Macular degeneration (aka age-related macular degeneration) is a condition that causes blurred, limited, or no vision in the center of the eye’s visual field.
Macular degeneration is an eye disease that results in irreversible impairments in visual function. The disease results from the progressive accumulation of damage to a part of the eye called the macula, a photoreceptor-dense area responsible for central vision.
Macular degeneration is classified into one of three stages: early, intermediate, or late. Signs and symptoms vary according to stage.
Early stage: Plaque deposits known as drusen accumulate in the retina. Eyesight is typically unaffected.
Intermediate stage: Drusen grow larger in size. Blurring of central vision and difficulty seeing in low light may occur, but most people experience no noticeable symptoms.
Late/Advanced stage: Drusen grow even larger in size. At this stage most people experience visual symptoms such as blurred vision, loss of color perception, difficulty seeing in low light, and central blindness.
Additionally, the late stage is further classified as either dry (a.k.a. geographic atrophy) or wet/neovascular macular degeneration. Wet/neovascular macular degeneration differs from the dry form in that it features abnormal blood vessel growth in the back of the eye. This form is less common, but much more likely to result in blindness.
The main method of diagnosing macular degeneration is a dilated fundus examination, in which the back of the eye (the fundus) is examined for the presence of drusen and certain pigmentation abnormalities. If macular degeneration is present, additional tests (e.g., optical coherence tomography, fluorescein angiography) are required to either diagnose or rule out wet/neovascular macular degeneration. Ophthalmological examinations are also used to assess visual function and eyesight changes.
There is no cure for macular degeneration, meaning treatment is focused on preventing or slowing progression. This involves avoiding risk factors that make the disease worse, like smoking. In the case of wet/neovascular macular degeneration, disease progression can be slowed with drugs called VEGF inhibitors, which are injected into the eye.
Several supplements, often in combination, have been tested for their effect on macular degeneration, including vitamin C, vitamin E, zinc, lutein, and zeaxanthin. Notably, one large clinical trial found that supplementation with lutein and zeaxanthin slowed disease progression among people with intermediate stage macular degeneration.
A Mediterranean dietary pattern has been linked to a lower risk of the disease and slower disease progression. Among individual foods, eating more fish is associated with a lower risk of developing macular degeneration, while eating more red meat tends to be associated with a higher risk. Foods rich in lutein and zeaxanthin (like green vegetables and eggs) may also help reduce the risk of developing late stage macular degeneration.
In rare cases, photodynamic therapy may be used to slow the progression of specific types of wet/neovascular macular degeneration. The procedure involves administering a drug and exposing the eye to a type of light that “activates” the drug.
Macular degeneration is caused by damage to the macula, which is the area of the retina with the highest concentration of photoreceptor cells, and thus a key factor in eyesight. The exact cause of this damage is not well understood, but it may be related to inflammation, the accumulation of lipofuscin (a type of particle arising from cell damage), oxidative stress, and reduced autophagy (a process that eliminates dysfunctional cellular material).
Aging is one of the most well-established and strongest risk factors for macular degeneration. Other risk factors include smoking, moderate-to-heavy alcohol consumption, type 2 diabetes, limited physical activity, and a lighter colored iris (e.g., blue vs. brown).
Finally, genetics can have a significant impact on the risk of macular degeneration. Two genes (CFH and ARMS2) seem especially important, as common variations in these genes can significantly increase a person’s risk of developing the disease.
- ^Seth R Flaxman, Rupert R A Bourne, Serge Resnikoff, Peter Ackland, Tasanee Braithwaite, Maria V Cicinelli, Aditi Das, Jost B Jonas, Jill Keeffe, John H Kempen, Janet Leasher, Hans Limburg, Kovin Naidoo, Konrad Pesudovs, Alex Silvester, Gretchen A Stevens, Nina Tahhan, Tien Y Wong, Hugh R Taylor, Vision Loss Expert Group of the Global Burden of Disease StudyGlobal causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysisLancet Glob Health.(2017 Dec)
- ^,Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study.Lancet Glob Health.(2021-02)
- ^Ambati J, Fowler BJMechanisms of age-related macular degeneration.Neuron.(2012-Jul-12)
- ^Stahl AThe Diagnosis and Treatment of Age-Related Macular Degeneration.Dtsch Arztebl Int.(2020-Jul-20)
- ^Evans JR, Lawrenson JGAntioxidant vitamin and mineral supplements for slowing the progression of age-related macular degenerationCochrane Database Syst Rev.(2012 Nov 14)
- ^Liwen Feng, Kailai Nie, Hui Jiang, Wei FanEffects of lutein supplementation in age-related macular degenerationPLoS One.(2019 Dec 30)
- ^Liu R, Wang T, Zhang B, Qin L, Wu C, Li Q, Ma LLutein and zeaxanthin supplementation and association with visual function in age-related macular degeneration.Invest Ophthalmol Vis Sci.(2014-Dec-16)
- ^Chew EY, Clemons TE, Agrón E, Domalpally A, Keenan TDL, Vitale S, Weber C, Smith DC, Christen W,Long-term Outcomes of Adding Lutein/Zeaxanthin and ω-3 Fatty Acids to the AREDS Supplements on Age-Related Macular Degeneration Progression: AREDS2 Report 28.JAMA Ophthalmol.(2022-Jul-01)
- ^Gastaldello A, Giampieri F, Quiles JL, Navarro-Hortal MD, Aparicio S, García Villena E, Tutusaus Pifarre K, De Giuseppe R, Grosso G, Cianciosi D, Forbes-Hernández TY, Nabavi SM, Battino MAdherence to the Mediterranean-Style Eating Pattern and Macular Degeneration: A Systematic Review of Observational Studies.Nutrients.(2022-May-12)
- ^Zhu W, Wu Y, Meng YF, Xing Q, Tao JJ, Lu JFish Consumption and Age-Related Macular Degeneration Incidence: A Meta-Analysis and Systematic Review of Prospective Cohort Studies.Nutrients.(2016-Nov-22)
- ^Cirone C, Cirone KD, Malvankar-Mehta MSLinkage between a plant-based diet and age-related eye diseases: a systematic review and meta-analysis.Nutr Rev.(2022-Sep-14)
- ^Juan Wu, Eunyoung Cho, Walter C Willett, Srinivas M Sastry, Debra A SchaumbergIntakes of Lutein, Zeaxanthin, and Other Carotenoids and Age-Related Macular Degeneration During 2 Decades of Prospective Follow-upJAMA Ophthalmol.(2015 Dec)
- ^Gopinath B, Liew G, Tang D, Burlutsky G, Flood VM, Mitchell PConsumption of eggs and the 15-year incidence of age-related macular degeneration.Clin Nutr.(2020-02)
- ^Ma L, Dou HL, Wu YQ, Huang YM, Huang YB, Xu XR, Zou ZY, Lin XMLutein and zeaxanthin intake and the risk of age-related macular degeneration: a systematic review and meta-analysis.Br J Nutr.(2012-Feb)
- ^Newman DKPhotodynamic therapy: current role in the treatment of chorioretinal conditions.Eye (Lond).(2016-Feb)
- ^Ma HH, Liutkevičienė RAge-Related Macular Degeneration: What Do We Know So Far?Acta Med Litu.(2021)
- ^Deng Y, Qiao L, Du M, Qu C, Wan L, Li J, Huang LAge-related macular degeneration: Epidemiology, genetics, pathophysiology, diagnosis, and targeted therapy.Genes Dis.(2022-Jan)
- ^Wang Y, Zhong Y, Zhang L, Wu Q, Tham Y, Rim TH, Kithinji DM, Wu J, Cheng C, Liang H, Yu H, Yang X, Liu LGlobal Incidence, Progression, and Risk Factors of Age-Related Macular Degeneration and Projection of Disease Statistics in 30 Years: A Modeling Study.Gerontology.(2022)
- ^Jingjing Zhang, Toshiharu Mitsuhashi, Toshihiko Matsuo, Takashi Yorifuji, Jun Hamada, Yangyang LiuAlcohol Consumption and Age-related Macular Degeneration: A Systematic Review and Dose-response Meta-analysisCurr Eye Res.(2021 Dec)
- ^Xue Chen, Shi Song Rong, Qihua Xu, Fang Yao Tang, Yuan Liu, Hong Gu, Pancy O S Tam, Li Jia Chen, Mårten E Brelén, Chi Pui Pang, Chen ZhaoDiabetes mellitus and risk of age-related macular degeneration: a systematic review and meta-analysisPLoS One.(2014 Sep 19)
- ^McGuinness MB, Le J, Mitchell P, Gopinath B, Cerin E, Saksens NTM, Schick T, Hoyng CB, Guymer RH, Finger RPPhysical Activity and Age-related Macular Degeneration: A Systematic Literature Review and Meta-analysis.Am J Ophthalmol.(2017-Aug)
- Visual acuity (VA) - Dario Marangoni, Benedetto Falsini, Marco Piccardi, Lucia Ambrosio, Angelo Maria Minnella, Maria Cristina Savastano, Silvia Bisti, Rita Maccarone, Antonello Fadda, Enrica Mello, Paola Concolino, Ettore CapoluongoFunctional effect of Saffron supplementation and risk genotypes in early age-related macular degeneration: a preliminary reportJ Transl Med.(2013 Sep 25)
- Visual acuity (VA) - Geoffrey K Broadhead, John R Grigg, Peter McCluskey, Thomas Hong, Timothy E Schlub, Andrew A ChangSaffron therapy for the treatment of mild/moderate age-related macular degeneration: a randomised clinical trialGraefes Arch Clin Exp Ophthalmol.(2019 Jan)
- Retinal Function - Alireza Lashay, Gholamreza Sadough, Elham Ashrafi, Mohammadreza Lashay, Morteza Movassat, Shahin AkhondzadehShort-term Outcomes of Saffron Supplementation in Patients with Age-related Macular Degeneration: A Double-blind, Placebo-controlled, Randomized TrialMed Hypothesis Discov Innov Ophthalmol.(Spring 2016)
- Cognitive Decline - Chew EY, Clemons TE, Agrón E, Launer LJ, Grodstein F, Bernstein PS, Age-Related Eye Disease Study 2 (AREDS2) Research GroupEffect of Omega-3 Fatty Acids, Lutein/Zeaxanthin, or Other Nutrient Supplementation on Cognitive Function: The AREDS2 Randomized Clinical TrialJAMA.(2015 Aug 25)