central vision, initially only in one eye. Wet macular degeneration, which accounts for 90% of all severe vision loss from the disease, involves a very sudden loss of central vision.
Signs and SymptomsMacular degeneration is accompanied by the following signs and symptoms:
- Slightly blurred vision
- Dry type: a blurred spot in the central field of vision, which may become larger and darker
- Wet type: straight lines that appear wavy and the rapid loss of central vision; sometimes, wet macular degeneration starts with a sudden blind spot
What Causes It?Dry macular degeneration occurs from the breakdown of the light sensitive cells in the center of the retina, called the macula. Wet macular degeneration occurs when new blood vessels behind the retina grow toward the macula and leak blood and fluid.
Who's Most At Risk?People with the following conditions or characteristics are at risk for developing macular degeneration:
- Age—the risk increases with age
- Cigarette smoking
- Family history of macular degeneration
- Cardiovascular disease
- Elevated levels of cholesterol
- Light eye color
- Excessive exposure to sunlight
What to Expect at Your Provider's OfficeYour eye care professional can detect macular degeneration during an eye examination that includes the following:
- Testing with an eye chart to measure your ability to see at various distances.
- Pupil dilation—drops are placed in your eyes to widen the pupils and reveal more of the retina.
- Checking for presence of drusen (tiny yellow deposits in the retina).
- Testing with Amsler's grid, which involves covering one eye and staring at a black dot in the center of a checkerboard-like grid. If the straight lines in the pattern appear wavy or some of the lines appear to be missing, these may be signs of wet macular degeneration.
- Fluorescein angiography—a special dye is injected into a vein in the arm and pictures are taken as the dye passes through the blood vessels in the retina.
PreventionIf you have wet macular degeneration, you will test your eyes daily at home using an Amsler's grid. You should report any distortion immediately to reduce the risk of vision loss. Other preventive measures include increasing your dietary intake of flavonoids and carotenoids (see section on Nutrition), using ultraviolet eye protection, estrogen replacement therapy, and moderate red wine consumption.
Treatment PlanThere is no known cure for macular degneration; however, there are procedures that can help slow vision loss.
Drug TherapiesYour provider may prescribe the following medications:
- Tissue plasminogen activator (tPA)
- Thalidomide (an investigational therapy)
Surgical and Other ProceduresSurgical and other procedures may be beneficial for some cases of wet macular degeneration.
- Laser surgery — a high-energy beam of light is aimed directly at the leaking blood vessels to seal them off
- Photodynamic therapy — photosensitized tissue is irradiated with a low-powered laser light
- Vitrectomy — removes newly formed blood vessels and blood underneath the retina if performed within 7 days of bleeding
Complementary and Alternative TherapiesNutrition is a valuable treatment for dry macular degeneration. It may also help prevent both wet and dry types related to aging.
Antioxidants that protect your retina—such as carotenoids, selenium, zinc, and vitamins C and E—may either delay the progression of macular degeneration if you already have the eye condition (meaning that your vision won't get worse as quickly) or prevent the development of this serious eye disorder. Two particular carotenoids, lutein and zeaxanthin, may be particularly beneficial. Antioxidants can be obtained from foods or supplements.
Eating a diet high in vitamins C and E and carotenoids is likely all that you need to lower your chances of developing macular degeneration in the first place. (In other words, supplements are probably not necessary for prevention.) Vegetables rich in carotene include orange and yellow squash, and dark, leafy greens, such as kale, collards, spinach, and watercress.
If you already have macular degeneration, especially if it is somewhat advanced, and you decide, with the advice of your healthcare provider, to take supplements, the following are some suggested amounts of key nutrients:
- Mixed carotenoids, 25,000 to 50,000 International Units (IU) a day
- The carotenoid lutein, 5 milligrams (mg) a day
- Selenium, 200 to 500 micrograms (mcg) a day
- Zinc, up to 50 mg a day
- Vitamin C, 60 to 2000 mg a day in divided doses; doses over 1000 mg a day may cause gastrointestinal problems, including nausea and diarrhea
- Vitamin E, 50 to 1000 IU a day (usually 400 to 800 IU a day)
Omega-3 fatty acids may also offer some protection against macular degeneration. In a study of more than 3000 people over the age of 49, those who consumed more fish in their diet were less likely to have macular degeneration than those who consumed less fish. (Most types of fish are rich in omega-3 fatty acids). Similarly, a study comparing 350 people with macular degeneration to 500 without found that those with a proper ratio of omega-3 to omega-6 fatty acids and higher intake of fish in their diets were less likely to have this particular eye disorder. Another larger study found that consuming docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), two types of omega-3 fatty acids found in fish, four or more times per week may reduce the risk of developing macular degeneration. Notably, however, this same study suggests that alpha-linolenic acid (ALA; another type of omega-3 fatty acid) may actually increase the risk of this eye condition.
Ginkgo (Ginkgo biloba), which contains flavonoids, may help halt or lessen some retinal problems. Clinical studies suggest that it may be useful in treating vision problems specifically due to macular degeneration. If you use anticoagulants, do not use ginkgo without close monitoring by your healthcare provider.
Bilberry (Vaccinium myrtillus) and grape seed (Vitis vinifera) are also high in flavonoids; therefore, they may help prevent and treat macular degeneration. Clinical studies suggest that these herbs may stop vision loss and improve visual sharpness. Here are the recommended doses:
- Ginkgo standardized to 24%, 120 mg once or twice a day
- Bilberry extract standardized to 25%, 120 to 240 mg twice a day
- Grape seed, 50 to 150 mg once or twice a day
Although scientific research does not necessarily support the use of homeopathy to treat or prevent macular degeneration specifically, an experienced homeopath would consider your individual case to decide whether treatment may be beneficial for you.
Studies on acupuncture and macular degeneration have been mixed. In a study of 51 patients with macular problems, researchers found little change in visual sharpness or other symptoms after 12 acupuncture treatments. Another study showed a connection between low blood flow to the head and macular degeneration. Restoring normal blood pressure with acupuncture improved vision.
Prognosis/Possible ComplicationsBlindness is a possible outcome of macular degeneration. Low vision aids may help if you have partial blindness. Sometimes blood vessels build up underneath the retina, causing the retina to become detached or scarred. If this happens, the chances of preserving your central vision are poor. This condition, called subretinal neovascularization, occurs in about 20% of cases of age-related macular degeneration. The condition will likely recur even after laser treatment.
Following UpYour healthcare provider will see you regularly to monitor your vision and eye health.
Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Arch Ophthalmol. 2001;119(10):1417-1436.
Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 9. Arch Ophthalmol. 2001;119(10):1439-1452.
Ames BN. Micronutrient deficiencies: A major cause of DNA damage. Ann NY Acad Sci. 2000;889:87-106.
Ausman LM. Criteria and recommendations for vitamin C intake. Nutr Rev. 1999;57(7):222-229.
Belda JI, Roma J, Vilela C, Puertas FJ, Diaz-Llopis M, Bosch-Morell F, et al. Serum vitamin E levels negatively correlate with severity of age-related macular degeneration. Mech Ageing Dev. 1999;107(2):159-164.
Bupropion. NMIHI. Accessed at http://www.nmihi.com/b/bupropion.html on January 18, 2018.
Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Newton, Mass: Integrative Medicine Communications; 1998:494.
Bone RA, Landrum JT, Guerra LH, Ruiz CA. Lutein and zeaxanthin dietary supplements raise macular pigment density and serum concentrations of these carotenoids in humans. J Nutr. 2003;133(4):992-998.
Brown NA, Bron AJ, Harding JJ, Dewar HM. Nutrition supplements and the eye. Eye. 1998;12(Pt 1):127-133.
Cai J, Nelson KC, Wu M, Sternberg P Jr, Jones DP. Oxidative damage and protection of the RPE. Prog Retin Eye Res. 2000;19(2):205-221.
Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69:1086-1107.
Chang CW, Chu G, Hinz BJ, Greve MD. Current use of dietary supplementation in patients with age-related macular degeneration. Can J Opthalmol. 2003;38(1):27-32.
Cho E, Hung S, Willet WC, et al. Prospective study of dietary fat and the risk of age-related macular degeneration. Am J Clin Nutr. 2001;73(2):209-218.
Christen WG, Ajani UA, Glynn RJ, Manson JE, Schaumberg DA, Chew EC, et al. Prospective cohort study of antioxidant vitamin supplement use and the risk of age-related maculopathy. Am J Epidemiol. 1999;149(5):476-484.
Clostre F. Ginkgo biloba extract (EGb 761). State of knowledge in the dawn of the year 2000 [in French]. Ann Pharm Fr. 1999;57(suppl 1):1S8-S88.
Complications of Age-related Macular Degeneration Prevention Trial (CAPT): ongoing study of the effects of low-intensity laser treatment for ARMD. National Eye Institute. Accessed at www.med.upenn.edu/ophth/research/CAPT.html on July 25, 2000.
Congdon NG, West KP. Nutrition and the eye. Curr Opin Opthalmol. 1999;10:464-473.
Cooper DA, Eldridge AL, Peters JC. Dietary carotenoids and certain cancers, heart disease, and age-related macular degeneration: a review of recent research. Nutr Rev. 1999;57(7):201-214.
Dambro MR, ed. Griffith's 5 Minute Clinical Consult. Baltimore, Md: Lippincott Williams & Wilkins; 1999.
Diamond BJ, Shiflett SC, Feiwell N, Matheis RJ, Noskin O, Richards JA, et al. Ginkgo biloba extract: mechanisms and clinical indications. Arch Phys Med Rehabil. 2000;81(5):668-678.
Evans JR. Antioxidant vitamin and mineral supplements for age-related macular degeneration. Cochrane Database Syst Rev. 2002;(20:CD000254.
Escitalopram. NMIHI. Accessed at http://www.nmihi.com/e/escitalopram.html on January 8, 2018.
Falsini B, Piccardi M, Iarossi G, Fadda A, Merendino E, Valentini P. Influence of short-term antioxidant supplementation on macular function in age-related maculopathy: a pilot study including electrophysiologic assessment. Ophthalmology. 2003;110(1):51-60;discussion 61.
Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.
Fies P, Dienel A. [Ginkgo extract in impaired vision – treatment with special extract Egb 761 of impaired vision due to dry senile macular degeneration]. Wiedn Med Wochenschr. 2002;152(15-16):423-426.
Flood V, Smith W, Wang JJ, Manzi F, Webb K, Mitchell P. Dietary antioxidant intake and incidence of early age-related maculopathy: the Blue Mountains Eye Study. Ophthalmology. 2002;109(12):2272-2278.
Goroll AH, ed. Primary Care Medicine. 3rd ed. Philadelphia, Pa: Lippincott-Raven Publishers; 1995.
Hambridge M. Human zinc deficiency. J Nutr. 2000;130(5S suppl):1344S-1349S.
Head KA. Natural therapies for ocular disorders. Part 1: Diseases of the retina. Altern Med Rev. 1999;4(5):342-359.
Heber D, Bowerman S. Applying science to changing dietary patterns. J Nutr. 2001;131(11 Suppl):3078-3081S.
Hyman L, Neborsky R. Risk factors for age-related macular degeneration: an update. Burr Opin Ophthalmol. 2002;13(3):171-175.
Jacques PF. The potential preventive effects of vitamins for cataract and age-related macular degeneration. Int J Vitam Nutr Res. 1999;69(3):198-205.
Kuzniarz M, Mitchell P, Flood VM, Wang JJ. Use of vitamin and zinc supplements and age-related maculopathy: the Blue Mountains Eye Study. Ophthalmic Epidemiol. 2002;9(4):283-295.
Landrum JT, Bone RA. Lutein, zeaxanthin, and the macular pigment. Arch Biochem Biophys. 2001;385(1):28-40.
Macular Degeneration. MedlinePlus. Accessed at https://medlineplus.gov/maculardegeneration.html on October 17, 2018.
Macular Degeneration. WebMD. Accessed at https://www.webmd.com/ on October 17, 2018.
McBee WL, Lindblad AS, Ferris III FL. Who should receive oral supplement treatment for age-related macular degeneration? Curr Opin Ophthalmol. 2003;14(3):159-162.
Miller JW, Schmidt-Erfurth U, Sickenberg M, Pournaras CJ. Photodynamic therapy with verteporfin for choroidal neovascularization caused by age-related macular degeneration. Arch Ophthalmol. 1999;117:1161-1173.
Murray MT, Pizzorno JE. Macular degeneration. In: Murray MT, Pizzorno JE, eds. Textbook of Natural Medicine. Vol 2. 2nd ed. New York, NY: Churchill Livingstone; 1999:1375.
Obisesan TO, Hirsch R, Kosoko O, Carlson L, Parrott M. Moderate wine consumption is associated with decreased odds of developing age-related macular degeneration in NHANES-1. J Am Geriatr Soc. 1998;46(1):1-7.
Omura Y. Non-invasive circulatory evaluation and electro-acupuncture TES treatment of diseases difficult to treat in Western medicine. Acupunct Electrother Res. 1983;8(3-4):177-256.
Pratt S. Dietary prevention of age-related macular degeneration. J Am Optom Assoc. 1999;70:39-47.
Seddon JM, Ajani UA, Sperduto RD, Hiller R, Blair N, Burton TC, et al. Dietary carotenoids, vitamins A, C, and E, and advanced age-related macular degeneration. JAMA. 1994;272:1413-1420.
Seddon JM, Rosner B, Sperduto RD, Yannuzzi L, Haller JA, Blair NP, Willett W. Dietary fat and risk for advanced age-related macular degeneration. Arch Opthalmol. 2001;119(8):1191-1199.
Segasothy M, Phillips PA. Vegetarian diet: panacea for modern lifestyle diseases? QJM. 1999;92(9):531-544.
Smith W, Mitchell P, Webb K, Leeder SR. Dietary antioxidants and age-related maculopathy: the Blue Mountains Eye Study. Ophthalmology. 1999;106(4):761-767.
Supplements may slow age-related macular degeneration. Mayo Clin Health Lett. 2002;20(3):4.
Supplements slow the course of macular degeneration. Harv Womens Health Watch. 2001;9(5):1-2.
Terbinafine. NMIHI. Accessed at http://www.nmihi.com/t/terbinafine.html on January 18, 2018.
VandenLangenberg GM, Mares-Perlman JA, Klein R, Klein BE, Brady WE, Palta M. Associations between antioxidant and zinc intake and the 5-year incidence of early age-related maculopathy in the Beaver Dam Eye Study. Am J Epidemiol. 1998;148(2):204-214.
West S, Vitale S, Hallfrisch J, Munoz B, Muller D, Bressler S, et al. Are antioxidants or supplements protective for age-related macular degeneration? Arch Ophthalmol. 1994;112(2):222-227.
Wong S, Ching R. The use of acupuncture in ophthalmology. Am J Chin Med. 1980;8(2):104-153.
What is age-related macular degeneration (AMD)? MedicalNews. Accessed at https://www.medicalnewstoday.com/ on January 18, 2018.