Understanding the Progression: Four Key Stages of AMD Demystified

The Four Stages of AMD

AMD the human eye is, perhaps, the most wondrous—and wondrously complex—organ in the human body. It is, moreover, among the most prone to ailment. While our eyes are relatively minor organs in the grand scheme of our biology, they’re afflicted by a disproportionately large number of conditionsm including cataracts, color blindness, glaucoma, diabetic retinopathy, and more.
One condition, age-related macular degeneration, or AMD, is particularly feared. And no wonder: There’s no cure for it, whether in the dry forms or wet variants of the condition. But while AMD may no way be a good diagnosis, it’s also far from the worst one, and there are many reasons for those diagnosed with the condition to look at the days head with optimism.
“Most patients will not end up with advanced AMD, which can sometimes be associated with legal though not complete blindness,” says Jayanth Sridhar, M.D., an assistant professor of clinical ophthalmology at the Bascom Palmer Eye Institute of the University of Miami’s Miller School of Medicine in Florida. “The majority of AMD patients maintain functional vision with appropriate therapy.” Knowing the precise mechanism that underpins the development of this condition can help you be one step ahead if you have been diagnosed office with this issue or know someone who has.
The macula simply put, controls our sharp, central vision . It is a small part of the retina, and it is located in the back of your eye. It is made up of light-receptor cells. When one has AMD, the macula is affected. If the macula is damaged by AMD, people can experience blurriness which may be gradual or suddenly. Wavy lines tend to appear straight, and people can have blind spots in the center of their field of vision. Almost always, if it is not treated, this condition affects daily activities that require central vision. They include cooking, reading, driving, and sometimes, even recognizing faces .
There is no consensus yet on why some people get AMD and others don’t. The Mayo Clinic says, “no one knows exactly what causes dry macular degeneration” but some research shows that heredity and environment both play vital roles. Caucasians, people who are overweight, smoke cigarettes, over 50 years, or have high blood pressure are at greater risk of AMD. People with AMD in their family are also more likely to be impacted.

Dry AMD: Early Stage

“Dry” AMD is the most common form of the disease, affecting somewhere between 85% and 90% of patients. (According to the National Institutes of Health, approximately 11 million people in the United States have AMD, most over age 50.)
Dry AMD usually progresses quite slowly; people can live with the condition for years without discomfort or symptoms that suggest they need treatment.
The disease, in the meantime, has three stages. “The overwhelming percentage of patients with AMD start off with the ‘dry’ form, which in its early stage is distinguished by the presence of drusen under the retina,” says Priyatham Mettu, M.D. who is an ophthalmologist as well as a retinal specialist at Duke Eye Center in Durham, NC . Drusen is trash that is basically being accumulated because the cells are either sick or there is a failure of clearance in a patient, according to Dr. Mettu . At the very first stage, “about half of the patients are asymptomatic. They do not have a lot of vision loss,” he adds .
The other half of early AMD patients, however, often have significant trouble seeing in low light, says Dr. Mettu: “What that means is that trying to read a menu in a dimly lit restaurant, for instance, can be a real challenge.”
When they do occur, early symptoms might include dark or blank spots in the center of one’s field of vision, or a dulling or dimming of colors—the result of light-receptor cells in or near the fovea, where visual acuity in the retina is highest, atrophying or dying off.
When a doctor makes a decision, they might recommend one of the “AREDS” (Age-Related Eye Disease Study) antioxidant supplements. The National Eye Institute’s large clinical trials in 1999 and 2006 were sponsored to prove that certain antioxidant vitamins and minerals help slow progression of the disease.

Dry AMD: Intermediate Stage

More sized drusen marks the intermediate stage. At that point, you might have a slight loss of vision or need, for instance, a brighter light for reading, but it is highly unlikely that you will become blind at this stage.
Drusen —that is, the condition described by the development of material under the retina—tend to be described as either “hard” or “soft.” These designations, however, are not terms of texture, but terms of appearance, with “hard” drusen being small, well-defined, and, as reported by the Mayo Clinic, “indicative of lower risk of advanced macular degeneration and vision loss” . “Soft” drusen are larger, more likely to cluster close together, and, according to the American Academy of Ophthalmology, have edges “that are not as clearly defined as hard drusen” . Their size, their clustering and their prevalence towards the center of the retina means that they are likely to cause some physical distortion of the vision.
A 25-year-old woman sees an optometrist because of a family history of early Age-related Macular Degeneration (AMD) in her mother. Her mother lost some of her central vision from  her late 50s. On examination, the doctor finds that the woman has 20/20 acuity with her correction. Her lens, pupils, and visual fields are normal and she has only a few hard drusen in each macula.
She asks what her risk is of losing some of her central vision from AMD in the next 5 years. The doctor responds that,
On the other hand, patients with intermediate dry risk developing the advanced stage of dry AMD, geographic atrophy. They may also develop wet , which has the potential to be an equally, if not more, legitimately grave condition. People may be comforted that they are not at increased risk of losing a significant proportion of their vision or of some other dramatic symptoms.

Dry AMD: Advanced stage

The advanced stage of dry AMD is also called “geographic atrophy”. This condition represents fovea involvement. Here, blind spots are a sure probability, along with difficulty of seeing certain things central vision is required for, primarily reading text and recognizing faces. However, there are techniques learning to remember the shape of an object and see it in peripheral vision, rather than focus on it with central vision, as well as specific behaviors to help patients tolerate some of the most disturbing features of this stage, such as using a certain type of light bulbs to read.
According to Dr. Sridhar, “Those who happen to have advanced dry AMD, which is about five percent of patients in the U.S, should know that there is a lot of encouraging treatment research going on today, including work with stem cell and gene therapies. And even in the worst-case scenarios, AMD does not typically result in total blindness unlike with other conditions we treat, such as glaucoma. Peripheral vision is almost always maintained, even with advanced AMD.”

Wet AMD

Also known as neovascular AMD, when left untreated “wet” AMD reliably causes more rapid and more Et factor basis plus astrograde serious vision loss than the dry form. With few exceptions, wet AMD develops after or in the middle of the intermediate stage of the disease . A very small percentage of patients develop wet independently of the dry form. Here’s one simple metapbor as the two forms of AMD are described as ‘dry ’ and ‘wet’ .
When I talk to patients about wet AMD, I describe a blood vessel sort of sneaking up from beneath the retina. In some ways that’s a colloquialism, but it’s also the reality ,” says Dr. Mettu. “We don’t necessarily know when that vessel will form or what part of the population is at greatest risk.
“Wet arises from the growth of abnormal blood vessels beneath the macula,” Dr. West says. “When these leak blood, fluid, or both, it builds up and causes distortion of vision.” For all intents and purposes, it’s not a normal vessel run amok. “It is a pathologic or abnormal vessel that grows from the retina’s vascular bed. It can also break through the retina as it grows. It can leak fluid, bleed, and scar—all activities that are bad enough for the retina’s light-sensing cells that they can get injured and even die, leading to decreased vision and very rarely, blindness.” Symptoms include straight lines appearing wavy or crooked, the result of fluid oozing up from leaking blood vessels and physically raising the macula.
Another difference between wet AMD and dry AMD involves the time line of the disease progression. According to the obtained resources, while the latter condition occurs and develops gradually within years or decades, the dry form is known to progress with stunning speed. As the authors of the American Academy of Ophthalmology article say, “Wet AMD is less common but much more serious”; however, the experts also specify, “You lose vision faster with wet AMD”.
We know, it sounds scary, but here’s a silver lining: Wet AMD, when caught early, is highly treatable. This medication, delivered in a targeted eye injection, is an anti-vascular endothelial growth factor or VEGF drug. The weirdness of having these abnormal vessels “sneak up” on your retina over the past few years is bad news, agreed. And yes, you do need the medication shot directly to your eye. But the most vital thing to remember is that it may actually save and sometimes even improve your vision .
What you should do, after you got your results, is to see your doctor: to timely detect either wet or dry form of AMD is not a tragedy for your eyesight. However, the only way to secure it and keep it as long as possible is to see your eye doctor on a regular basis.