Understanding age-related macular degeneration

Age-related macular degeneration is most common in adults over age 65.
Age-related macular degeneration is most common in adults over age 65.

Part of our training as clinicians is to understand the importance of eye health, especially in aging adults. One important eye disease that we need to be able to recognize is age-related macular degeneration (AMD), as it can result in vision loss. It is most common in adults over the age of 65.

AMD is further characterized as either dry AMD and wet AMD. Dry AMD is the most common, affecting 85% to 90% of patients with AMD. These patients lose their vision slowly over time. Wet AMD can cause more severe vision loss and blindness, so differentiating between the 2 is important. Some patients start with dry AMD and later develop wet AMD.

Testing for AMD includes a dilated eye exam, fluorescein angiography, and optical coherence tomography (OCT). The retina is examined for abnormal blood vessels and signs of drusen, which are seen in patients with AMD. Patients also examine an Amsler grid, which looks like a piece of graph paper. Patients with wet AMD see the lines as wavy or bent.

Both types of AMD are treated with a combination of vitamins and minerals called the AREDS (Age Related Eye Disease Study) or AREDS2 formula. This formula includes high doses of vitamin A, vitamin C, beta-carotene, and zinc, which have been found to be helpful to patients with macular degeneration. Smokers are encouraged to stop smoking as smoking increases the risk of AMD; quitting can actually slow the progression of the disease.

Treatments for patients with wet AMD include vascular endothelial growth factor (VEGF) inhibitors, photodynamic therapy, and laser surgery. Research is also looking into using stem cell therapy, but this is still in a preliminary phase. Surgical options are also being explored.

Most importantly, encourage your older patients to get regular eye exams. The earlier treatment can be initiated for AMD, the better. 

Sharon M. O'Brien, MPAS, PA-C, is a practicing physician assistant and health coach in Asheville, N.C.

Reference

  1. Arroyo JG. Age-related macular generation: Treatment and prevention. Up to Date website. http://www.uptodate.com/contents/age-related-macular-degeneration-treatment-and-prevention. Updated March 2, 2016. Accessed March 31, 2016.
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