As we age, many of us will start noticing changes
in our vision as we reach for reading glasses more
frequently and need regular eye exams to update our
existing prescriptions.But many older adults find
their vision is further impeded by the onset of
age-related macular degeneration (AMD), which can
blind people in their straight-ahead (central)
vision. Tasks that used to be simple, like
selecting the right cereal brand or recognizing the
face of a neighbor, become increasingly challenging
as the disease progresses.
As AMD worsens, the need for caregiving goes up.
According to a recent study, people living with
advanced AMD may need assistance as much as 3.7
hours per day and 4.7 days per week. Given
that 72 percent of people living with AMD are cared
for by either their spouse or adult child and there
is no cure, family caregivers need a good
understanding of how to best assist someone with
limited central vision and the different treatment
options available for their loved one as the disease
progresses. Education and practical strategies
can also mitigate the stress that caregivers report
feeling in caring for someone living with AMD.
What is Age-Related Macular Degeneration?
Macular degeneration is an eye condition that
attacks the macula, the region of the retina
responsible for central, detailed vision. Although
it does not cause complete blindness, it often leads
to a central vision “blind spot,” which you cannot
see around as it follows natural eye movement.
AMD does not affect peripheral vision; however,
while a person will be able to see things to the
side, this vision is usually too blurry to discern
the object of interest.
More than 15 million Americans are affected by some
form of AMD and approximately two million Americans
have the advanced (end-stage) form with associated
vision loss, which is the leading cause of
irreversible vision loss and legal blindness in
individuals over the age of 60. Despite the
availability of new drug treatments that slow, but
not stop, the progression of AMD, the number of
people with end-stage AMD is expected to double by
the year 2050.
How is AMD diagnosed?
The early and intermediate stages of AMD usually
start without symptoms, although some may notice
when straight lines like doorways or telephone wires
appear wavy or disconnected. Only a
comprehensive dilated eye exam, usually given by an
ophthalmologist, can detect AMD. The eye exam may
include the following:
- Visual acuity test:
This eye chart measures how well
you see at distances.
- Dilated eye exam:
This exam provides a better
view of your retina
(the back of your eye).
- Amsler grid test:
This vision test checks whether
you are seeing unusual wavy lines.
- Fluorescein angiogram:
This test makes it possible
to see leaking blood vessels, a sign of wet AMD.
- Optical coherence tomography:
Like an ultrasound,
OCT can achieve very high-resolution images of any
tissues that can be penetrated by light—such as the
There are two primary forms of AMD, wet or dry.
Wet (neovascular) AMD is caused by abnormal blood
vessels that leak fluid or blood into the region of
the macula. More common is dry AMD (also
called atrophic AMD), which occurs when the layer of
retinal pigment epithelium cells (RPE) found in the
macular break down or die. (RPEs nourish retinal
visual cells and, when they absorb light, help to
focus the macula.)
Caring for the AMD Patient
Regardless of whether your loved one has the wet or
dry form of AMD, it is very likely to progress over
time. Caregivers have an important role to play in
helping their loved ones manage their diminishing
vision and the tasks of daily living. For example,
as the blind-spot grows larger, patients will need
more assistance in navigating rooms. It is
helpful to describe the furniture location and let
them know who is in the room with them as this helps
with orientation and reduces patient stress.
Caregivers should also explore low vision centers in
their community (e.g., Lions Clubs or Lighthouse
organizations), as those organizations can provide
education about and access to low vision assistive
devices that can improve patients’ ability to read,
watch TV or use the computer. A low vision
specialist can also train patients to navigate their
changing world more effectively.
AMD Treatment Strategies
Treatment for AMD is tailored to each patient and
available treatments have improved vastly in just
the past ten years. Of course, patients should speak
with their physician before starting any treatment,
which might include:
- Vitamin therapy: Often called the AREDS2
prescription (named after a very large government
study), this therapy includes a specific combination
of vitamins to slow the progression of AMD.
- Eye injections: Called anti-VEGF treatment, the
injections (e.g., Avastin, Lucentis, Eyelea) can
slow progression of the wet form of AMD.
- Photodynamic therapy: A “cold” laser treatment for
(often in combination with injections).
- Laser therapy: Also for wet AMD, a laser destroys or
seals off new blood vessels to prevent leakage.
- Telescope implant: For end-stage AMD patients, a
(the size of a pea) is implanted in
one eye to restore central vision.
eye is left “as is” to preserve peripheral vision.
will need to support patients as they
learn to use the telescope implant and their new
Note, cataract surgery is often performed on the AMD
patient. However, studies show that there is
little central vision improvement for the patient
whose condition is advanced.
Linda Supports her mother, Patty
Linda T., from Schenectady, NY, was helping her
mother, Patty G., almost daily as her vision
worsened due to age-related macular degeneration.
Though Patty still lived in the home where she
raised her children, Linda visited to help her with
shopping, getting to medical appointments and other
daily life tasks, like cooking and bill paying.
Embarrassed that she couldn’t recognize friends and
family any more, Patty also found herself
withdrawing from her life, which was hard on the
It was Linda who discovered
that Patty would benefit from the telescope implant
for end-stage AMD. She brought Patty to her
ophthalmologist to learn about it, then accompanied
her to the out-patient surgery and practiced the
exercises Patty’s occupational therapists prescribed
to master her new vision. Today, Patty can see
the faces of her family, read and watch TV, and even
travel independently. She walks to her local
stores and can navigate train stations.
(Driving is not an expected outcome from this
procedure because normal vision is not restored.)
The telescope implant is one of the newest
treatments for AMD and the only FDA approved
surgical option. Like the other treatments, it
is not a cure for AMD, but it is proven to restore
vision and improve quality of life. Patients
must be at least 65 years old and meet other health
requirements. Most importantly, their cataract
must be in place in the eye to be operated on.
The procedure is Medicare eligible.
Attitude and AMD
We don’t realize how much we rely on our vision
until it starts to diminish. People living
with AMD reportedly experience increased depression
and stress, so it’s important to provide both
practical and emotional support as the disease
progresses. Simultaneously, make sure to take
care of yourself. Even the most devoted
caregiver needs a break to feel refreshed and ready
to take on the next challenge. The good news
is that treatment for AMD can slow progression,
which means you and your loved one can “see” a
bright future ahead.