Age-Related Macular Degeneration

Topic Overview

What is age-related macular degeneration?

Age-related macular degeneration is a disease that causes blurring of your central vision. The blurring happens because of damage to the macula, a small area at the back of the eye . The macula helps you see the fine detail in things that your eyes are focusing on.

Macular degeneration makes it harder to do things that require sharp central vision, like reading, driving, and recognizing faces. It does not affect side vision, so it does not lead to complete blindness.

There are two types of macular degeneration-wet and dry. The dry form is by far the most common type. The wet form is much less common, but it happens more quickly and is more severe.

• The dry form accounts for about 9 out of 10 cases of macular degeneration.¹ It develops slowly and causes central vision to become dimmer or more blurry over time. It usually does not cause severe vision loss unless it turns into the wet form.
• The wet form accounts for only about 1 out of 10 cases of macular degeneration.¹ It can cause serious vision loss within months or even weeks. People who have the wet form have the dry form first.

You may have either type in just one eye, but over time you may get it in the other eye too.

What causes macular degeneration?

Macular degeneration is the result of damage to the nerve cells in the macula. The process that leads to this damage is different for each type.

• The dry form is a gradual process. As you age, the cells in the macula start to thin and break down, and waste deposits build up in the back of the eye. Over time, this damages the macula.
• The wet form happens when abnormal blood vessels grow in the back of the eye. These blood vessels break easily and leak blood and fluid under the macula. This can quickly damage the macula and distort your central vision.

Experts are still studying the causes of both forms, but they know several different things may play a part. You are more likely to have macular degeneration if:

• You are an older adult. The risk of getting macular degeneration increases as you age, starting at around age 50.
• A close family member has macular degeneration.
• You smoke.
• You are white.

What are the symptoms?

The main symptom of macular degeneration is dim or fuzzy central vision. Objects may look warped or smaller than they really are. You may have a blank or blind spot in the center of your field of vision. As the disease gets worse, you may have trouble with tasks like reading and driving.

The two forms differ in how quickly symptoms develop and how severe they are.

• If you have the dry form, your vision will probably become blurry slowly. You may have it for several years before it affects your ability to read, drive, and do everyday activities.
• In the wet form, vision loss happens quickly and can be severe.

Often the first symptom of the wet form is that straight lines look wavy or curved. If you think you might have wet macular degeneration, see your doctor right away. In some cases, quick treatment may help you keep your central vision.

How is macular degeneration diagnosed?

A doctor can usually detect macular degeneration by doing a regular eye exam and asking questions about your past health. You may have some vision tests, including an ophthalmoscopy. This test lets your doctor look at the inside of your eye. If you have macular degeneration, your doctor may see drusen. These are yellowish white waste deposits that can build up at the back of the eye.

The doctor may have you look at a chart with lines and a dot at the center. This is called an Amsler grid . It can help detect changes in your central vision. If you have the wet form, the lines near the center dot will look wavy or curved, or you may see a blank spot or hole in part of the grid.

If you have macular degeneration, your doctor will want to see you for regular follow-up exams. You can also use an Amsler grid at home. Looking at it every day will help you keep track of any changes in your vision.

How is it treated?

At this time, there is no cure for macular degeneration. But experts are exploring many new treatments that hold hope for the future. Your doctor can keep you up to date on any changes in treatment that might help you.

A diet rich in antioxidant vitamins and minerals may help slow down vision loss in some people with moderate to severe macular degeneration.² Talk to your doctor about whether this diet might help you.

If you have the wet form of macular degeneration, you may have one or more of the following treatments:

• Photodynamic therapy.
• Injections of medicine into your eye.
• Laser surgery.

These treatments can't restore central vision, but they may slow down vision loss. If your doctor recommends photodynamic therapy, injections, or laser surgery, it is important to have it done right away.

How can you cope with vision problems?

There are many things you can do at home to make the most of your remaining vision. Using vision aids like magnifying glasses or brighter lighting in your house may help you see better. You may be able to get large-print books and newspapers or a computer screen that displays large print or pictures. Having a good support network is important too.

If you need more help, your doctor may refer you to an occupational therapist or rehabilitation specialist. These professionals can help you get the tools and training you need to cope with reduced vision. Local agencies may also offer services for people with vision loss.

It can be scary to find out that you have a vision problem that will get worse. It is common to have a range of emotions. But if you feel very sad or hopeless, talk to your doctor. Antidepressant medicines may help. Your doctor can also refer you to a counselor who helps people adjust to living with low vision.

Frequently Asked Questions

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	Macular degeneration: Coping with reduced vision

Cause

Vision loss from age-related macular degeneration (AMD) is caused by damage to the light-detecting nerve cells in the macula. The cause of this damage to the nerve cells is unknown.

Dry AMD

In dry AMD, cells in the macula break down, resulting in vision problems. No one knows why some people get AMD but others do not. In the early stages of dry AMD, a type of debris called drusen, which comes from cells, builds up in the area under and around the macula. When viewed with ophthalmoscopy, which is a way of seeing inside the eye, drusen appear as yellowish white spots under the retina. Although some small drusen can usually be found in the macula as a normal result of aging, the development of numerous large drusen is associated with AMD.²

Wet AMD

Wet AMD is caused by the growth of abnormal blood vessels under the macula. Experts are still studying why this happens. The blood vessels break easily and leak blood and fluid under the macula. The excess blood and fluid, along with abnormal scar tissue that forms under the macula, distort and damage the macula.

Symptoms

Dry age-related macular degeneration (AMD) and wet age-related macular degeneration both cause vision loss and may produce similar symptoms:

• Central vision becomes dim, fuzzy, or less sharp.
• Reading requires more light than in the past.
• You find it harder to see people's faces clearly.
• Objects appear distorted or smaller than they really are.
• A new blank or blind spot develops in your central field of vision.
• Straight lines begin to appear wavy or curved. This is usually the first symptom of wet AMD.
• You have a loss of central vision that does not go away or becomes worse over time. The loss may be severe and rapid if you have wet AMD.

The symptoms of wet and dry AMD differ in two important ways:

Rate of development.

• Dry AMD happens slowly. Vision changes caused by dry AMD may be so slow and gradual that you do not notice them. You may have the disease for several years before it affects your ability to read, drive, and do everyday activities. If you have AMD in only one eye, you may not notice minor vision changes because your unaffected eye automatically makes up for vision problems in your other eye.
• Wet AMD happens suddenly. Symptoms caused by wet AMD tend to appear suddenly and get worse rapidly.

Severity.

• Dry AMD symptoms are usually mild at first. Later, the symptoms can be more severe.
• Wet AMD tends to cause more severe vision changes and vision loss.

What Happens

Dry AMD

With dry age-related macular degeneration (dry AMD), vision gradually becomes worse over the years. As the cells and blood vessels beneath the macula age, they begin to thin and break down. When these cells and blood vessels stop working, the nerve cells in the macula that detect light cannot function properly. As more and more of the nerve cells in the macula break down, vision loss very slowly gets worse. At present, there is no treatment to prevent this vision loss. But a diet rich in zinc and antioxidant vitamins may slow the progression of vision loss.

Vision loss from dry AMD is often slow and gradual, allowing you to make adjustments over time. A small percentage of people who have dry AMD develop the abnormal blood vessels that lead to wet AMD.

The impact AMD has on your life will depend on the severity of your vision loss and your lifestyle. Even though AMD may affect central vision, it does not cause complete blindness, and most people keep good side (peripheral) vision. For information on adapting to reduced vision, see the Home Treatment section of this topic.

Wet AMD

With wet age-related macular degeneration (wet AMD), vision can suddenly become worse. Wet AMD begins with the growth of abnormal blood vessels under the macula, which is the part of the eye that is responsible for central vision. These blood vessels break easily. They leak blood and fluid and cause scar tissue, all of which push against the macula. They change the macula's shape and cause it to send distorted images to your brain. Straight lines begin to appear wavy or curved, and objects may seem oddly shaped or smaller.

Scar tissue also cuts off the macula from the normal support cells that it needs in order to work. Nerve cells in the macula begin to die, causing a loss of central vision.

When the nerve cell damage is contained in a small area, it causes a blank spot to develop in your field of vision. As this area expands, the blank spot also gets larger.

If not treated, the scar beneath the macula may continue to grow, affecting more and more of the nerve cells in the macula. Vision loss gets worse as more of the macula becomes involved. The entire macula may be destroyed by this process, resulting in a complete loss of central vision.

Treatment can sometimes delay or prevent further vision loss, but it cannot reverse vision loss that has already occurred. Normal use of the eyes (such as for reading or watching television) will not speed up vision loss or make the condition worse. Loss of vision from wet AMD may progress rapidly. This does not allow much time for those affected to adjust to the vision loss and find ways to live with it.

For information on adapting to reduced vision, see the Home Treatment section of this topic.

What Increases Your Risk

The major risk factors for age-related macular degeneration (AMD) include:

• Older age. Age is the biggest risk factor for developing AMD. About 2% of people who are older than 50 have AMD. After age 75, up to 46% of people may have some form of it.²
• A family history of the disease. You are much more likely to get AMD if a close relative has it.
• Race. Whites appear to have a higher risk than blacks or Hispanics.
• Smoking. People who smoke are about twice as likely to develop AMD than nonsmokers. The risk appears to be higher for people who have been heavy smokers or who have smoked for a long time.²
• One eye with wet AMD. Nearly half of people with wet AMD in one eye get wet AMD in the other eye within 5 years.¹

Other risk factors for developing AMD may include:²

• Deposits at the back of the eye called drusen. Eyes with large, soft drusen deposits are at a greater risk for developing abnormal blood vessels and wet AMD.
• A diet high in saturated fat and cholesterol.
• Low dietary intake of carotenoids, antioxidant vitamins, and zinc.

When To Call a Doctor

Wet age-related macular degeneration (wet AMD) can damage your vision within days or even hours. This damage can be severe and permanent.

Call your doctor immediately if:

• You have a sudden, rapid loss of vision.
• You suddenly notice a new blank or dark spot in the center of your vision that does not go away.
• Straight lines appear wavy or curved, or objects begin to change size or shape or appear distorted.

Your doctor will refer you to an eye doctor (ophthalmologist) if needed.

Call your doctor immediately if you see either of the following on an Amsler grid :

• Lines that change or appear wavy and curved
• A blank spot that you have not noticed before in the grid

These are signs of the more serious form of the disease, wet AMD. If you have been diagnosed with dry age-related macular degeneration (dry AMD), check your vision in each eye using an Amsler grid every day or as often as your doctor recommends. Dry AMD does not usually develop into wet AMD, but be on the lookout for signs of wet AMD.

The slow vision loss caused by dry AMD does not demand urgent care. The fading of colors or dimming of vision may progress so slowly that it does not bother you, especially if it only affects one eye. But even gradual changes in vision may signal a larger problem.

Call your doctor to discuss whether you need an eye exam if:

• You need more light to read than you used to.
• Colors seem faded or less vivid than they used to.
• Your vision seems to be getting more blurry.

In general, sudden changes in your vision that do not go away need immediate attention. Gradual or slow changes in vision tend to be less serious. If you have noticed gradual changes in your vision, talk to your doctor about whether you need an eye exam.

The American Academy of Ophthalmology recommends that all people between 40 and 54 years of age have a comprehensive eye exam every 2 to 4 years to help detect AMD early. The following table summarizes the recommendations for comprehensive eye exams:³

Watchful Waiting

Watchful waiting means to take a wait-and-see approach.

Watchful waiting is not appropriate if you have rapid vision loss or sudden changes in your vision. If you have any rapid vision changes, see your doctor as soon as possible. Immediate treatment may be able to slow vision loss caused by wet AMD. Delaying treatment for wet AMD could mean further loss of central vision.

If you have mild, slow vision loss, such as that caused by dry age-related macular degeneration (dry AMD), watchful waiting is appropriate. There is no treatment for dry AMD, and you may never develop vision loss to the point that it disrupts your regular lifestyle.

Who To See

Age-related macular degeneration (AMD) can usually be detected during a routine eye exam by your regular doctor or an eye care professional (optometrist or ophthalmologist).

An ophthalmologist who specializes in problems with the retina and macula can diagnose which type of AMD you have. Also, laser surgery and medicine injections for wet AMD are done by an ophthalmologist.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

A doctor can usually detect age-related macular degeneration (AMD) with a regular eye exam. The doctor first will find out more about your symptoms, past eye problems, and other health conditions by asking you about your medical history.

Next, the doctor will test your central vision with a visual acuity test. During this test, you cover one eye and read letters on a wall chart 20 ft (6.1 m) away. Central vision gets worse over time in a person with AMD, and a visual acuity test can measure whether your vision has gotten worse since your last exam. The doctor may also test your visual field, which includes both your central vision and side (peripheral) vision.

Ophthalmoscopy allows the doctor to examine the inside of your eye (see a picture of macular degeneration ). Using a beam of light and a magnifying lens to view the inside of your eye, the doctor will examine your retina and macula for signs of AMD. The presence of bright, yellowish white deposits called drusen is one of the early signs of AMD. If you have wet AMD, the doctor may be able to see blood in part of the retina or a white or gray scar near the macula.

An Amsler grid test can also detect wet AMD. An Amsler grid is a series of straight lines that run up and down and left to right. The grid has a dot at the center. If you have wet AMD, the lines near the center dot will appear wavy or curved instead of straight, or you may see a blank spot or hole on part of the grid.

For more information on vision testing, see the topic Vision Tests.

If your doctor thinks that you may have wet AMD, you may also have a test called an eye angiogram to find out if abnormal blood vessels are growing beneath the macula. The test can also locate leaky blood vessels under the macula and help your doctor determine whether they can be treated.

If you have AMD and some loss of vision, your doctor may perform a low-vision evaluation to help find ways for you to make the most of your remaining vision and keep your quality of life.

Early Detection

Anyone older than 50 is at risk of developing age-related macular degeneration. Doctors screen for the disease during regular eye exams by looking for deposits called drusen and other changes in the macula caused by AMD.

Regular use of an Amsler grid can detect the progression of dry AMD to wet AMD. People who have dry AMD and those who have an increased risk for developing AMD should use the Amsler grid.

Treatment Overview

Dry AMD

There is no cure or treatment for dry age-related macular degeneration (dry AMD) at this time.

You may not have significant problems with your vision for many years. Vision loss happens very slowly and is usually not severe. It often affects only one eye, and you may be able to adjust for the vision loss with the unaffected eye. If you have dry AMD, follow your doctor's advice for having regular exams and watching the condition at home (such as using an Amsler grid ), because dry AMD may sometimes develop into wet AMD.

Your doctor may advise vitamin supplements or a diet rich in zinc and antioxidant vitamins. These vitamins may help slow the progression of advanced AMD and delay vision loss if you already have AMD.

Wet AMD

In a few cases, wet age-related macular degeneration (wet AMD), which is the more serious form of the disease, can be treated with photodynamic therapy (PDT), medicines that are injected into the eye, or thermal laser photocoagulation surgery.

Treatment cannot cure AMD, but it can slow its progression. Other types of treatments using radiation are being investigated. But these treatments are considered experimental and are not part of standard treatment.

Some cases of wet AMD cannot be treated by either laser photocoagulation or PDT. And PDT can only be used for a minority of cases.⁴

Treatment cannot restore vision, but it can sometimes slow down or delay further damage to your central vision. But in most cases, growth of fragile new blood vessels in wet AMD recurs, and even repeated treatment is usually not effective over the long term in preventing some loss of central vision.

Because wet AMD often causes rapid and severe loss of central vision, it is important not to delay treatment if your doctor recommends it.

If you already have AMD

Do not smoke. For more information about quitting smoking, see the topic Quitting Smoking.

A large study by the U.S. National Eye Institute (NEI) found that taking zinc and antioxidant vitamins may help slow the progression of advanced AMD and delay vision loss if you already have AMD.⁵

If you already have vision loss from AMD, your doctor may also conduct a low-vision evaluation. The evaluation will help you and your doctor find ways to make the best use of your remaining vision. It also can include suggestions for counseling and training on dealing with reduced vision to help you keep your quality of life as much as possible.

Because AMD often leads to a significant loss of vision and, in most cases, there is no effective treatment, finding out that you have AMD can be very difficult. Your doctor can refer you to counselors who specialize in helping people adjust to living with low vision.

Prevention

You cannot prevent age-related macular degeneration (AMD). But there are some steps you can take that may lower your risk of developing AMD.

• Have regular eye exams. Eye exams may help determine whether you are at risk for developing AMD or, if you have AMD, may detect it early. If it is treatable, early detection may help reduce or delay any loss of vision.
• Do not smoke. People who smoke may be twice as likely to develop AMD than those who do not smoke.² Even after you stop smoking, this increased risk may persist for many years.
• Eat plenty of fruits and nuts. Eating regular servings of fruits and nuts may lower your chances of getting AMD.^{6, 7}

Several measures may help prevent wet AMD if you already have the dry form:

• Eat a diet rich in dark green, leafy vegetables (such as spinach). Your doctor may also advise you to take antioxidant vitamins and zinc. A diet rich in vitamins may slow the progression of AMD and delay vision loss. But this treatment is most effective if you already have moderate AMD. Check with your doctor before taking any supplements. Some can have harmful side effects, especially in high doses.⁵
• Eat fish. Eating fish, a good source of omega-3 fatty acids, may lower your chances of getting AMD.²
• Limit harmful fats. Too much saturated fat and cholesterol in your diet may increase your risk that AMD will get worse.²
• Get regular exercise and stay at a healthy weight. These choices may lower your risk of developing wet AMD.⁸

Check your vision in each eye with an Amsler grid every day or as often as your doctor recommends. Watch for vision loss by looking for changes in your ability to read, see the television clearly, or see people's faces at a distance. If you notice a change, discuss with your doctor whether you need to have an eye exam.

Home Treatment

People with either type of age-related macular degeneration (AMD) in one or both eyes should check the vision in each eye using an Amsler grid every day or as often as the doctor recommends. If any of the lines on the grid change or begin to appear wavy and curved, or if you notice that your vision is getting worse, call your doctor. If wet AMD has started to develop or is progressing, early treatment may be able to delay further loss of your central vision.

Living with reduced vision

Reduced vision or vision loss from AMD can affect your life in many ways. How much it will affect you depends on the severity of your vision loss and on your lifestyle. Work with your doctor to find ways to make the best use of your remaining vision. There are several things that you can do to adjust and keep your quality of life as much as possible:

• Use vision aids, such as magnifying devices and special appliances designed for people with limited vision.
• Rely on your support network of friends and family to help you.
• Seek counseling and training to help you cope with your reduced vision.
• Talk with your doctor about starting a self-management program, including health education and problem-solving skills related to living with vision loss. One study suggested that such programs may improve well-being and quality of life in older people who have AMD.⁹

Macular degeneration: Coping with reduced vision

Emotional impact of AMD

Because AMD can lead to a significant loss of vision and, in most cases, because there is no effective treatment, finding out that you have AMD can be very difficult. You may feel angry if treatment cannot help you or feel anxious that loss of vision from AMD will make you less able to function on your own.

Although it is normal to feel unhappy about these changes, if your feelings of sadness are severe or do not improve, you may develop depression, which requires treatment. If you need help in dealing with your feelings about AMD, talk to your doctor and to your family and friends. Your doctor can also refer you to a counselor who specializes in helping people adjust to living with limited vision.

Medications

Anti-VEGF medicines can slow the vision loss that is linked to wet age-related macular degeneration (AMD). These medicines block a protein that leads to the wet type of macular degeneration. This protein is called vascular endothelial growth factor (VEGF). VEGF causes new abnormal vessels to grow in the eye. The growth of these abnormal vessels leads to macular degeneration.

Anti-VEGF medicines appear to slow the growth of abnormal blood vessels that cause vision loss in wet AMD.¹⁰

Anti-VEGF medicines are injected into the eye.

Anti-VEGF medicines are also known as VEGF inhibitors.

Surgery

Wet AMD

Thermal laser photocoagulation surgery is used to treat wet age-related macular degeneration (wet AMD). But this surgery is an option for less than one-fourth of people with wet AMD.⁴ Whether your AMD can be treated by laser photocoagulation surgery or other surgery depends on the location and development of abnormal blood vessels under the retina.

Surgery does not cure wet AMD, but it can sometimes slow down or prevent further loss of central vision. Without treatment, vision loss from wet AMD may progress until a person has no central vision left. Early surgery is vital to slowing down vision loss, which can be rapid.

By the time many people are diagnosed with wet AMD, it is often too late for surgery to provide much benefit. Even with treatment, many people will still go on to lose more of their central vision.

Dry AMD

Currently, surgery is not used to treat dry AMD. Laser surgery to remove deposits called drusen may slow vision loss in people with dry AMD, but experts think that it may increase the chance of developing wet AMD. Researchers are currently doing studies to see if this is an effective treatment.¹

Surgery Choices

The only surgical method for treating wet age-related macular degeneration (wet AMD) is laser surgery, or laser photocoagulation.

What To Think About

Laser surgery can result in some loss of central vision, because the laser cannot burn the abnormal blood vessels under the macula without also burning some of the normal nerve cells in the macula. But while your vision may be worse right after surgery, it may be less likely to continue to get worse than if you did not have the surgery.

AMD does not cause the same amount of vision loss in everyone who develops the disease. It is often hard to know in advance whether laser surgery will do more harm than good.

Other Treatment

Photodynamic therapy (PDT) is another treatment for age-related macular degeneration (AMD). Photodynamic therapy uses a light-sensitive dye that produces blood clots to stop the growth of abnormal new blood vessels under the macula. But PDT has only recently begun to be widely used, and its effectiveness and long-term consequences are still being studied. Most people need multiple treatments to get the full benefits of the therapy.

Currently, no treatment has proven effective for dry AMD, so the search for other treatments continues. Not all cases of wet AMD can be treated with laser photocoagulation surgery or PDT. And only about 15 out of 100 people can be effectively treated with laser photocoagulation surgery. PDT can only be used for a minority of cases as well. ⁴

Other Treatment Choices

• Photodynamic therapy (PDT) is used to treat wet AMD. PDT is a procedure in which light from a laser activates a drug that has been injected into your bloodstream. The drug, reacting to the light from the laser, seals off abnormal blood vessels caused by wet AMD.

Surgeries and treatments under investigation

Experts are currently studying possible surgeries for AMD. These include:

• Macular translocation surgery. In this procedure, surgeons detach the macula and move it to a more healthy area of the eye. Unlike most other AMD treatments, this treatment may even be able to restore some vision. But there are serious risks involved, and researchers need to study the treatment more to see if it is safe and effective.
• Submacular surgery. In this procedure, surgeons remove abnormal blood vessels from beneath the macula. This treatment might help maintain vision in some people, but studies show that this type of surgery has significant risks and may not be very effective.

Researchers are studying several possible treatments for wet AMD. These include:

• Laser therapy to remove deposits in the eye called drusen. Although the treatment may improve vision, it also may increase the growth of abnormal vessels under the macula that eventually lead to vision loss. More research is needed to determine whether this treatment is effective.
• Electronic devices to restore vision. Researchers are investigating tiny implants in the retina and other devices that replace damaged cells that capture light and send information to the brain. It likely will be several years before we know what role these devices will play in treating AMD. But promising results from initial studies indicate that these devices may someday be used to restore lost vision.
• Steroids injected into the eye. Steroids, such as triamcinolone, may slow the progress of vision loss or even help improve vision.

What To Think About

The most recent treatment that has been developed for wet AMD are the anti-VEGF medicines. These medicines are injected into the eye.

Laser treatment almost always causes some immediate, permanent central vision loss (a central blind spot), and it does not prevent future growth of abnormal blood vessels. Some experts think that photodynamic therapy (PDT) and radiation therapy could prove to be more effective and less destructive than laser surgery because they are more precise. These procedures may be better able to target the blood vessels without damaging the nerve cells in the retina and macula. But the effectiveness and long-term consequences of PDT are still being studied.

Many treatments for AMD are costly, need to be repeated, and may have limited effectiveness. Some treatments may even make your AMD worse or cause vision loss. Talk with your doctor to make sure that you understand the possible benefits, risks, and side effects of your treatment choices.

Other Places To Get Help

Organizations

Related Information

• Cataracts
• Eye Problems, Noninjury
• Presbyopia

References

Citations

1. Arnold J (2006). Age-related macular degeneration, search date March 2005. Online version of Clinical Evidence (15).

2. American Academy of Ophthalmology (2006). Age-Related Macular Degeneration (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Available online: http://www.aap.org/ppp.

3. American Academy of Ophthalmology (2005). Comprehensive Adult Medical Eye Evaluation, Preferred Practice Pattern. San Francisco: American Academy of Ophthalmology. Available online: www.aao.org/ppp.

4. Martidis A, Tennant TS (2004). Age-related macular degeneration. In M Yanoff et al., eds., Ophthalmology, 2nd ed., pp. 925-933. St. Louis: Mosby.

5. Age-Related Eye Disease Study (AREDS) Research Group (2001). A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss. Archives of Ophthalmology, 119(10): 1417-1436.

6. Cho E, et al. (2004). Prospective study of intake of fruits, vegetables, vitamins, and carotenoids and risk of age-related maculopathy. Archives of Ophthalmology, 122(6): 883-892.

7. Seddon JM, et al. (2003). Progression of age-related macular degeneration: Association with dietary fat, transunsaturated fat, nuts, and fish intake. Archives of Ophthalmology, 121(12): 1728-1737.

8. Seddon JM, et al. (2003). Progression of age-related macular degeneration: Association with body mass index, waist circumference, and waist-hip ratio. Archives of Ophthalmology, 121(6): 785-792.

9. Brody BL, et al. (2005). Self-management of age-related macular degeneration at the 6-month follow-up. Archives of Ophthalmology. 123(1): 46-53.

10. Drugs for some common eye disorders (2007). Treatment Guidelines from The Medical Letter, 5(53): 4-5.

Other Works Consulted

• American Academy of Ophthalmology (2007). Vision Rehabilitation for Adults (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Also available online: http://www.aap.org/ppp.

• Tomany SC, et al. (2004). Risk factors for incident age-related macular degeneration. Ophthalmology, 111(7): 1280-1287.

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