Dry macular degeneration

Diagnosis

Your eye doctor may diagnose your condition by reviewing your medical and family history and conducting a complete eye exam. Other tests may be performed, including:

• Examination of the back of your eye. Your eye doctor puts drops in your eyes to dilate them and uses a special instrument to examine the back of your eye. The eye doctor looks for a mottled appearance that's caused by yellow deposits that form under the retina, called drusen. People with macular degeneration often have many drusen.
• A test for changes in the center of your vision. During an eye examination, your eye doctor may use an Amsler grid to test for changes in the center of your vision. If you have macular degeneration, some of the straight lines in the grid may look faded, broken or distorted.
• Fluorescein angiography. During this test, your eye doctor injects a dye into a vein in your arm. The dye travels to and highlights the blood vessels in your eye. A special camera takes several pictures as the dye travels through the blood vessels. The images will show if you have retinal or blood vessel changes, which are a sign of wet macular degeneration.
• Indocyanine green angiography. Like fluorescein angiography, this test uses an injected dye. It may be used alongside a fluorescein angiogram to identify specific types of macular degeneration.
• Optical coherence tomography. This noninvasive imaging test displays detailed cross-sectional images of the retina. It identifies areas where the retina may be thinning, thickening or swelling. These can be caused by fluid buildup from leaking blood vessels in and under your retina.

Treatment

For now, there's no way to reverse damage from dry macular degeneration. However, there are many clinical trials in progress. If your condition is diagnosed early, you can take steps to help slow its progression, such as taking vitamin supplements, eating healthy and not smoking.

Vitamin supplements

For people with intermediate or advanced disease, taking a high-dose formulation of antioxidant vitamins and minerals may help reduce the risk of vision loss. Research from the Age-Related Eye Disease Study 2 (AREDS2) has shown benefit in a formulation that includes:

• 500 milligrams (mg) of vitamin C.
• 400 international units (IU) of vitamin E.
• 10 mg of lutein.
• 2 mg of zeaxanthin.
• 80 mg of zinc (as zinc oxide).
• 2 mg of copper (as cupric oxide).

The evidence doesn't show benefit in taking these supplements for people with early-stage dry macular degeneration. Ask your eye doctor if taking supplements is right for you.

Low vision rehabilitation

Age-related macular degeneration doesn't affect your side vision and usually doesn't cause total blindness. But it can reduce or eliminate your central vision. Central vision is necessary for reading, driving and recognizing people's faces. It may help for you to get care from a low vision rehabilitation specialist, an occupational therapist, your eye doctor and others trained in low vision rehabilitation. They can help you find ways to adapt to your changing vision.

Surgery to implant a telescopic lens

For selected people with advanced dry macular degeneration in both eyes, an option to improve vision may be surgery to implant a telescopic lens in one eye. The telescopic lens, which looks like a tiny plastic tube, is equipped with lenses that magnify your field of vision. The telescopic lens implant may improve both distance and close-up vision, but it has a very narrow field of view. It can be particularly useful in an urban environment to aid in identifying street signs.

Lifestyle and home remedies

Even after receiving a diagnosis of dry macular degeneration, you can take steps that may help slow vision loss.

• Don't smoke. If you smoke, ask your health care provider for help quitting.

• Choose a healthy diet. The antioxidant vitamins in fruits and vegetables contribute to eye health. Kale, spinach, broccoli, squash and other vegetables have high levels of antioxidants, including lutein and zeaxanthin, which may benefit people with macular degeneration. Eating foods containing high levels of zinc also may be helpful for people with macular degeneration. These include high-protein foods, such as beef, pork and lamb. Nonmeat sources include milk, cheese, yogurt, whole-grain cereals and whole-wheat bread.

  Another good choice is healthy unsaturated fat, such as in olive oil. And research studies have shown that a diet high in omega-3 fatty acids, such as in salmon, tuna and walnuts, may lower the risk of advanced age-related macular degeneration (AMD). But the same benefit is not shown from taking omega-3 supplements, such as fish oil pills.

• Manage your other medical conditions. If you have cardiovascular disease or high blood pressure, for example, take your medicine and follow your provider's instructions for controlling the condition.
• Maintain a healthy weight and exercise regularly. If you need to lose weight, reduce the number of calories you eat and increase the amount of exercise you get each day.
• Have routine eye exams. Ask your eye doctor about the recommended schedule for follow-up exams. In between checkups, you can do a self-assessment of your vision using an Amsler grid. These steps will help tell you if your condition develops into wet macular degeneration, which can be treated with medicines.

Coping and support

These tips may help you cope with your changing vision:

• Ask your eye doctor to check your eyeglass prescription. If you wear contacts or glasses, be sure your prescription is up to date. If new glasses don't help, ask for a referral to a low vision specialist.

• Use magnifiers. A variety of magnifying devices can help you with reading and other close-up work, such as sewing. Such devices include hand-held magnifying lenses or magnifying lenses you wear like glasses.

  You also may use a closed-circuit television system that uses a video camera to magnify reading material and project it on a video screen.

• Change your computer display and add audio systems. Adjust the font size in your computer's settings. And adjust your monitor to show more contrast. You also may add speech-output systems or other technologies to your computer.
• Use electronic reading aids and voice interfaces. Try large-print books, tablet computers and audiobooks. Some tablet and smartphone apps are designed to help people with low vision. And many of these devices now come with voice recognition systems, which can be a helpful low vision aid.
• Select special appliances made for low vision. Some clocks, radios, telephones and other appliances have extra-large numbers. You may find it easier to watch a television with a larger high-definition screen, or you may want to sit closer to the screen.
• Use brighter lights in your home. Better lighting helps with reading and other daily activities, and it also may reduce the risk of falling.
• Consider your transportation options. If you drive, check with your doctor to see if it's safe to continue doing so. Be extra cautious in certain situations, such as driving at night, in heavy traffic or in bad weather. Use public transportation or ask family members to help, especially with night driving. Or use local van or shuttle services, volunteer driving networks, or rideshares.
• Get support. Having macular degeneration can be difficult, and you may need to make changes in your life. You may go through many emotions as you adjust. Consider talking to a counselor or joining a support group. Spend time with supportive family members and friends.

Preparing for your appointment

You will likely need a dilated eye exam to check for macular degeneration. Make an appointment for a complete eye exam with a doctor who specializes in eye care — an optometrist or an ophthalmologist.

What you can do

Before your appointment:

• When you make the appointment, ask if you need to do anything to prepare.
• List any symptoms you're experiencing, including those that seem unrelated to your vision problem.
• List all medications, vitamins and supplements you take, including the doses.
• Ask a family member or friend to go with you. Having your pupils dilated for the eye exam will affect your vision for a time afterward, so you may need someone to drive or be with you after your appointment.
• List questions to ask your doctor.

For macular degeneration, questions to ask your eye doctor include:

• Do I have dry or wet macular degeneration?
• How advanced is my macular degeneration?
• Is it safe for me to drive?
• Will I experience further vision loss?
• Can my condition be treated?
• I have other health conditions. How can I best manage these conditions together?
• Will taking a vitamin or mineral supplement help prevent further vision loss?
• What's the best way to monitor my vision for any changes?
• What changes in my symptoms warrant calling you?
• What low vision aids might be helpful to me?
• What lifestyle changes can I make to protect my vision?

What to expect from your doctor

Your eye doctor is likely to ask you a few questions, such as:

• When did you first notice your vision problem?
• Does the condition affect one or both eyes?
• Do you have trouble seeing things near to you, at a distance or both?
• Do you smoke or did you used to smoke? If so, how much?
• What types of foods do you eat?
• Do you have other medical problems, such as high cholesterol, high blood pressure or diabetes?
• Do you have a family history of macular degeneration?