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While age-related macular degeneration (AMD) rarely causes total blindness, the loss of central vision may make everyday activities extremely difficult. Visual deterioration associated with wet age-related macular degeneration is generally severe and can be rapid. Visual distortions may appear due to the formation of leaky, abnormal blood vessels on the overlying retina. By contrast, vision loss with dry age-related macular degeneration is usually gradual and less severe. The patient may begin to notice blank areas in the central visual field. Over time, dry age-related macular degeneration can cause a large loss of detailed vision. In either form of age-related macular degeneration once retinal tissue is damaged, lost vision cannot be regained.
Clinical suspicion of age-related macular degeneration should be raised if middle-aged or elderly patients report that they need extra light for everyday tasks, experience changed color perceptions, or see a blurred spot in the center of their vision. The diagnosis can only be confirmed during a comprehensive ophthalmologic examination that includes a visual acuity test, a dilated eye examination, and tonometry. Dry AMD is characterized by the appearance of drusen under the retina.
During the examination, the patient can also be asked to look at an Amsler grid. One of the first noticeable symptoms of wet age-related macular degeneration is a distortion of straight lines, and patients may report that the grid appears wavy. Patients who are at significant risk for macular degeneration, especially those with one affected eye, can be encouraged to monitor their vision by using the Amsler grid at home. They should be instructed to look at it carefully every day, once with each eye, to ensure that the lines do not appear bent or distorted.
In addition, a fluorescein angiogram can be used to identify the leaking ocular blood vessels associated with wet age-related macular degeneration. Results of the test may also be used to determine whether treatment is indicated.
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