Eye HealthRSS Feed
The Basics about Eye Testing
Have your eyes tested every 2 years. Older adults and people with diabetes need to get eye exams more often.
Regular eye exams help your doctor find eye problems early, when they may be easier to treat. The doctor will also do tests to make sure you are seeing as clearly as possible.
These 2 types of doctors can perform eye exams:
What happens during an eye exam?
- You will read charts with letters and numbers so the doctor can check your vision.
- The doctor will do tests to look for problems with your eyes, including glaucoma.
- The doctor will put drops in your eyes to dilate (enlarge) your pupils. A dilated eye exam is the only way to find some types of eye disease.
What will the doctor look for during an exam?
As you get older, your eyes change. Some changes in your eyes are more serious than others. Eye diseases like glaucoma can lead to vision loss and blindness if they aren’t caught early.
Depending on your age, the doctor may look for eye problems that are common in older adults, including:
- Age-related macular degeneration (or AMD)
- Diabetic eye disease (also called diabetic retinopathy)
- Low vision
Am I at risk for eye disease?
You may be at higher risk for eye disease if you:
- Are age 60 or older
- Are African-American and over age 40
- Have diabetes
- Have a family member with diabetes or eye disease
Am I at risk for a vision problem?
Your chance of developing a vision problem increases as you get older. And you may be at higher risk if one of your parents had a vision problem, like needing to wear glasses.
Common vision problems are:
- Nearsightedness – when far away objects are blurry
- Farsightedness – when far away objects are easier to see than near ones
- Astigmatism – a condition that makes it hard to see fine details
- Presbyopia (“prez-bee-OH-bee-uh”) – problems seeing things up close
Learn more about common vision problems. See an eye doctor right away if your vision or eyes suddenly change.
Protect your vision. Get regular eye exams so you can find problems early, when they may be easier to treat.
Schedule an eye exam.
Ask your doctor or health center for the name of an eye care professional. Or use these tips for finding an eye doctor.
When you go for your exam, be sure to:
- Ask the doctor for a dilated eye exam.
- Tell the doctor if anyone in your family has eye problems or diabetes.
For more help, go through this checklist for your eye doctor appointment .
What about cost?
Check with your insurance plan about costs and co-payments. If you have Medicare, it will pay for your eye exam if you have diabetes or if you are at risk for glaucoma.
If you don’t have insurance, look here for free or low-cost eye care programs where you live.
Watch for problems.
See an eye doctor right away if you have any of these problems:
- Sudden loss of vision
- Flashes of light
- Tiny spots that float across your eye
- Eye pain
- Redness or swelling
Get regular physical exams.
Get regular exams to help you stay healthy. Ask your doctor or nurse how you can prevent type 2 diabetes and high blood pressure. These diseases can cause eye problems if they aren’t treated.
Lower your risk of falling.
Poor vision or the wrong glasses can increase your risk of falling. Falling can cause serious injuries and health problems, especially for people over age 64.
Facts About Cataracts
This information was developed by the National Eye Institute to help patients and their families search for general information about cataracts. An eye care professional who has examined the patient's eyes and is familiar with his or her medical history is the best person to answer specific questions.
Table of Contents
- Cataract Defined
- Causes and Risk Factors
- Symptoms and Detection
- Current Research
- More Information
What is a cataract?
A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are related to aging. Cataracts are very common in older people. By age 80, more than half of all Americans either have a cataract or have had cataract surgery.
A cataract can occur in either or both eyes. It cannot spread from one eye to the other.
What is the lens?
The lens is a clear part of the eye that helps to focus light, or an image, on the retina. The retina is the light-sensitive tissue at the back of the eye.
In a normal eye, light passes through the transparent lens to the retina. Once it reaches the retina, light is changed into nerve signals that are sent to the brain.
The lens must be clear for the retina to receive a sharp image. If the lens is cloudy from a cataract, the image you see will be blurred.
Are there other types of cataract?
Yes. Although most cataracts are related to aging, there are other types of cataract:
- Secondary cataract. Cataracts can form after surgery for other eye problems, such as glaucoma. Cataracts also can develop in people who have other health problems, such as diabetes. Cataracts are sometimes linked to steroid use.
- Traumatic cataract. Cataracts can develop after an eye injury, sometimes years later.
- Congenital cataract. Some babies are born with cataracts or develop them in childhood, often in both eyes. These cataracts may be so small that they do not affect vision. If they do, the lenses may need to be removed.
- Radiation cataract. Cataracts can develop after exposure to some types of radiation.
Causes and Risk Factors
What causes cataracts?
The lens lies behind the iris and the pupil. It works much like a camera lens. It focuses light onto the retina at the back of the eye, where an image is recorded. The lens also adjusts the eye's focus, letting us see things clearly both up close and far away. The lens is made of mostly water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light pass through it.
But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract. Over time, the cataract may grow larger and cloud more of the lens, making it harder to see.
Researchers suspect that there are several causes of cataract, such as smoking and diabetes. Or, it may be that the protein in the lens just changes from the wear and tear it takes over the years.
How can cataracts affect my vision?
Age-related cataracts can affect your vision in two ways:
- Clumps of protein reduce the sharpness of the image reaching the retina.
The lens consists mostly of water and protein. When the protein clumps up, it clouds the lens and reduces the light that reaches the retina. The clouding may become severe enough to cause blurred vision. Most age-related cataracts develop from protein clumpings.
When a cataract is small, the cloudiness affects only a small part of the lens. You may not notice any changes in your vision. Cataracts tend to "grow" slowly, so vision gets worse gradually. Over time, the cloudy area in the lens may get larger, and the cataract may increase in size. Seeing may become more difficult. Your vision may get duller or blurrier.
- The clear lens slowly changes to a yellowish/brownish color, adding a brownish tint to vision.
As the clear lens slowly colors with age, your vision gradually may acquire a brownish shade. At first, the amount of tinting may be small and may not cause a vision problem. Over time, increased tinting may make it more difficult to read and perform other routine activities. This gradual change in the amount of tinting does not affect the sharpness of the image transmitted to the retina.
If you have advanced lens discoloration, you may not be able to identify blues and purples. You may be wearing what you believe to be a pair of black socks, only to find out from friends that you are wearing purple socks.
When are you most likely to have a cataract?
The term "age-related" is a little misleading. You don't have to be a senior citizen to get this type of cataract. In fact, people can have an age-related cataract in their 40s and 50s. But during middle age, most cataracts are small and do not affect vision. It is after age 60 that most cataracts steal vision.
Who is at risk for cataract?
The risk of cataract increases as you get older. Other risk factors for cataract include:
- Certain diseases such as diabetes.
- Personal behavior such as smoking and alcohol use.
- The environment such as prolonged exposure to sunlight.
What can I do to protect my vision?
Wearing sunglasses and a hat with a brim to block ultraviolet sunlight may help to delay cataract. If you smoke, stop. Researchers also believe good nutrition can help reduce the risk of age-related cataract. They recommend eating green leafy vegetables, fruit, and other foods with antioxidants.
If you are age 60 or older, you should have a comprehensive dilated eye exam at least once every two years. In addition to cataract, your eye care professional can check for signs of age-related macular degeneration, glaucoma, and other vision disorders. Early treatment for many eye diseases may save your sight.
Symptoms and Detection
What are the symptoms of a cataract?
The most common symptoms of a cataract are:
- Cloudy or blurry vision.
- Colors seem faded.
- Glare. Headlights, lamps, or sunlight may appear too bright. A halo may appear around lights.
- Poor night vision.
- Double vision or multiple images in one eye. (This symptom may clear as the cataract gets larger.)
- Frequent prescription changes in your eyeglasses or contact lenses.
- These symptoms also can be a sign of other eye problems. If you have any of these symptoms, check with your eye care professional.
How is a cataract detected?
Cataract is detected through a comprehensive eye exam that includes:
- Visual acuity test. This eye chart test measures how well you see at various distances.
- Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.
- Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.
Your eye care professional also may do other tests to learn more about the structure and health of your eye.
How is a cataract treated?
The symptoms of early cataract may be improved with new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses. If these measures do not help, surgery is the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial lens.
A cataract needs to be removed only when vision loss interferes with your everyday activities, such as driving, reading, or watching TV. You and your eye care professional can make this decision together. Once you understand the benefits and risks of surgery, you can make an informed decision about whether cataract surgery is right for you. In most cases, delaying cataract surgery will not cause long-term damage to your eye or make the surgery more difficult. You do not have to rush into surgery.
Sometimes a cataract should be removed even if it does not cause problems with your vision. For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy. If your eye care professional finds a cataract, you may not need cataract surgery for several years. In fact, you might never need cataract surgery. By having your vision tested regularly, you and your eye care professional can discuss if and when you might need treatment.
If you choose surgery, your eye care professional may refer you to a specialist to remove the cataract.
If you have cataracts in both eyes that require surgery, the surgery will be performed on each eye at separate times, usually four to eight weeks apart.
Many people who need cataract surgery also have other eye conditions, such as age-related macular degeneration or glaucoma. If you have other eye conditions in addition to cataract, talk with your doctor. Learn about the risks, benefits, alternatives, and expected results of cataract surgery.
What are the different types of cataract surgery?
There are two types of cataract surgery. Your doctor can explain the differences and help determine which is better for you:
- Phacoemulsification, or phaco. A small incision is made on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. Your doctor inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the lens so that it can be removed by suction. Most cataract surgery today is done by phacoemulsification, also called "small incision cataract surgery."
- Extracapsular surgery. Your doctor makes a longer incision on the side of the cornea and removes the cloudy core of the lens in one piece. The rest of the lens is removed by suction.
After the natural lens has been removed, it often is replaced by an artificial lens, called an intraocular lens (IOL). An IOL is a clear, plastic lens that requires no care and becomes a permanent part of your eye. Light is focused clearly by the IOL onto the retina, improving your vision. You will not feel or see the new lens.
Some people cannot have an IOL. They may have another eye disease or have problems during surgery. For these patients, a soft contact lens, or glasses that provide high magnification, may be suggested.
What are the risks of cataract surgery?
As with any surgery, cataract surgery poses risks, such as infection and bleeding. Before cataract surgery, your doctor may ask you to temporarily stop taking certain medications that increase the risk of bleeding during surgery. After surgery, you must keep your eye clean, wash your hands before touching your eye, and use the prescribed medications to help minimize the risk of infection. Serious infection can result in loss of vision.
Cataract surgery slightly increases your risk of retinal detachment. Other eye disorders, such as high myopia (nearsightedness), can further increase your risk of retinal detachment after cataract surgery. One sign of a retinal detachment is a sudden increase in flashes or floaters. Floaters are little "cobwebs" or specks that seem to float about in your field of vision. If you notice a sudden increase in floaters or flashes, see an eye care professional immediately. A retinal detachment is a medical emergency. If necessary, go to an emergency service or hospital. Your eye must be examined by an eye surgeon as soon as possible. A retinal detachment causes no pain. Early treatment for retinal detachment often can prevent permanent loss of vision. The sooner you get treatment, the more likely you will regain good vision. Even if you are treated promptly, some vision may be lost.
Talk to your eye care professional about these risks. Make sure cataract surgery is right for you.
Is cataract surgery effective?
Cataract removal is one of the most common operations performed in the United States. It also is one of the safest and most effective types of surgery. In about 90 percent of cases, people who have cataract surgery have better vision afterward.
What happens before surgery?
A week or two before surgery, your doctor will do some tests. These tests may include measuring the curve of the cornea and the size and shape of your eye. This information helps your doctor choose the right type of IOL.
You may be asked not to eat or drink anything 12 hours before your surgery.
What happens during surgery?
At the hospital or eye clinic, drops will be put into your eye to dilate the pupil. The area around your eye will be washed and cleansed.
The operation usually lasts less than one hour and is almost painless. Many people choose to stay awake during surgery. Others may need to be put to sleep for a short time.
If you are awake, you will have an anesthetic to numb the nerves in and around your eye.
After the operation, a patch may be placed over your eye. You will rest for a while. Your medical team will watch for any problems, such as bleeding. Most people who have cataract surgery can go home the same day. You will need someone to drive you home.
What happens after surgery?
Itching and mild discomfort are normal after cataract surgery. Some fluid discharge is also common. Your eye may be sensitive to light and touch. If you have discomfort, your doctor can suggest treatment. After one or two days, moderate discomfort should disappear.
For a few days after surgery, your doctor may ask you to use eyedrops to help healing and decrease the risk of infection. Ask your doctor about how to use your eyedrops, how often to use them, and what effects they can have. You will need to wear an eye shield or eyeglasses to help protect your eye. Avoid rubbing or pressing on your eye.
When you are home, try not to bend from the waist to pick up objects on the floor. Do not lift any heavy objects. You can walk, climb stairs, and do light household chores.
In most cases, healing will be complete within eight weeks. Your doctor will schedule exams to check on your progress.
Can problems develop after surgery?
Problems after surgery are rare, but they can occur. These problems can include infection, bleeding, inflammation (pain, redness, swelling), loss of vision, double vision, and high or low eye pressure. With prompt medical attention, these problems can usually be treated successfully.
Sometimes the eye tissue that encloses the IOL becomes cloudy and may blur your vision. This condition is called an after-cataract. An after-cataract can develop months or years after cataract surgery.
An after-cataract is treated with a laser. Your doctor uses a laser to make a tiny hole in the eye tissue behind the lens to let light pass through. This outpatient procedure is called a YAG laser capsulotomy. It is painless and rarely results in increased eye pressure or other eye problems. As a precaution, your doctor may give you eyedrops to lower your eye pressure before or after the procedure.
When will my vision be normal again?
You can return quickly to many everyday activities, but your vision may be blurry. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has a cataract. Ask your doctor when you can resume driving.
If you received an IOL, you may notice that colors are very bright. The IOL is clear, unlike your natural lens that may have had a yellowish/brownish tint. Within a few months after receiving an IOL, you will become used to improved color vision. Also, when your eye heals, you may need new glasses or contact lenses.
What can I do if I already have lost some vision from cataract?
If you have lost some sight from cataract or cataract surgery, ask your eye care professional about low vision services and devices that may help you make the most of your remaining vision. Ask for a referral to a specialist in low vision. Many community organizations and agencies offer information about low vision counseling, training, and other special services for people with visual impairments. A nearby school of medicine or optometry may provide low vision services.
What research is being done?
The National Eye Institute is conducting and supporting a number of studies focusing on factors associated with the development of age-related cataract. These studies include:
- The effect of sunlight exposure, which may be associated with an increased risk of cataract.
- Vitamin supplements, which have shown varying results in delaying the progression of cataract.
- Genetic studies, which show promise for better understanding cataract development.
Content last reviewed in September 2009.
This online resource guide provides information about cataracts. It answers questions about causes and symptoms, and discusses diagnosis and types of treatment. It was adapted from Don't Lose Sight of Cataract (NIH Publication No. 94-3463) and Cataract: What You Should Know (NIH Publication No. 03-201).
The National Eye Institute (NEI) is part of the National Institutes of Health (NIH) and is the Federal government's lead agency for vision research that leads to sight-saving treatments and plays a key role in reducing visual impairment and blindness.
What you should know about age-related macular degeneration
Perhaps you have just learned that you or a loved one has age-related macular degeneration, also known as AMD. If you are like many people, you probably do not know a lot about the condition or understand what is going on inside your eyes.
This page will give you a general overview of AMD. You will learn about the following:
- Risk factors and symptoms of AMD
- Treatment options
- Low vision services that help people make the most of their remaining eyesight
- Support groups and others who can help
The aim is to answer your questions and to help relieve some of the anxiety you may be feeling.
What is AMD?
AMD is a common eye condition and a leading cause of vision loss among people age 50 and older. It causes damage to the macula, a small spot near the center of the retina and the part of the eye needed for sharp, central vision, which lets us see objects that are straight ahead.
In some people, AMD advances so slowly that vision loss does not occur for a long time. In others, the disease progresses faster and may lead to a loss of vision in one or both eyes. As AMD progresses, a blurred area near the center of vision is a common symptom. Over time, the blurred area may grow larger or you may develop blank spots in your central vision. Objects also may not appear to be as bright as they used to be.
AMD by itself does not lead to complete blindness, with no ability to see. However, the loss of central vision in AMD can interfere with simple everyday activities, such as the ability to see faces, drive, read, write, or do close work, such as cooking or fixing things around the house.
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 electrical signals through the optic nerve to the brain, where they are translated into the images we see. When the macula is damaged, the center of your field of view may appear blurry, distorted, or dark.
Who is at risk?
Age is a major risk factor for AMD. The disease is most likely to occur after age 60, but it can occur earlier. Other risk factors for AMD include:
- Smoking. Research shows that smoking doubles the risk of AMD.
- Race. AMD is more common among Caucasians than among African-Americans or Hispanics/Latinos.
- Family history. People with a family history of AMD are at higher risk.
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 eye care professional 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. Your eye care professional also may ask you to look at an Amsler grid. Changes in your central vision may cause the lines in the grid to disappear or appear wavy, a sign of AMD.
- 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 AMD (see below). In rare cases, complications to the injection can arise, from nausea to more severe allergic reactions.
- Optical coherence tomography. You have probably heard of ultrasound, which uses sound waves to capture images of living tissues. OCT is similar except that it uses light waves, and can achieve very high-resolution images of any tissues that can be penetrated by light—such as 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. The light beam is painless.
During the exam, your eye care professional 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 AMD.
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, your eye care professional may see dark clumps of released pigment and later, areas that are less pigmented. These changes will not affect your eye color.
Questions to ask your eye care Professional
Below are a few questions you may want to ask your eye care professional to help you understand your diagnosis and treatment. If you do not understand your eye care professional's responses, ask questions until you do understand.
- What is my diagnosis and how do you spell the name of the condition?
- Can my AMD be treated?
- How will this condition affect my vision now and in the future?
- What symptoms should I watch for and how should I notify you if they occur?
- Should I make lifestyle changes?
What are the stages of AMD?
There are three stages of AMD defined in part by the size and number of drusen under the retina. It is possible to have AMD in one eye only, or to have one eye with a later stage of AMD than the other.
- Early AMD. Early AMD is diagnosed by the presence of medium-sized drusen, which are about the width of an average human hair. People with early AMD typically do not have vision loss.
- Intermediate AMD. People with intermediate AMD typically have large drusen, pigment changes in the retina, or both. Again, these changes can only be detected during an eye exam. Intermediate AMD may cause some vision loss, but most people will not experience any symptoms.
- Late AMD. In addition to drusen, people with late AMD have vision loss from damage to the macula. There are two types of late AMD:
- In geographic atrophy (also called dry AMD), 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 AMD (also called wet AMD), abnormal blood vessels grow underneath the retina. ("Neovascular" literally means "new vessels.") These vessels can leak fluid and blood, which may lead 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 geographic atrophy and neovascular AMD in the same eye, and either condition can appear first.
AMD has few symptoms in the early stages, so it is important to have your eyes examined regularly. If you are at risk for AMD because of age, family history, lifestyle, or some combination of these factors, you should not wait to experience changes in vision before getting checked for AMD.
Not everyone with early AMD will develop late AMD. For people who have early AMD in one eye and no signs of AMD in the other eye, about five percent will develop advanced AMD after 10 years. For people who have early AMD in both eyes, about 14 percent will develop late AMD in at least one eye after 10 years. With prompt detection of AMD, there are steps you can take to further reduce your risk of vision loss from late AMD.
If you have late AMD in one eye only, you may not notice any changes in your overall vision. With the other eye seeing clearly, you may still be able to drive, read, and see fine details. However, having late AMD in one eye means you are at increased risk for late AMD in your other eye. If you notice distortion or blurred vision, even if it doesn’t have much effect on your daily life, consult an eye care professional.How is AMD treated?
Currently, no treatment exists for early AMD, which in many people shows no symptoms or loss of vision. Your eye care professional may recommend that you get a comprehensive dilated eye exam at least once a year. The exam will help determine if your condition is advancing.
As for prevention, AMD occurs less often in people who exercise, avoid smoking, and eat nutritious foods including green leafy vegetables and fish. If you already have AMD, adopting some of these habits may help you keep your vision longer.
Intermediate and late AMD
Researchers at the National Eye Institute tested whether taking nutritional supplements could protect against AMD in the Age-Related Eye Disease Studies (AREDS and AREDS2). They found that daily intake of certain high-dose vitamins and minerals can slow progression of the disease in people who have intermediate AMD, and those who have late AMD in one eye.
The first AREDS trial showed that a combination of vitamin C, vitamin E, beta-carotene, zinc, and copper can reduce the risk of late AMD by 25 percent. The AREDS2 trial tested whether this formulation could be improved by adding lutein, zeaxanthin or omega-3 fatty acids. Omega-3 fatty acids are nutrients enriched in fish oils. Lutein, zeaxanthin and beta-carotene all belong to the same family of vitamins, and are abundant in green leafy vegetables.
The AREDS2 trial found that adding lutein and zeaxanthin or omega-three fatty acids to the original AREDS formulation (with beta-carotene) had no overall effect on the risk of late AMD. However, the trial also found that replacing beta-carotene with a 5-to-1 mixture of lutein and zeaxanthin may help further reduce the risk of late AMD. Moreover, while beta-carotene has been linked to an increased risk of lung cancer in current and former smokers, lutein and zeaxanthin appear to be safe regardless of smoking status.
Here are the clinically effective doses tested in AREDS and AREDS2:
- 500 milligrams (mg) of vitamin C
- 400 international units of vitamin E
- 80 mg zinc as zinc oxide (25 mg in AREDS2)
- 2 mg copper as cupric oxide
- 15 mg beta-carotene, OR 10 mg lutein and 2 mg zeaxanthin
A number of manufacturers offer nutritional supplements that were formulated based on these studies. The label may refer to "AREDS" or "AREDS2."
If you have intermediate or late AMD, you might benefit from taking such supplements. But first, be sure to review and compare the labels. Many of the supplements have different ingredients, or different doses, from those tested in the AREDS trials. Also, consult your doctor or eye care professional about which supplement, if any, is right for you. For example, if you smoke regularly, or used to, your doctor may recommend that you avoid supplements containing beta-carotene.
Even if you take a daily multivitamin, you should consider taking an AREDS supplement if you are at risk for late AMD. The formulations tested in the AREDS trials contain much higher doses of vitamins and minerals than what is found in multivitamins. Tell your doctor or eye care professional about any multivitamins you are taking when you are discussing possible AREDS formulations.
Finally, 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 AMD
Neovascular AMD typically results in severe vision loss. However, eye care professionals 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 AMD is to inject drugs into the eye. With neovascular AMD, 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. If you get this treatment, you may need multiple monthly injections. Before each injection, your eye will be numbed and cleaned with antiseptics. To further reduce the risk of infection, you may be prescribed antibiotic drops. A few different anti-VEGF drugs are available. They vary in cost and in how often they need to be injected, so you may wish to discuss these issues with your eye care professional.
- Photodynamic therapy. This technique involves laser treatment of select areas of the retina. First, a drug called verteporfin will be injected into a vein in your arm. The drug travels through the blood vessels in your body, and is absorbed by new, growing blood vessels. Your eye care professional then shines a laser beam into your eye to activate the drug in the new abnormal blood vessels, while sparing normal ones. Once activated, the drug closes off the new blood vessels, slows their growth, and slows the rate of vision loss. This procedure is less common than anti-VEGF injections, and is often used in combination with them for specific types of neovascular AMD.
- Laser surgery. Eye care professionals treat certain cases of neovascular AMD with laser surgery, though this is less common than other treatments. It involves aiming an intense "hot" laser at the abnormal blood vessels in your eyes to destroy them. This laser is not the same one used in photodynamic therapy which may be referred to as a "cold" laser. This treatment is more likely to be used when blood vessel growth is limited to a compact area in your eye, away from the center of the macula, that can be easily targeted with the laser. Even so, laser treatment also may destroy some surrounding healthy tissue. This often results in a small blind spot where the laser has scarred the retina. In some cases, vision immediately after the surgery may be worse than it was before. But the surgery may also help prevent more severe vision loss from occurring years later.
- What is the treatment for advanced neovascular AMD?
- When will treatment start and how long will it last?
- What are the benefits of this treatment and how successful is it?
- What are the risks and side effects associated with this treatment and how has this information been gathered?
- Should I avoid certain foods, drugs, or activities while I am undergoing treatment?
- Are other treatments available?
- When should I follow up after treatment?
Coping with AMD and vision loss can be a traumatic experience. This is especially true if you have just begun to lose your vision or have low vision. Having low vision means that even with regular glasses, contact lenses, medicine, or surgery, you find everyday tasks difficult to do. Reading the mail, shopping, cooking, and writing can all seem challenging.
However, help is available. You may not be able to restore your vision, but low vision services can help you make the most of what is remaining. You can continue enjoying friends, family, hobbies, and other interests just as you always have. The key is to not delay use of these services.What is vision rehabilitation?
To cope with vision loss, you must first have an excellent support team. This team should include you, your primary eye care professional, and an optometrist or ophthalmologist specializing in low vision. Occupational therapists, orientation and mobility specialists, certified low vision therapists, counselors, and social workers are also available to help. Together, the low vision team can help you make the most of your remaining vision and maintain your independence.
Second, talk with your eye care professional about your vision problems. Ask about vision rehabilitation, even if your eye care professional says that "nothing more can be done for your vision." Vision rehabilitation programs offer a wide range of services, including training for magnifying and adaptive devices, ways to complete daily living skills safely and independently, guidance on modifying your home, and information on where to locate resources and support to help you cope with your vision loss.
Medicare may cover part or all of a patient's occupational therapy, but the therapy must be ordered by a doctor and provided by a Medicare—approved healthcare provider. To see if you are eligible for Medicare—funded occupational therapy, call 1—800—MEDICARE or 1—800—633—4227.
Where to go for services
Low vision services can take place in different locations, including:
- Ophthalmology or optometry offices that specialize in low vision
- Hospital clinics
- State, nonprofit, or for-profit vision rehabilitation organizations
- Independent-living centers
What are some low vision devices?
Because low vision varies from person to person, specialists have different tools to help patients deal with vision loss. They include:
- Reading glasses with high-powered lenses
- Handheld magnifiers
- Video magnifiers
- Computers with large-print and speech-output systems
- Large-print reading materials
- Talking watches, clocks, and calculators
- Computer aids and other technologies, such as a closed-circuit television, which uses a camera and television to enlarge printed text
Keep in mind that low vision aids without proper diagnosis, evaluation, and training may not work for you. It is important that you work closely with your low vision team to get the best device or combination of aids to help improve your ability to see.Questions to ask your eye care professional about low vision
- How can I continue my normal, routine activities?
- Are there resources to help me?
- Will any special devices help me with reading, cooking, or fixing things around the house?
- What training is available to me?
- Where can I find individual or group support to cope with my vision loss?
People with impaired vision sometimes see things that are not there, called visual hallucinations. They may see simple patterns of colors or shapes, or detailed pictures of people, animals, buildings, or landscapes. Sometimes these images fit logically into a visual scene, but they often do not.
This condition can be alarming, but don’t worry—it is not a sign of mental illness. It is called Charles Bonnet syndrome, and it is similar to what happens to some people who have lost an arm or leg. Even though the limb is gone, these people still feel their toes or fingers or experience itching. Similarly, when the brain loses input from the eyes, it may fill the void by generating visual images on its own.
Charles Bonnet syndrome is a common side effect of vision loss in people with AMD. However, it often goes away a year to 18 months after it begins. In the meantime, there are things you can do to reduce hallucinations. Many people find the hallucinations occur more frequently in evening or dim light. Turning on a light or television may help. It may also help to blink, close your eyes, or focus on a real object for a few moments.
Coping with AMD
AMD and vision loss can profoundly affect your life. This is especially true if you lose your vision rapidly.
Even if you experience gradual vision loss, you may not be able to live your life the way you used to. You may need to cut back on working, volunteering, and recreational activities. Your relationships may change, and you may need more help from family and friends than you are used to. These changes can lead to feelings of loss, lowered self-esteem, isolation, and depression.
In addition to getting medical treatment for AMD, there are things you can do to cope:
- Learn more about your vision loss.
- Visit a specialist in low vision and get devices and learning skills to help you with the tasks of everyday living.
- Try to stay positive. People who remain hopeful say they are better able to cope with AMD and vision loss.
- Stay engaged with family and friends.
- Seek a professional counselor or support group. Your doctor or eye care professional may be able to refer you to one.
Shock, disbelief, depression, and anger are common reactions among people who are diagnosed with AMD. These feelings can subside after a few days or weeks, or they may last longer. This can be upsetting to family members and caregivers who are trying to be as caring and supportive as possible.
Following are some ideas family members might consider:
- Obtain as much information as possible about AMD and how it affects sight. Share the information with the person who has AMD.
- Find support groups and other resources within the community.
- Encourage family and friends to visit and support the person with AMD.
- Allow for grieving. This is a natural process.
- Lend support by "being there."
Where can I get more information?
Content last reviewed in July 2013.
This online resource guide provides information about macular degeneration. It answer questions about its causes and symptoms, and discusses diagnosis and types of treatment. It was adapted from Don't Lose Sight of Age-Related Macular Degeneration (NIH Publication No. 02-3462) and Age-Related Macular Degeneration: What You Should Know (NIH Publication No. 03-2294).
The National Eye Institute (NEI) is part of the National Institutes of Health (NIH) and is the Federal government's lead agency for vision research that leads to sight-saving treatments and plays a key role in reducing visual impairment and blindness.