What Are the Early Warning Signs of Macular Degeneration?

Medically reviewed by Christine L. Larsen, MD

With age-related macular degeneration (AMD), you can lose the detailed central vision you rely on for reading, recognizing faces, and navigating many life tasks. This occurs as the part of the eye responsible for sharp vision, known as the macula, deteriorates or is damaged. For those over age 50, this is the leading cause of vision loss.

Macular degeneration has two main types: wet and dry. With wet macular degeneration, abnormal leaking blood vessels are the culprits leading to vision loss. With dry AMD, cells responsible for detailed vision begin to die off.

Since this condition can threaten sight if left unchecked and early symptoms can be subtle, undergoing regular eye exams is crucial. The sooner early warning signs for macular degeneration are recognized and the condition is detected, the better the chance of preserving vision.

In this article, you'll learn about early warning signs of macular degeneration, later symptoms, how AMD is diagnosed and treated, and the prognosis for those with this condition.

What Are the Early Warning Signs of Macular Degeneration?

Early symptoms of macular degeneration are experienced in the dry form, but as the condition progresses, symptoms can occur with either dry or wet AMD.

Early on, even though you have the condition, you may not have any symptoms, so it is important to have your eyes examined regularly. Otherwise, some damage may be done by the time you notice that your vision is affected.

Macular degeneration strictly affects the central vision, not the peripheral vision (what you see out of the corner of your eyes). The macula is part of the retina, the light-sensing layer at the back of the eye.

Early Symptoms

The sooner macular degeneration is detected, the better. Early in the disease process, there may be no signs of macular degeneration or only very subtle ones, so it is essential to undergo regular eye exams.

Even before macular degeneration causes symptoms, your ophthalmologist or optometrist (eye specialists) can identify retinal changes associated with this condition. They can perform testing and determine if there are changes to the area that indicate that you have early macular degeneration.

Since macular degeneration tends to occur as you age, it is recommended that people over age 50 have their eyes examined every two years and those over 65 every year. If macular degeneration is detected, your eye specialist will tell you how frequently follow-ups are needed.

The first symptoms can be very subtle. You may notice that part of your central vision in one or both eyes is blurred or distorted, and you are just not seeing as you should. It is important to promptly bring this information to the attention of your eye specialist and not ignore this symptom.

Intermediate Symptoms

Even at the intermediate stage, some people with macular degeneration have no symptoms. But at this point, some may notice signs not present before, such as mild central blurriness or difficulty seeing in low light. You may notice, for example, that you need more light to read.

Late Symptoms

By the late stage, clear-cut signs may begin to emerge, such as the following;

• Straight lines appear wavy or bent.

• You notice a blurry central area in your vision.

• You may notice blank spots.

• Colors appear muted.

• You have difficulty navigating in low light.

If you notice any of these symptoms, which could indicate that you are developing late AMD, contact your eye specialist promptly.

How Is Macular Degeneration Diagnosed

A variety of tests can help detect macular degeneration. After having a comprehensive eye exam, you may undergo some of the following:

• Acuity test: You read aloud letters that appear progressively smaller on each line.

• Dilated eye exam: Drops are used to widen the pupil so your eye doctor can examine the back of your eye with the aid of a magnifying lens to help detect early signs of macular degeneration, as well as other eye conditions.

• Optical coherence tomography: The eye specialist scans the retina and produces images of the macula that show whether there is any fluid collecting there or other signs of degeneration.

• Fluorescein angiography: Dye is injected into your arm. As your blood circulation brings the dye through the blood vessels of the eye, pictures can be taken with a special camera to help detect any leaking blood vessels.

• Fundus autofluorescence imaging: Light emissions from pigments in the retina are captured by a special camera and used to detect small changes in the retina associated with macular degeneration.

• Amsler grid: This is a low-tech test that you can take at home. It involves using a chart resembling a piece of graph paper with a dot in the center surrounded by a grid pattern. With one eye covered, you look at the grid to detect gaps and distortions of lines.

It is important to undergo thorough testing to ensure that your symptoms are indeed signs of macular degeneration. Other eye conditions can mimic AMD, such as the following:

• Best's disease: This is a hereditary condition in which individuals usually start to lose central vision in their 50s and 60s, although for some, it can develop in childhood.

• Pattern dystrophies: These conditions are passed down in families and can cause mild problems with central vision in one or both eyes as you age.

• Central serous chorioretinopathy: This involves a fluid buildup behind the retina and causes visual distortion. While this can affect younger people initially, it may become a chronic issue around age 60.

• Macular telangiectasia: With this condition, abnormal blood vessels around the center of the macula cause vision loss.

How Is Macular Degeneration Treated

The options for treating macular degeneration vary depending on the form and where you are in the course of the disease.

Early Macular Degeneration

Unfortunately, nothing can be done to treat macular degeneration early in the disease process. Still, your eye specialist will monitor your condition and will likely recommend that you eat healthy, exercise, and avoid any factors that can increase your risk, like smoking.

Intermediate Macular Degeneration

If your macular degeneration has reached the intermediate stage, the eye doctor may recommend taking AREDS 2 formula dietary supplements to help slow down the progression to late AMD.

Late Dry Macular Degeneration

For dry macular degeneration that has reached the late stage, Syfovre (pegcetacoplan injection), approved by the Food and Drug Administration (FDA) in 2023, can help to keep a form of the condition known as geographic atrophy from progressing.

With geographic atrophy, the macula begins to deteriorate, and protein collects in the area. Syfovre keeps a protein called C3 in the body's complement system (which promotes inflammation and enhances the immune response) at bay. Otherwise, the immune system may overreact and attack retinal cells.

A second drug FDA-approved in 2023, Izervay (avacincaptad pegol), works by blocking a protein known as C5 that is associated with the breakdown of retinal cells. This slows the development of geographic atrophy.

Late Wet Macular Degeneration

Two treatments can help slow wet macular degeneration. One approach is the use of anti-vascular endothelial growth factor (anti-VEGF) injections.

With wet macular degeneration, abnormal blood vessels begin to grow in the eye, spurred by vascular endothelial growth factors (VEGF). Anti-VEGF medication can inhibit VEGF in the area and help keep abnormal blood vessels from forming. The procedure involves numbing the surface of the eye and injecting the drug with a small needle.

The other anti-VEGF approach involves photodynamic therapy (PDT). A light-sensitive medication (verteporfin) is injected into your arm. The eye doctor shines a laser light on the back of your eye, which activates the medication. The medication causes the blood vessels that are creating problems to begin to break down, which slows disease progression.

What’s the Outlook for Someone With Macular Degeneration?

If you have been diagnosed with macular degeneration, it's natural to be concerned about your prognosis and what it means for your sight.

While you may be worried about losing your vision, most people with macular degeneration maintain adequate vision throughout their lives. Also, even in cases where some central vision is lost, in nearly all cases, side vision is maintained.

Summary

With macular degeneration, catching the condition as early as possible is important. In the earliest stages, AMD may have no signs but can be detected during an eye exam, making it vital to undergo these at least every couple of years if you are over 50.

When present, early signs can be subtle and may appear as mild blurring or distortion. Even subtle symptoms, as well as other concerns, should be promptly evaluated by an eye specialist. If macular degeneration is diagnosed, treatments can help to slow disease progression and help preserve vision.

Read the original article on Verywell Health.