What is Age Related Macular Degeneration?
Age Related Macular Degeneration also known as ARMD or AMD is an eye condition that causes vision loss in 50 years and older persons. It causes damage to the macula, which is located near the centre of the retina and the part of eye which is needed for sharp, central vision.

In some people, ARMD advances so slowly that vision loss does not occur for a long time. In others, the disease progresses faster. As ARMD progresses, patients experience a blurred area near the centre of vision which over time may grow bigger or there may be blank spots in the central vision. Also objects may not appear to be bright.

The Macula
The macula is made up of millions of light-sensing cells that provide sharp, central vision. It is the most sensitive part of the retina, which is located at the back of the eye. The retina turns light into electrical signals and then sends these signals through the optic nerve to the brain, where they are translated into the images we see. When the macula is damaged, the centre of your field of view may appear blurry, distorted, or dark.

What are the risk factors?
Age is a major risk factor for AMD. The disease is most likely to occur after 50 years, but it can occur earlier.
Smoking. Research shows that smoking doubles the risk of AMD.
Family history. People with a family history of AMD are at higher risk.
Diet. A diet high in saturated fat (found in foods like meat, butter, ghee and cheese)
Weight. Being overweight increases the risk.
Race. ARMD is more common in Caucasians.
Does lifestyle make a difference?
Researchers have found links between AMD and some lifestyle choices, such as smoking. You might be able to reduce your risk of AMD or slow its progression by making these healthy choices:

Avoid smoking
Exercise regularly
Maintain normal blood pressure and cholesterol levels
Eat a healthy diet rich in green, leafy vegetables and fish

How is AMD detected?
The early and intermediate stages of AMD usually start without symptoms. Only a comprehensive dilated eye exam can detect AMD. The eye exam may include the following:

Visual acuity test. This eye chart measures how well you see at distances.
Dilated eye exam. Your ophthalmologist places drops in your eyes to widen or dilate the pupils. This provides a better view of the back of your eye. Using a special magnifying lens, he or she then looks at your retina and optic nerve for signs of AMD and other eye problems.
Amsler grid. The ophthalmologist may ask you to look at an Amsler grid. Changes in the central vision may cause the lines in the grid to disappear or appear wavy.
Fluorescein angiogram. In this test, which is performed by an ophthalmologist, a fluorescent dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your eye. This makes it possible to see leaking blood vessels, which occur in a severe, rapidly progressive type of ARMD.
Optical coherence tomography or OCT. OCT uses light waves, and enables capture of high-resolution images of the eyes. After your eyes are dilated, you’ll be asked to place your head on a chin rest and hold still for several seconds while the images are obtained.
During the exam, your ophthalmologist will look for drusen, which are yellow deposits beneath the retina. Most people develop some very small drusen as a normal part of aging. The presence of medium-to-large drusen may indicate that you have ARMD.

Another sign of AMD is the appearance of pigmentary changes under the retina. In addition to the pigmented cells in the iris (the colored part of the eye), there are pigmented cells beneath the retina. As these cells break down and release their pigment, the ophthalmologist may see dark clumps of released pigment and later, areas that are less pigmented.

What are the stages of ARMD?
There are three stages of ARMD defined in part by the size and number of drusen under the retina. It is possible to have ARMD in one eye only, or to have one eye with a later stage of ARMD than the other.

Early ARMD. This is diagnosed by the presence of medium-sized drusen. People with early ARMD typically do not have vision loss.
Intermediate AMD. People with intermediate ARMD typically have large drusen, pigment changes in the retina, or both. Intermediate ARMD may cause some vision loss, but most people will not experience any symptoms.
Late ARMD. In addition to drusen, people with late ARMD have vision loss from damage to the macula. There are two categories:
In geographic atrophy (also called dry ARMD), there is a gradual breakdown of the light-sensitive cells in the macula that convey visual information to the brain, and of the supporting tissue beneath the macula. These changes cause vision loss.
In neovascular ARMD (also called wet ARMD), abnormal blood vessels grow underneath the retina. These vessels leak fluid and blood, which leads to swelling and damage of the macula. The damage may be rapid and severe, unlike the more gradual course of geographic atrophy. It is possible to have both dry and wet ARMD in the same eye.
ARMD has few symptoms in the early stages, so if you are at risk for ARMD because of age, family history, lifestyle, or some combination of these factors, you should routinely get your eyes checked up from an ophthalmologist.

How is ARMD treated?
Early AMD
Currently, no treatment exists for early ARMD, which in many people shows no symptoms or loss of vision. Your ophthalmologist may recommend that you get a comprehensive eye check-up at least once a year.
ARMD occurs less often in people who have a healthy lifestyle with diet rich in green leafy vegetables and fish. If you already have ARMD, adopting some of these habits delays the progression.

Intermediate and late AMD
The Age-Related Eye Disease Studies (AREDS and AREDS2). found that daily intake of certain high-dose vitamins and minerals slows progression of the disease in people who have intermediate ARMD, and those who have late ARMD in one eye.
The following are the recommended doses of vitamins and minerals

500 milligrams (mg) of vitamin C
400 international units of vitamin E
80 mg zinc as zinc oxide
2 mg copper as cupric oxide
10 mg lutein and 2 mg zeaxanthin
It is important to note that many supplements have different ingredients, or different doses, from those tested in the AREDS trials, so do consult your ophthalmologist about which supplement, if any, is right for you. It is important to remember that the AREDS formulation is not a cure. It does not help people with early AMD, and will not restore vision already lost from AMD. But it may delay the onset of late AMD. It also may help slow vision loss in people who already have late AMD.

Advanced neovascular ARMD
Neovascular ARMD typically results in severe vision loss. However, ophthalmologists can try different therapies to stop further vision loss. You should remember that the therapies described below are not a cure. The condition may progress even with treatment.

Injections. One option to slow the progression of neovascular ARMD is to inject drugs into the eye. With neovascular ARMD, abnormally high levels of vascular endothelial growth factor (VEGF) are secreted in your eyes. VEGF is a protein that promotes the growth of new abnormal blood vessels. Anti-VEGF injection therapy blocks this growth. This treatment may require multiple injections.
Photodynamic therapy. This technique involves laser treatment of select areas of the retina. This procedure is less common than anti-VEGF injections, and is often used in combination with them for specific types of neovascular ARMD.