Macular Degeneration: Managing This Vision Condition

Helyn Guerry, 88, of Houston, looks around her room but struggles to make out the objects directly in front of her. Macular degeneration, a common eye condition among older adults, seriously blurs her central vision.

Driving is no longer possible for Guerry. Fortunately, she has a support system in place. "I have a grandson who's very near and dear, and he comes once a day," she says. He helps her catch up with paperwork and takes her to the grocery store because she can't read labels now. She also has occasional professional help from an aide who accompanies her on visits to the doctor.

Guerry can't read print books anymore. When she recently picked up her Kindle, she noticed her eyesight had deteriorated a bit more. Now she uses a machine that reads books aloud. Fortunately, she says, her hearing is still good.

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Age-related macular degeneration is the leading cause of visual loss in the U.S., according to the National Eye Institute. As the population ages, it will only become more common. In 2010, among adults ages 50 and older, nearly 2.1 million people had macular degeneration. By 2050, that figure will more than double, according to NEI projections.

Macular degeneration is a disease of the retina. The retina records any images you see and transmits them to your brain through your optic nerve. The macula is the central portion of the retina and it's responsible for your central vision.

The ability to recognize faces, read, write, watch TV, cook, drive and do other tasks depends on the macula. If it deteriorates, blurred areas can appear in the middle of your visual field. If the condition progresses, blurred areas may grow larger or blank spots may develop. Whatever you see may appear darker or distorted.

"If anything happens to that central vision, then your function is affected right away," says Dr. Bhavani Iyer, director of the Dan Arnold Center for Vision Rehabilitation in the department of ophthalmology and visual science at the University of Texas McGovern Medical School in Houston. "You can immediately tell: 'Oh, I can't see my grandchild's face,' or 'I can't see to read my newspaper or read road signs.'"

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Up to 90 percent of cases are "dry" macular degeneration, according to the American Academy of Ophthalmology. Dry macular degeneration involves small deposits of fatty protein that form on the retina. Wet macular degeneration, the more advanced form, involves the growth of abnormal blood vessels within the retina that can leak and damage the macula.

A common misconception is that macular degeneration typically leads to blindness. In fact, that's not the case for the vast majority of patients nowadays, says Dr. Peter Campbell, a retina specialist. Advances in treatment mean patients are far less likely to go blind than they were 15 years ago, says Campbell, an assistant professor of ophthalmology at the Oregon Health & Science University.

For most patients, the condition never progresses to the point of low vision, Campbell says. However, he adds, "Patients with macular degeneration often describe the sense that they don't see as well as they used to, even if the vision on the chart looks the same. That's a very real phenomenon. Patients over time do feel that they need more light and more contrast."

Prompt recognition of macular degeneration is important to avoid it advancing to the point where failing central vision means people can no longer recognize faces, Campbell says. That scenario can result if patients seek treatment in later stages, he says, when there's already a significant scar on the macula.

The first thing people over 60 should do is start having regular eye exams, Campbell says. An ophthalmologist or optometrist can provide primary eye care and screening for common age-related conditions such as cataracts, glaucoma and macular degeneration. Patients can better understand their own risk for macular degeneration, which primarily goes up with age, smoking and family history.

If you have macular degeneration, your doctor may recommend treatment with a specific combination of high-dose vitamins and minerals. Taking such supplements reduces the risk of disease progression, according to the age-related eye disease studies from the National Eye Institute, known as AREDS and AREDS2. Supplements containing the AREDS2 ingredients -- vitamin C, vitamin E, zinc oxide, cupric (copper) oxide, lutein and zeaxanthin -- in the correct doses are available.

For wet macular degeneration, treatment is managed with eye injections at monthly or other intervals. These injections are used to block the growth of abnormal blood vessels.

Less common treatments for advanced macular degeneration may include laser-based procedures such as photodynamic therapy and laser surgery.

Iyer works with patients who have low vision. That means vision that falls below 20/60 and is not correctable by conventional glasses, contact lenses or surgery, explains Iyer, who serves as chair of the American Optometric Association's vision rehabilitation committee.

Helping patients meet their goals for staying independent is the focus of vision rehabilitation. Patients go through a multipart functional vision assessment. Specialized, detailed eye charts test patients' ability to determine the clarity and sharpness of numbers, letters, words and sentences at various distances.

Another test involves the Amsler grid, which, to most people, looks like a simple black grid on a white background. To people with macular degeneration, however, the grid appears as wavy or distorted lines, possibly with black spots or holes in the center.

Contrast sensitivity assesses whether patients can tell objects and background of a similar color apart. "It's sort of like your ability to [distinguish] mashed potatoes on a white plate," Iyer says. The results suggest how well you might recognize faces or step off curbs or stairs. "Contrast affects everything," she says. "So those are indicators of how that person might function in day-to-day life."

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Mapping out the blind spot at the back of the eye is another part of testing. Specialists determine the precise location and shape of that blind spot, known as a central scotoma. They also map out the location of the next best area the patient with macular damage can use to see. "We call this area the sweet spot," Iyer says. "Patients turn their eye a certain way and turn their head a certain way to access it." Known as "eccentric viewing," it's a method patients can learn to take advantage of their intact peripheral vision.

To manage low vision, Iyer says, "Ultimately, it's a combination of devices, strategies, lighting, contrast, training and resources." For instance, she says, if your goal is to recognize a loved one's face, a handheld monocular telescope could help. If you want improved vision while walking or driving, small devices called bioptic telescopes can be mounted on top of your glasses.

Cost is an issue. Custom low-vision glasses are priced at $1,200 and more, for example. Guerry is unhappy with the pair of glasses she recently purchased because they didn't fix all her vision problems and because insurance didn't cover them. However, she still enjoys going online, and appreciates all the computer adaptations that make that possible.

Overall, Guerry feels that she manages pretty well, as she lives on her own with a little dog to keep her company. "I don't sit around feeling sorry for myself," she says.

Support groups and technology training can help people with vision loss function independently, and in doing so, decrease their risk of depression, Iyer says. Because the learning curve is steeper the longer they wait, she strongly advises people with advanced macular degeneration to ask doctors about all their options and resources, including referral to a low-vision clinic.

Lisa Esposito is a Patient Advice reporter at U.S. News. She covers health conditions, drawing on experience as an RN in oncology and other areas and as a research coordinator at the National Institutes of Health. Esposito previously reported on health care with Gannett, and she received her journalism master's degree at Georgetown University. You can follow her on Twitter, connect with her on LinkedIn or email her at lesposito@usnews.com.