KEY POINTS:
- Age-related macular degeneration (AMD) is the leading cause of severe vision loss in adults over age 60.
- Anyone can use an Amsler Grid test to track their vision changes with AMD
- Dry macular degeneration accounts for 90% of AMD, while wet AMD is associated with more significant vision loss
Marion, 85, lives in a condominium on her own. She has macular degeneration, a disease that gradually causes vision loss. Marion moved into a condominium after she realized she could no longer keep up with the upkeep of her home. Marion considers herself to be very independent. She uses public transportation to get around. Her diminishing vision has not kept her from having lunch with her friends. She is also very involved in activities sponsored by her local senior center.
Lately, Marion has been finding it harder to manage on her own. She highly values her privacy and rejects any suggestions for potential long-term care facilities that could provide her with the support she needs. However, Marion’s vision loss puts her at high risk for fractures and falls.
What is age-related macular degeneration?
Age-related macular degeneration is the leading cause of severe vision loss in older adults. The macula is the most sensitive visual receptor area in the eye. With macular degeneration, central vision is lost, but peripheral vision is preserved.
There are two forms of age-related macular degeneration (AMD): dry and wet.
Dry AMD: Accounting for about 90% of macular degeneration, in the dry form of AMD, light-sensitive cells gradually break down over time. The macula gets thinner and dryer with age.
Wet AMD: In the other 10%, wet macular degeneration, fluid accumulates under the retina, and the sensory layer slowly detaches from the blood supply underneath, causing significant vision loss.
Risk factors for macular degeneration include:
- Having a history of smoking
- Having a family history
- Being over age 75
- Having high blood pressure
- Having lightly pigmented skin and light-colored eyes
- Spending a lot of time in the sun
- Obesity
What does a person with macular degeneration see?
Light rays strike the cornea, the clear covering over the front of the eye, and enter the eye through the pupil. Once inside the eye, rays of light are bent by the lens to focus them on the macula—a specific region in the retina, which is the sensory part of the eye.
There are two main types of sensory receptors on the retina of the eye:
Rods: provide vision in shades of gray, at low light, and with low spatial acuity.
Cones: provide color vision, are active at brighter lights, and have high spatial acuity.
The macula contains a high population of cones and a sparse population of rods. This high acuity region is needed for reading, driving, watching television, and performing many of the activities of daily living.
With macular degeneration, only the macula is affected, and peripheral vision is typically preserved. As a result, adults with age-related macular degeneration rarely need guide dogs or canes as they can get around using their peripheral vision. However, their quality of life is adversely affected. Experts say that people with age-related macular degeneration rate their quality of life as lower than people with chronic obstructive lung disease (COPD) or acquired immunodeficiency syndrome.
Early symptoms of macular degeneration include:
- Visual distortions (The Amsler Grid is used to track changes in vision)
- Reduced central vision in one or both eyes
- A need for brighter light to read or do close work
- Blurry vision
- Decreased color intensity
- Difficulty recognizing faces
- Shadows in vision
Marion has found ways to compensate for her central vision loss. However, her increasing frailty as she ages, combined with her vision loss, has put her at a higher risk of falling. Marion contacted Sunland Home Care & Medical to inquire about having a registered nurse assess her fall risk using the Balance Tracking System. She hopes that by completing this assessment and making any necessary modifications to her home, she will be able to live independently for a longer period of time.
Contact us for helpHow common is age-related macular degeneration?
When experts surveyed U.S. citizens aged 40 and older, an estimated 9.2% of the population had age-related macular degeneration. Macular degeneration is the leading cause of vision loss in adults aged 60 in older. The prevalence of macular degeneration increases from 2% in those aged 50 to 59 to nearly 30% of those over age 75.
What are the stages of macular degeneration?
In the early stages of macular degeneration, there is an increase in a yellowish-colored substance called drusen, a waste deposit, and increased pigment deposits. In early disease, vision is usually stable or a gradual loss of vision.
As the disease progresses, it is divided into wet and dry forms. The wet form of macular degeneration is only found in 10% of cases but is responsible for 90% of vision loss.
How is age-related macular degeneration treated?
There are several treatment options available for age-related macular degeneration. These treatments usually slow the progression of the disease.
Vitamins
In the Age-Related Eye Disease Study 2, people with varying stages of age-related macular degeneration (AMD) were followed. Researchers found that those taking high levels of antioxidants and zinc had a reduced risk of developing advanced AMD.
The recommended vitamin formulation included:
- 500 mg of vitamin C
- 400 International Units of vitamin E
- 80 mg of zinc as zinc oxide
- two mg of copper as cupric oxide
- 10 mg of lutein
- two mg of zeaxanthin
Medications
Anti-vascular endothelial growth factor (VEGF) treatments can help prevent the growth of abnormal blood vessels. These medications are injected into your eye by an ophthalmologist and may need to be repeated.
Procedures
Laser therapy can be used to target and decrease the growth of abnormal blood vessels. Newer treatment options have largely replaced laser therapy.
Photodynamic therapy uses an injected medication that is activated by a special light. This medication shrinks abnormal blood vessels in the eye.
Marion had her Fall, and Balance Assessment completed by a Sunland Home Care & Medical registered nurse. She found that she was at a higher risk of falling than she thought. Marion spoke with the nurse and arranged for a monthly nurse visit to assess her current health. She also arranged for a one-on-one caregiver to come three days a week to assist her with her activities of daily living.
How can home healthcare help you manage when you have age-related macular degeneration?
As the quality of life surveys have shown, having macular degeneration can significantly impact your quality of life. It is reassuring to know that nurses and caregivers from Sunland Home Care & Medical can provide the assistance you might need to live independently in your home.
Sunland Home Care & Medical can:
- Complete wellness checks
- Do fall and balance assessments
- Provide companionship and conversation
- Provide reading assistance
- Develop an action plan
- Do light housekeeping
- Provide transportation to medical appointments
- Prepare meals
- Assist with personal care
