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Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is the most common condition among patients seen in the Vision Rehabilitation Service. AMD is one of the leading causes of vision impairment in older adults. It affects the central vision (macula) and does not cause total blindness. AMD can be either “wet” or “dry” which means that there is or is not leaking retinal blood vessels. Eyes may go through stages where the blood vessels in the retina start and stop leaking and patients may have one type of disease in one eye and the other type in the fellow eye.

Typically, the earliest stages of AMD are dry and this is “treated” through regular monitoring and the use of ocular vitamins (the AREDS formula) to prevent progression and worsening of the vision. There is currently no treatment to restore vision in the dry form of macular degeneration. The current treatment for the “wet” form includes laser and injections such as Avastin®, Lucentis® and Eylea®. Again, the goal of these treatments is to prevent worsening of the vision, though some patients do have improvements in visual acuity when treated.

Since most visual acuity improvement is maximized after 3-6 injections and treatment can be chronic over years, vision rehabilitation services can be initiated when functional concerns exist. The best tips for prevention for AMD include smoking cessation and regular eye exams, particularly in those patients with a strong family history or who have the initial signs of the diseases.

AMD can cause difficulty with “fine detail” or 20/20 vision. This includes the vision necessary to read small print, see faces and to navigate when driving or walking especially in unfamiliar places or in places with low lighting and contrast. Many patients with macular degeneration report difficulty identifying curbs and steps as well as uneven ground. People with AMD retain normal peripheral or “side” vision which is also important for safe navigation.

In the Vision Rehabilitation Service, we help people with AMD maximize their visual function and maintain independence. Through the prescribing of strong or specialized glasses, telescopes, hand-held or spectacle-mounted magnifiers, electronic/digital magnification and low vision occupational therapy, improvements in function and engagement in activities can be seen. This can include eccentric viewing training, assistance with developing and teaching skills to manage activities of daily living, and training with the recommended devices and assistive technology.

It often takes some adjustment to understanding and using residual vision. A low vision evaluation is a good first step to getting educated on vision loss and initiating using new strategies to enhance function. Vision rehabilitation services are designed to assist patients manage the continuum from the very early stages of visual loss.

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