Millions of people who are living with Age-related Macular Degeneration (AMD) were once asking the same question: What does my future look like? The answer is, it’s hard to know. Most people over age 50 have drusen—the yellow-colored deposits that gather near the macula. In some people, the condition progresses very slowly and leads to little change in vision. In others, AMD advances faster and may lead to some loss of vision in one or both eyes.
You can’t predict your future with AMD, but it’s worth knowing all you can about what may happen so that you can plan ahead—while you do everything you can to try and limit your vision loss.
Everyone’s AMD journey is different. But the stages that macular degeneration progresses through—if it progresses—and how each stage affects vision are usually the same. Besides vision-related symptoms, many people also experience a range of emotions as their condition advances, from shock on first being diagnosed to fear and sadness. Sooner or later, though, most people come to terms with their diagnosis and resolve to do all they can to protect their vision.
In the beginning, your doctor may detect small deposits, or drusen, in your macula that can damage the eye, though you may not notice any change in your vision. The drusen may be in one or both eyes.
What does it mean for me? Some people with drusen never develop any central vision loss at all—while the drusen typically won’t disappear, they might not develop to a point where they cause problems. This is why many doctors recommend prevention strategies, such as vitamin supplementation, that may limit further damage to your macula.
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Drusen can slowly damage the macular cells and start to affect your central vision. But if only one eye is affected and your other eye compensates, you may not notice significant vision changes.
What does it mean for me? You may notice a blurred spot in the center of your vision. Using a stronger light will make reading and other close tasks easier, and you may be able to still drive in the daytime. Still, as your vision changes you’re likely to feel a sense of loss and to fear for your future. Just remember: You may have reached a plateau that can last for years.
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If your AMD progresses to the advanced stage, also known as geographic atrophy, which can happen over many years or more rapidly, your central vision will likely be significantly affected by a blind spot in the center of your visual field.
What does it mean for me? Your central vision is how you’re able to see things in detail, read, write, do close work, use stairs and recognize faces. So, with advanced AMD daily tasks and activities can become hard to do. It’s a scary thought—but with help, many people learn new ways of doing things by using their peripheral vision (AMD typically only affects your central vision) and trying the many low-vision tools and technologies that are available.
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About one in 10 people who have dry AMD go on to develop wet AMD, which can lead to significant vision loss. People with certain types of drusen are more at risk of this form of the condition, even in the early stages of AMD, so ask your doctor. Especially if your risk factor is higher, it’s important to monitor your vision weekly for any changes, because wet macular degeneration typically comes on suddenly and can be treated to limit the damage.
What does it mean for me? In addition to central vision blurring, the wet form of AMD tends to drastically distort what you see in front of you. It may be harder to discriminate between light and dark tones, and colors will appear dull. Vision loss may be serious enough that you’ll need to make many adjustments in how you get by at home and outside—but prompt treatment can decrease risk of vision loss.
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Peripheral vision, which is unaffected by AMD, is responsible for 65% of your visual field.
In a small number of people who have dry AMD—around one in 10—the condition progresses to the wet form. Wet macular degeneration typically comes on suddenly and tends to distort vision rapidly over weeks or months. But, unlike dry macular degeneration, wet AMD is treatable, and researchers are working on some promising new drugs. That’s why it’s important to catch wet AMD early by monitoring your vision so you can begin treatment right away.
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A lot will depend on the stage of your disease—early or late—and if you have other risk factors. Smoking, for example, raises your risk. Statistically, if one of your eyes is affected with early AMD, there’s a one in five chance that eventually AMD will occur in your other eye. If you have more advanced AMD in one eye, you have a 50% chance of developing AMD in your other eye in the next five years. You can try to minimize your risk by taking action to protect your vision.
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While peripheral vision is important when your drive, you need your central vision to see street signs and the road ahead. If your AMD progresses to the point where you can’t read an eye chart (visual acuity) or have blind spots, it will impact your safety and others’. Your state’s Department of Motor Vehicles has regulations governing minimum acceptable acuity; some DMVs allow daytime driving for people with low vision or will let you use special glasses. If you don’t already use a smartphone, this might be a good time to learn so you can maintain your independence by using one of the many ridesharing apps.
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AMD rarely leads to complete blindness, because even in the advanced stage, it typically only affects central vision, not peripheral or side vision. Many people who are legally blind because of advanced or wet AMD learn to get by with their peripheral vision and by using low vision tools and assistive technologies.
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There’s evidence that some types of macular degeneration have a genetic component, since it tends to run in families. In fact, a person’s chances of developing age-related macular degeneration are three times higher if they have a close relative with AMD. What can you do? Let your kids know that it’s never too early to start practicing macular degeneration prevention strategies—no tobacco, a healthy diet, plenty of aerobic exercise and good UV filtering sunglasses. If they are over 50, they should also have an annual comprehensive eye exam that will spot any signs of macular degeneration.
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