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Legal blindness (vision of 20/200 or worse with glasses) develops in a minority of AMD patients (fewer than 5% overall); however, when it occurs in both eyes, it of course has a huge impact on one's lifestyle.
The prognosis for age-related macular degeneration (AMD) is highly variable. The prognosis is generally worse for those with a strong family history of AMD and those who develop either geographic atrophy or wet AMD (see below for information on the types of AMD). Approximately 1%-1.5% of all patients with dry AMD go on to develop the wet form.
In all cases, the success rate of therapy is dependent on timing. The earlier the condition is treated, the higher the likelihood of success. This is why regular checkups with an eye doctor to detect AMD and close monitoring of vision once AMD is found are very important.
There are two types of age-related macular degeneration:
- Dry form: This type results from the gradual breakdown of cells in the macula, which can result in a gradual blurring of central vision. Small, round, yellow-white spots called drusen accumulate under the macula in the dry type. Drusen can be seen by your doctor using standard eye exam equipment. Drusen can become visible at any age but are much more common in people over the age of 55. Many people with drusen alone have excellent vision and no symptoms. However a small percentage of people will go on to develop an advanced form of dry AMD known as geographic atrophy (GA), in which the macular tissue gradually thins. When this occurs, there can be vision loss ranging from mild to profound.
- Wet (exudative or neovascular) form: In the wet form of AMD, abnormal blood vessels grow under the macula. These blood vessels may leak fluid or blood, distorting or diminishing central vision. Wet AMD usually starts in one eye and may affect the other eye later. In contrast to the dry type, vision loss may be rapid.
- Wet macular degeneration affects only 10%-15% of people who have AMD but accounts for the majority of people who have significant visual loss.
- For dry AMD, including geographic atrophy, there are no standard treatments currently available, however, research is under way and many promising experimental treatments are currently being evaluated.
For the wet form of AMD, there are treatment options. Your eye doctor will refer you to a retina specialist (an ophthalmologist who has done additional specialized training in treatment of retinal diseases). A class of medications known as anti-VEGF (anti-vascular endothelial growth factor) can help shrink or even eliminate the abnormal blood vessels that form under the macula in wet AMD. These include ranibizumab (Lucentis), bevacizumab (Avastin), and aflibercept (Eylea). They are injected into the eye directly, and often several injections are necessary over the course of months or years. Anti-VEGF therapy has had a high success rate in stabilizing or reversing the abnormal vessels, and many patients experience improved vision, as well.
For more information, read our full medical article on macular degeneration
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