What is AMD?
Age-related macular degeneration (AMD) is a chronic, progressive eye disease that causes loss of central vision. It affects the macula, the part of the eye that allows you to see fine detail. AMD can affect one or both eyes. It causes no pain, and it usually does not lead to total blindness. Some peripheral (side) vision usually remains.

There are two forms of AMD. Dry AMD is more common and has three stages: early, intermediate, and advanced. Wet AMD is considered advanced and can be more severe. Although there is no cure for AMD, early detection is important because treatments are available to slow the progression of the disease and, in some cases, even restore some lost vision.

What are the risk factors for AMD?
Scientists are still learning about the causes of AMD, but they have identified some important risk factors. As the name of the disease suggests, age is the most significant risk factor for AMD, which usually occurs in people age 55 and older. AMD is more prevalent among white people, and women appear to be at higher risk than men. Anyone who has a family history of AMD is also at greater risk of developing the disease.

Although you cannot control your age, sex, race, or family history, the following are risk factors you can control:

    Smoking — People who smoke tobacco are 2 to 3 times more likely to develop AMD than nonsmokers. The more you smoke, the greater the risk and the faster AMD will progress.
  • Obesity
  • High blood pressure
  • High cholesterol
  • Sun exposure —Excessive exposure of your eyes to sunlight, particularly ultraviolet (UV) light, is considered a risk factor for AMD.

What is the difference between dry and wet AMD?
Dry AMD occurs when the light-sensitive cells in the macula slowly break down. About 85% to 90% of people diagnosed with AMD have the dry form, which is less severe.

Wet AMD occurs when abnormal blood vessels behind the retina begin to grow under the macula. These new vessels tend to be fragile and often leak blood and fluid, which seep underneath and into the macula. This causes significant changes in central vision. About 10% to 15% of AMD patients have advanced or wet AMD.

Does AMD have symptoms?
Early AMD may not cause any noticeable symptoms. In the later stage of dry AMD, the most common symptom is blurred vision. People with dry AMD may have trouble recognizing faces and may need more light for reading and other close tasks.

An early symptom of wet AMD is that straight lines, such as doorways, appear crooked or faces appear wavy. Objects appear smaller or farther away than they are. People with wet AMD may also develop a blind spot in their central vision.

In some people, AMD advances slowly, but in others, it advances rapidly, severely limiting central vision so that only peripheral vision remains. If you have AMD, you must notify your doctor immediately if you notice a change in your central vision. This is also why regular eye examinations are important after age 50.

Can dry AMD turn into wet AMD?
Dry AMD can convert to wet AMD, but at this time, there is no way to predict if and when this will happen. This is another reason why early diagnosis is important so that your doctor can monitor your disease and start therapy when appropriate.

What tests can detect AMD?
Your doctor will perform a comprehensive eye examination, which includes measuring your visual acuity using a standard eye chart and examining the structures at the back of your eyes through your dilated pupils. Your doctor may show you a simple black-and-white graphic called an Amsler grid (see page 4). If the straight lines of the checkerboard pattern appear wavy, broken, or distorted, these may be signs of AMD.

Another test often used to diagnose and monitor AMD is optical coherence tomography (OCT). Using light, the OCT machine rapidly scans the eye to show a cross-section of the retina and its layers, giving your doctor more information about the structure of your eye.

If your doctor suspects AMD, he or she will likely order a fluorescein angiogram. In this test, a vegetablebased dye is injected into a vein in your arm. As the dye passes through the blood vessels in the retina, several pictures are taken. These photos help your doctor detect and evaluate leaking blood vessels.

Can dry AMD be treated?
No treatment is currently available for early-stage dry AMD. If you are diagnosed with dry AMD, your best defense is to minimize your risks (see “6 Things You Can Do to Reduce Your Risk of AMD” on page 2). Your doctor will likely recommend a comprehensive, dilated eye examination at least once a year to determine if your disease is advancing.

If dry AMD advances to the intermediate stage, your doctor may recommend that you take a dietary supplement that contains specific antioxidants and zinc. This supplement is commonly called the AREDS formulation because researchers working on the National Eye Institute's Age- Related Eye Disease Study (AREDS) learned that high doses of specific vitamins and minerals may slow AMD's progress. Currently, other supplements are being tested and prescribed by some physicians. There is some support in the medical literature that lutein and zeaxanthin as well as omega-3 fatty acids (DHA and EPA) may be beneficial for AMD. These supplements are currently being tested by the National Eye Institute in the AREDS2 Trial. Do not take these supplements unless your doctor recommends them, particularly if you take other dietary supplements or prescribed medications. Smokers or former smokers should ask their doctors about the risk vs the benefits of taking a beta-carotene supplement.

Can wet AMD be treated?
Yes! The most exciting advancement in AMD research to date was the development of a prescription medicine called Lucentis by scientists at Genentech, Inc. Lucentis is the first and only treatment clinically proven to restore vision in some patients with wet AMD. In clinical trials, about 95% of patients treated with Lucentis maintained their vision, and 40% achieved vision of 20/40 or better. Wet AMD is a chronic condition and there is no cure, but it can be managed with regular treatment with Lucentis.

How does Lucentis work?
With wet AMD (sometimes called exudative AMD), abnormally high levels of a substance called vascular endothelial growth factor (VEGF) are secreted in the eyes. This substance promotes the growth of new abnormal blood vessels that are unstable and tend to leak fluid under and into the retina. This fluid damages the macula and leads to central vision loss. Lucentis is an antibody that binds to VEGF, thus blocking the effect of VEGF and halting the disease.

How is Lucentis administered?
Lucentis is injected directly into the eye at regular intervals (every 4 to 6 weeks, depending on your particular situation). Before the injection is given, the eye is cleaned thoroughly to help avoid an infection, and then numbing drops are applied to the eye to limit any discomfort. During the injection, many people feel some pressure on their eye, but this feeling should go away after the injection. Because wet AMD is a chronic condition, treatment is ongoing. Your doctor will evaluate your response to determine the frequency of injections.

Are there side effects with Lucentis therapy?
As with any procedure performed on the eye, the most worrisome complication is infection. Fortunately, this is rare, but it can have devastating outcomes if it occurs.

The most common side effects to your eye are increased redness on the white portion of your eye, eye pain, small specks or round floaters in vision, or the feeling that something is in your eye. These are not serious side effects. If your eye becomes very red, sensitive to light or painful, or if your vision changes, you should call or visit your eye doctor right away.

Although not common, Lucentis patients have had eye-related and non eye-related blood clots (heart attacks, strokes, and death). Some patients have increases in eye pressure within 1 hour of an injection. Other side effects include inflammation inside the eye and, rarely, problems related to the injection procedure such as developing a cataract. These can make your vision worse.

For additional safety information, talk to your retina specialist. Full prescribing information is available at www.lucentis.com.

Are there other treatments for wet AMD?
Lucentis is the only drug approved by the US Food and Drug Administration for treating wet AMD. Some doctors also use Avastin, which has properties similar to those of Lucentis and is approved for use in some types of cancer. Use of Avastin in the eye is considered an off-label use.

Under certain rare circumstances, some older therapies, such as a laser treatment called photodynamic therapy or another anti-VEGF agent called Macugen, may be used.

What if I have already lost some vision?
Many patients who have lost vision from AMD are able to maintain their independence and enjoy many of their current hobbies and activities. Low vision specialists can help you make the most of your remaining sight and teach you new ways to accomplish everyday tasks. A few simple adjustments in and around the house will help ensure many activities are still within reach (See “5 Simple Ways to Aid Your Vision at Home”). Organizations such as those listed on page 8 are excellent resources to learn about research and new therapies, and products and services to assist people who have low vision.

What is low vision?
Low vision is a visual impairment that cannot be corrected by standard eyeglasses, contact lenses, medicine, or surgery, and that interferes with a person's ability to perform everyday activities.

Are special tools available to help me see better?
Low vision devices range from simple handheld magnifiers to closed circuit televisions and implantable miniature telescopes. Screen magnification software is available to enhance text on a computer monitor making using the Internet and reading and writing e-mail easier.

A low vision specialist can help you find the devices that are best for you. Training is essential to ensure that you are getting the greatest benefits from these devices. Low vision rehabilitation is an ongoing process to ensure you have appropriate devices as your needs change.

Where can I get more information about AMD?
The following are some of the organizations that provide information and support to AMD patients, family members, loved ones, and caregivers:

AMD Alliance International
(416) 486–2500, ext. 7505
info@amdalliance.org
www.amdalliance.org

American Society of Retina Specialists
www.amdawareness.org

Association for Macular Diseases
(212) 605–3719
association@ retinal-research.org
www.macula.org

Foundation Fighting Blindness
(800) 683–5555
(800) 683–5551 (TDD)
info@fightblindness.org
www.blindness.org

Genentech Inc.
www.lucentis.com

Lighthouse International
(800) 829–0500
(212) 821–9713 (TTY)
info@lighthouse.org
www.lighthouse.org

Macular Degeneration Partnership
(310) 623-4466
contactus@amd.org
www.amd.org

National Association for the Visually Handicapped
www.navh.org

National Eye Institute
(301) 496–5248
2020@nei.nih.gov
www.nei.nih.gov/amd

Prevent Blindness America
(800) 331–2020
info@preventblindness.org
www.preventblindness.org

IS AMD RESEARCH CONTINUING?
Researchers around the world continue to study AMD. For example, a company in the United Kingdom received authorization from the US Food and Drug Administration to begin a clinical trial of gene therapy for wet AMD. In addition, researchers for the National Eye Institute are searching for ways to improve detection, treatment, and prevention. They are looking at:

  • the possibility of transplanting healthy cells into a diseased retina;
  • the role of genetic and hereditary factors; and
  • the use of certain anti-inflammatory treatments for wet AMD.

Scientists are continuing to study Lucentis to determine the optimal number of treatments for wet AMD. They also have discovered that Lucentis is effective for treating other eye conditions, and they are looking at even more vision-saving applications such as for diabetes patients who have visual complications.

5 SIMPLE WAYS TO AID YOUR VISION AT HOME
1. Bring in more light.
Brighter direct lighting will help with close tasks, and brighter overall room lighting will improve safety. Eliminating glare and shadows will make a big difference in how you see.

2. Neatness counts.
Keep frequently used items, such as your keys, wallet, and medications, in the same place so you can find them easily.

3. Get organized.
Designate a specific shelf or drawer for your spices, canned goods, and cooking utensils so you can put your hand on what you need without searching.

4. Use contrasting colors.
Dark plates on a light-colored tablecloth or white knobs on dark-colored cabinets, for example, will help you distinguish items.

5. Fine-tune your other senses.
Wrap a rubber band around the juice container so you can distinguish it from the milk container. Sniff the tin of seasoning so you don't add pepper to your cookie dough instead of cinnamon.

WHAT TO ASK YOUR EYE DOCTOR WHEN DISCUSSING AMD
Whenever you have a doctor's appointment, it is a good idea to write down any questions you may have. If your eye doctor suspects you have AMD, be sure to include the following questions on your list:

  1. What is my diagnosis? (Ask your doctor to spell any unfamiliar words.)
  2. Can my AMD be treated?
  3. If you are recommending treatment, what is your treatment plan? When will treatment start?
  4. If you do not recommend treatment at this time, how often should I return for a check-up?
  5. What is my prognosis?
  6. What symptoms should I watch for, and how should I notify you if they occur?
  7. Should I make lifestyle changes?