Your Questions, Expert Answers

Being diagnosed with age-related macular degeneration can be very unsettling. But just like any other health condition, once you learn more about it, you’ll probably feel more comfortable with it. As you start working on doing everything you can to slow the progression, it’s very likely that you’ll stop thinking about it as much. It will just become part of your life and hopefully be less bothersome to you.

It’s important to know that many people with AMD never have dramatic changes to their vision. So don’t think that it’s just a matter of time until something bad happens—many people never get to that point.

You’re right in that you can’t absolutely control what will happen, just like you can’t with any other health condition. But there are ways to take some control. There are five things you should be doing, four of which you’ve undoubtedly already heard from every doctor you’ve been to in the past few years. Those four are: Don’t smoke cigarettes. Don’t become obese, or if you are, try to lose some weight. Try to have a diet with more green, leafy vegetables and less refined carbohydrates. And try to get some sort of exercise five days a week. The fifth thing is the only one that’s different. That’s to take a vitamin based on the nutrient formula recommended by the National Eye Institute (AREDS2 study), which we know can help reduce the risk of progression of moderate to advanced AMD. So take the vitamin, try to do everything you can to maintain your vision where it is and assume that your vision will stay as good as it is right now.

What you’re looking for is any change from the last time you used the grid, including very subtle changes in how you see the lines of the grid. That’s why the two most important things you need to know about using the Amsler grid are these: You need to use it regularly—once a month is not enough, once a week is OK—and you have to be very consistent in how you use it. The best way to be consistent is to use the grid in the same place every time, with the same lighting conditions, and always stand the same distance from it. Without a regular weekly check and consistent use, you might miss important changes.

The third important thing is to use the Amsler grid properly. Always test one eye at a time. As you’re doing the test, make sure you’re only looking at the dot in the center, and not moving your eyes around. As you’re looking at that dot in the center, you’re seeing whether any of the lines around it seem wavy or distorted or missing or any different than the last time you did the test.

If you’re not regular and consistent in how you do the test, or if you’re not doing it properly—one eye at a time and holding the grid still—then using an Amsler grid may just give you a false sense of security.

If you think you see a change, even a subtle one, then it’s important to call your eye care provider and get it checked out. Your doctor will likely do a dilated exam and an imaging test called an OCT, looking for any changes in your macular degeneration.

People sometimes ask, how am I going to remember to use the Amsler grid every week? The answer is, find something that you can associate it with. It could be going to church, or a TV show you watch that’s on once a week, or a magazine you get in the mail once a week. It’s really anything that is a regular occurrence or habit.

The first thing I’ll tell you is that the apprehension you’re feeling about getting these injections is actually the worst part of the procedure. The idea of getting an injection in your eye sounds like it would be horrible. But what most patients would tell you from experience is it’s really not a big deal at all, and for most people there’s very little pain at all, if any. When they go back for the second injection, most people aren’t apprehensive any more, because the first time turned out to be much easier than they’d expected, and oftentimes they’re actually really enthusiastic, because their vision got better after the first injection.

Sometimes knowing more about the procedure helps relieve the apprehension, so I’ll tell you this: The injection is in the white of your eye. You’re not looking at it or watching when it’s happening. The ophthalmologist who’s doing the injection will generally talk you through it and make it quite simple. Sometimes you’ll see a temporary “floater” afterward, but that typically doesn’t last.

As far as how many injections, typically doctors will give a patient one a month for three months, and then reassess what needs to be done moving forward. Most people need ongoing injections.

Researchers are studying stem cell treatment for wet AMD. However, it’s not to the point where there’s a treatment available, and in fact the research is not even far enough along to be able to accurately predict when a treatment will be available. So it’s on the horizon, but we’re not there yet.

The problem is, even though it’s unapproved, some stem cell clinics are prematurely offering stem cell treatment for macular degeneration. I wouldn’t want anyone to go to a stem cell clinic for treatment, because it’s potentially harmful. So it’s important to wait until we really know whether it’s beneficial and how to safely do the treatment.

Just like you, I’m waiting and hoping, and I hope we’ll have a treatment in five or ten years. But again, we’re not there yet, and we don’t even know when we’ll get there.

OCT scans are usually part of the follow-up protocol for anyone with age-related macular degeneration. And they’re important to make sure that you do, in fact, have the dry kind and not wet macular degeneration, which would need further treatment. As it turns out, your doctor has probably already done this scan, even if you didn’t realize it at the time. You can confirm that with your doctor.

You can ask your doctor about the risk of progression regardless of the OCT scan. There are ways that doctors can look and have some idea of who’s more or less likely to do worse over a certain period of time. For example, for someone with very mild macular degeneration, the likelihood of having any issues over the next five years is very, very low. And there are certain things in your eyes that may tell your doctor if there are more reasons for concern.

I generally encourage patients to consider clinical trials. As a matter of fact, I had several patients who were part of the AREDS2 clinical trial, which was so groundbreaking in helping us understand how we may be able to slow the progression of dry age-related macular degeneration. However, it’s important to look into a couple of things first. Number one: Is this clinical trial legitimate? If a trial requires participants to pay, for example, then it’s likely not a legitimate clinical trial. Generally, clinical trials are at no cost to the patient, and sometimes patients even get paid travel fees to participate.

Being in something like a National Eye Institute-sponsored trial or a legitimate drug company’s trial is potentially very beneficial. That said, somewhere between a third to a half of the people in a clinical trial are just getting whatever the standard for today is, whether that’s injections for wet AMD or observation and when appropriate a vitamin based on the nutrient formula recommended by the National Eye Institute (AREDS2 study) for dry AMD. So not everybody in the trial is receiving the treatment that’s being tried. There’s still a benefit, though. Oftentimes in trials, if the treatment that’s being tried has been shown to have benefits, the participants who were in the control groups are offered the new treatment.

The first thing you should look at is what kind of sunglasses you’re using. There could be a big difference between an inexpensive over-the-counter pair of sunglasses versus a pair of sunglasses that have polarized lenses. Polarized lenses do a much better job of cutting down glare than just plain, dark sunglasses do. [See our article on protecting your eyes from UV rays.]

Second, the doctor probably talked to you about taking a vitamin based on the nutrient formula recommended by the National Eye Institute (AREDS2 study). You should take one that has lutein and zeaxanthin. Part of what these two antioxidants do is build up what’s essentially your "internal sunglasses" inside your eyes—your macular pigments. When you build up that pigment layer, it helps to essentially shield your photoreceptors, a part of your retina, from the light. The average American gets less than two mg. a day, and in order to support that pigment layer and have the beneficial effects, you need at least six mg. a day, so unless you‘re eating a lot of spinach and kale and broccoli, then you’ll need to get them through supplements. Several months of taking supplements with lutein and zeaxanthin should help to decrease your light sensitivity and the sensation of glare.

And then finally, you should know that just because you have age-related macular degeneration doesn’t mean there may not be some other eye issue that could be causing the glare. Talk to your doctor about making sure your eyes aren’t dry or that you don’t have cataracts or some other condition that could be addressed.