Macular Degeneration and Age: How Young Can You Be Diagnosed With AMD?
Medically reviewed by Andrew Greenberg, MD
Macular degeneration is an eye disease that causes problems with your central vision, what you see straight ahead of you. It is also called age-related macular degeneration (AMD) because it occurs as a result of changes linked with aging.
AMD ranks as the leading cause of vision loss and blindness among people age 65 and over in the United States. While rare, it can also affect much younger people. Other forms of the disease can strike between childhood and early adulthood.
Age is the main risk factor for AMD. Other factors such as smoking, poor diet, lack of movement, and a family history of AMD can increase your risk of developing it.
This article describes the most common ages when AMD occurs. It explains when symptoms can present and reasons they may not be recognized. It also describes risk factors and treatments.
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Age at Which Macular Degeneration Could Start
Macular degeneration occurs as a result of changes to your macula. It is often called age-related macular degeneration because it is most commonly found in people over 60 years old. While it is a rare diagnosis before age 55, it can occur at any age. The majority of people who experience macular degeneration are age 75 and older.
The prevalence of macular degeneration increases with age, ranging from 2% for people aged 40 to 44 vs. 44 % to 46.6% for people aged 85 and older.
Determining the age of onset can be challenging because dry AMD often exists without symptoms. Wet AMD only occurs after dry AMD. The age at which macular degeneration could start includes the following ranges:
Dry AMD: 35 to 44, though most commonly occurs after age 50
Wet AMD: 75 and older, though can occur earlier based on the start of dry AMD
From Symptom Onset to Diagnosis
Age-related macular degeneration occurs differently in everyone. This can be problematic because early detection is critical for effective disease management and reducing vision loss.
In a cross-sectional study, researchers reported that 25% of the eyes examined using a dilated eye exam and then diagnosed as normal had characteristics of AMD. A total of 30% of those undiagnosed eyes had symptoms of intermediate AMD that could have been treated if an earlier diagnosis had been made.
Other research indicates that people with AMD had a delay in diagnosis due to a wide range of reasons that included the following:
Lack of knowledge about the symptoms of AMD
Symptoms misdiagnosed as another less-urgent eye condition
Symptoms not regarded as urgent
Lack of appointments, facilities, or staff needed to make a diagnosis
Undetectable levels of AMD in the initial examination
Misdiagnosis of symptoms to a natural part of aging
Early-stage dry AMD usually occurs without symptoms. Vision impairment may include slight problems adjusting from bright to dark environments, though changes are usually undetectable or very subtle. As a result, many people don't realize they have the condition until it is diagnosed during a routine dilated eye exam.
Understanding how AMD progresses can improve your chances of getting an early diagnosis. The rate at which dry AMD progresses to the intermediate stage varies. The impact on visual ability can be minimal or more noticeable. At this stage, one or more of the following symptoms may occur:
Fuzzy or blurred area within your central vision
Problems seeing in low light
Declining ability to adapt from bright to dark environments
Difficulty distinguishing between similar colors or among shades of the same color due to loss of color vibrancy
In advanced or late-stage dry AMD, also called geographic atrophy, irreversible vision loss can occur. This disease stage can involve the following symptoms:
Hazy vision
Blurry reading and/or distance vision
Central vision limited by a blurred, gray, or empty spot in the middle of it
Seeing objects as being smaller than their actual size
Inability to recognize faces
Advanced-stage wet AMD occurs in about 10% to 15% of people with dry AMD. By the time of diagnosis, it is typically a serious condition that requires prompt treatment. Symptoms are similar to those that occur with the advanced stage of dry AMD but also include the following:
Seeing straight lines as being crooked or wavy
Seeing a blurry area in the middle of your central vision that grows or forms into blind spots
Learn More: Stages of Macular Degeneration
Age-Related MD in Young Adulthood
Age-related macular degeneration is characterized by physical changes during the natural aging process in people older than age 50. Though rare, this disease has also been observed in much younger people.
Researchers have reported finding evidence of early AMD in people under age 30. In one large-scale population study, evidence showed early AMD features in 3.8% of participants aged 35 to 44.
A diagnosis of early age-related MD may be related to the following types of changes in a person's retina:
Excessive amounts of small drusen (small white or yellow deposits in your retina)
Several large drusen
Larger areas of color abnormality
Due to the asymptomatic nature of early AMD, people at any age can remain unaware of its existence as it progresses. However, regular eye examinations that check your macula can help identify AMD in its earliest stages.
While age-related macular degeneration can occur in younger adults, macular degeneration at this time of life can also be caused by juvenile macular degeneration (JMD). JMD is a group of inherited, genetic conditions. These diseases include Stargardt disease, Best disease, and juvenile retinoschisis.
Unlike AMD, which occurs with the natural aging process, juvenile macular degeneration is linked to genetic causes. This type of macular degeneration typically causes a slow loss of central vision that can begin in childhood or early adulthood.
Learn More: Causes and Risk Factors of Macular Degeneration
How Old Are AMD Patients With Blindness?
Being age 50 or older increases your risk of AMD. Once the disease begins, factors such as your disease severity, lifestyle, genetics, and general health can impact how quickly the disease progresses and the type of vision loss it will cause.
While AMD is one of the leading causes of blindness among people 60 and older, not everyone with AMD develops the advanced form of the disease. Even among people with advanced AMD, blindness is not inevitable since the disease affects everyone differently.
The vision loss caused by AMD affects your central vision, not your peripheral (side) vision. While losing central vision may classify you as being "legally blind" and can interfere with your ability to perform daily activities, AMD rarely causes total blindness.
Learn More: Macular Degeneration: Timeline of Vision Loss Progression
Reasons Macular Degeneration Symptoms Start
Macular degeneration occurs due to the natural aging process of your macula. The macula is the part of your eye that controls central vision and your ability to perceive color. It is located near the center of your retina (the tissue in the back of your eye that sends visual signals to your brain).
Dry Macular Degeneration
Dry macular degeneration results when parts of your macula thin with age and dysfunction. The deterioration of macular tissue allows for the accumulation of waste deposits in the form of fatty proteins called drusen. Drusen usually don't cause symptoms in the early stages of AMD.
As they accumulate, drusen begin to interfere with the flow of oxygen to the photoreceptor cells that send visual messages to your brain. The affected cells eventually die, causing vision to become blurry. Dry AMD progresses slowly and worsens as the drusen grow and accumulate.
Wet Macular Degeneration
Wet macular degeneration occurs when dry AMD changes to wet AMD. Wet AMD is a more serious type of AMD in which new, abnormal blood vessels form under your retina and macula. These abnormal vessels leak blood and other fluids, damaging the macula. Symptoms of vision loss can occur dramatically and rapidly.
While the specific cause of AMD is not known, certain risk factors increase your chances of having this disease. People with the following characteristics have a higher risk of developing AMD:
Over age 60
White
Having an immediate family member with AMD
Female
Presence of AMD in one eye
Having light-colored eyes
Hypertension (high blood pressure)
Genetic mutations
The likelihood of having AMD increases further if you have any of the following lifestyle risk factors:
Smoking: Smoking interferes with oxygen delivery to your retina.
Prolonged exposure to sunlight: There is some evidence that cumulative damage from ultraviolet (UV) light may damage your retina and make you more likely to develop AMD.
Sedentary lifestyle: Exercise promotes blood circulation, which delivers oxygen to your retina. Remaining sedentary may prevent your retina from receiving the oxygen it needs to maintain healthy macular cells.
Diet: Consuming a diet high in fat and cholesterol and eating foods high on the glycemic index can increase your risk of AMD.
Learn More: Macular Degeneration: Foods to Avoid Disease Progression
After Diagnosis: Supporting Eye Health With AMD
The treatment plan your ophthalmologist recommends after a diagnosis of AMD will depend on the severity and stage of your disease. While macular degeneration is incurable, appropriate AMD treatments may help slow disease progression. In some cases, treatments may help you regain vision loss.
Early-Stage Dry AMD
A diagnosis of early-stage dry AMD means that you caught the disease as early as possible. While AMD is often asymptomatic at this stage, it can still cause damage, leading to vision loss.
Recommendations at this stage often involve lifestyle changes that can help slow disease progression. These changes include the following:
Perform self-screenings of your central vision using an Amsler grid (a simple eye test) to track vision changes and AMD progression.
Follow a diet with plenty of nuts, fruits, vegetables, dark leafy greens, and fish rich in omega-3 fatty acids.
Limit long-term exposure to bright sunlight without sunglasses or a wide-brimmed hat.
Manage chronic conditions such as obesity, hypertension, and atherosclerosis (a buildup of fats, cholesterol, and other substances in and on walls of the arteries).
Schedule annual eye exams.
Contact your ophthalmologist immediately if you notice any vision changes between office visits.
Consider the benefits of genetic testing if you have a family history of AMD.
Intermediate-Stage Dry AMD
A diagnosis of intermediate-stage dry AMD means you have a higher risk of the disease progressing to late-stage AMD and some vision impairment. The same lifestyle modifications used in early-stage AMD are advised at this more advanced stage.
Treatment at this stage of AMD involves a daily regimen of supplements called AREDS 2 to help slow the progression to late-stage AMD. These vitamins, minerals, and antioxidants are based on evidence from research in the second Age-Related Eye Disease Study (AREDS 2).
AREDS2 supplements are packaged in a single over-the-counter formulation. They include the following ingredients:
Vitamin C: 500 milligrams (mg)
Vitamin E: 400 international units (IU)
Copper (cupric oxide): 2 mg
Zinc: 80 mg
Lutein: 10 mg
Zeaxanthin: 2 mg
Advanced, or Late-Stage, Dry AMD
Treatments for late-stage dry AMD, or geographic atrophy, are relatively new. In 2023, the Food and Drug Administration (FDA) approved the following medications for administration via intravitreal injection. This is an injection in the vitreous cavity (the space at the back of your eye behind the lens):
Syfovre (pegcetacoplan)
Izervay (avacincaptad pegol)
Advanced, or Late-Stage, Wet AMD
Late-stage wet AMD is the most severe type of AMD. Treatments work to reduce the growth of abnormal blood vessels and slow leaking from existing ones. Treatments include the following:
Anti-VEGF (Anti–Vascular Endothelial Growth Factor) Treatment
Anti-VEGF treatments are regarded as the first-line treatments for this stage of AMD. These medications reduce vascular endothelial growth factor, which promotes the growth of abnormal blood vessels and their leaking in your retina.
Drugs used in anti-VEGF treatments include the following:
Avastin (bevacizumab)
Lucentis (ranibizumab)
Vabysmo (faricimab-svoa)
Photodynamic Therapy
When used with anti-VEGF treatments, photodynamic therapy may help a small portion of wet AMD cases. It involves the injection in the arm of verteporfin, a photosensitizing agent (a substance sensitive to the influence of radiant energy, namely light). When it reaches your eye, a laser beam is directed toward the back of your eye. This activates the drug so it can attack the abnormal blood vessels.
Laser Photocoagulation
Laser photocoagulation is a type of minimally invasive laser surgery. It uses thermal laser treatments to shrink and destroy faulty blood vessels. However, it is only appropriate for certain types of wet AMD that involve abnormal blood vessels not beneath the center of your macula. This is because there is a risk of laser damage to overlying vision cells in the treated area.
Learn More: Coping With Macular Degeneration
Summary
Age-related macular degeneration is an eye disease that most often affects people over age 60. However, research shows the disease may also affect a small group of people at a much younger age.
Getting yearly eye exams can help you identify vision problems at any age. Knowing AMD's risk factors and symptoms can help you identify the need for care as early as possible. This can help you begin treatments proven to reduce vision loss and slow disease progression.
Medical experts advise not ignoring any changes in your vision, especially those that affect how you see objects in your central vision. Prompt treatment may make a difference in preventing vision loss from AMD.
Read the original article on Verywell Health.
