Macular Degeneration: Timeline of Vision Loss Progression

Medically reviewed by Johnstone M. Kim, MD

Age-related macular degeneration (AMD) has three stages: early, intermediate, and late stage.

Vision loss usually happens in the last stage of AMD. However, not everyone with AMD progresses through all the stages. Many people with AMD do not lose their vision. Even people who do reach late-stage AMD are often able to keep their normal vision for most of their life.

This article will go over what research has shown about the progression of vision loss in macular degeneration.

Learn More: Signs You May Have AMD

What Is AMD?

AMD is a group of long-term (chronic) degenerative eye diseases. It's sometimes just called macular degeneration. AMD is the leading cause of legal blindness in the United States and in many countries around the world.

AMD affects a part of the retina called the macula. The macula is an oval yellowish area near the center of the retina in the eye. It is the part that is responsible for clear, straightforward vision. The retina is a layer of cells that are light-sensitive. These cells trigger nerve impulses that pass through the optic nerve to the brain, where visual images are formed.

AMD causes irreversible deterioration, which can cause visual distortions and can eventually lead to vision loss. The condition is diagnosed with an exam by an eye health specialist (ophthalmologist) with tests such as scans of the retina.

When providers do an exam, they often see small yellow deposits called drusen which are a normal part of aging. However, if drusen grow larger and increase in number, they can contribute to the deterioration of the macula and increase your risk for macular degeneration.

Once a certain number and size of drusen can be seen by a provider, the macular degeneration timeline of vision loss progression starts. The timeline of vision loss in AMD goes through several stages. How fast you progress depends on the type of AMD you have.

Wet vs. Dry AMD

There are two forms of AMD: wet and dry.

• Dry AMD involves the presence of drusen, as well as pigment changes that can affect a person’s vision over time. Usually, dry AMD progresses very slowly.

• Wet AMD involves the abnormal growth of blood vessels under the retina that leak or burst, causing visual distortion, blank spots, and rapid decline in vision. Some people develop severe visual impairment within days or weeks of the onset of wet AMD.

Related: Can Dry AMD Become Wet AMD?

AMD Vision Loss Timeline

You may find conflicting information about the average timeline from a diagnosis of AMD to vision loss. Understanding the stages of AMD will help you understand how the disease can progress.

Will I Lose My Sight From AMD?

An ophthalmologist at the Bright Focus Foundation, Joshua Dunaief, MD, writes that “most patients with AMD can keep good vision for their entire lives, and even those who lose their central vision almost always maintain their side, or peripheral vision."

Early-Stage AMD

Early-stage AMD involves medium-sized drusen deposits seen on an eye exam. No pigment changes are present, and there is usually no vision loss at this stage. Early-stage AMD is usually detected on a routine eye examination by an opthalmologist or another healthcare provider.

An ophthalmologist can often detect drusen long before symptoms start. Your provider may want you to have frequent eye exams to monitor for new signs or symptoms that could indicate AMD progression.

Even if you have no symptoms, it’s very important to follow your provider’s advice regarding the regularity of eye exams once the early stage of AMD has been spotted.

What You Can Do During Early-Stage AMD

There are several things you can do to try to slow the progression of AMD once you are diagnosed with stage-one macular degeneration:

• Quit smoking. Studies have shown that smoking more than doubles a person’s risk of AMD.

• Eat a nutritious diet. Choose foods that are rich in dark green leafy vegetables (such as romaine lettuce, kale, and spinach), yellow and orange fruits and vegetables (such as cantaloupe, apricots, orange and yellow peppers; sweet potatoes and squash), and omega 6 fatty acids (found in wild-caught, cold-water fish, like salmon).

• Visit your ophthalmologist regularly. Follow your healthcare provider’s advice about how often to have eye exams.

• Start doing self-screenings to check for the progression of AMD. The Amsler chart is the most common home screening tool to keep track of the progression to wet AMD. You can download the chart and follow the directions for doing self-exams. Your eye healthcare provider can tell you how often to do the exam—for example, they might want you to do a weekly screening.

• Have regular health check-ups. Get your blood pressure checked regularly, have routine physical exams, and maintain a heart-healthy lifestyle when it comes to diet, exercise, and managing stress. According to the American Macular Degeneration Foundation, the risk factors for AMD include being overweight or having undiagnosed or untreated heart disease or high blood pressure.

• Protect your eyes. Avoid long-term exposure to bright sunlight without eye protection.

Will Early-Stage AMD Progress?

AMD usually begins when someone is around age 55 or older. Data suggests that the progression from early and intermediate AMD to more advanced disease ranges from 0.4% to 53%. A lot of that variation depends on how severe the disease is at any given stage and a patient's individual risk factors. For some people, the chances of early AMD progressing are very low.

More recent research has suggested that certain characteristics of the drusen might be also linked to more advanced AMD.

Related: Can You Prevent Macular Degeneration?

Intermediate-Stage AMD

Intermediate-stage AMD involves large drusen or multiple medium-sized drusen and/or pigment changes are present in one or both eyes on an eye exam. Pigment changes—also called retinal pigment epithelium (RPE) disturbances—can lead to vision loss.

The RPE is the pigmented layer of the cells which is located between the retina and the layer of blood vessels (choroid layer). Studies have shown that RPE is where AMD starts to occur. The function of the RPE is to absorb light and transport nutrients to the retinal cells.

Symptoms that commonly occur during the intermediate stage of AMD may include subtle changes in vision. However, many people at this stage do not have symptoms.

If people do have symptoms during the intermediate stage, they may see black or gray spots in the center of their visual field or have trouble adjusting from a location with bright light to a dim area.

Things You Can Do During Intermediate Stage AMD

Know that if you have intermediate AMD, you are at a much higher risk of developing late-stage AMD with vision loss.

There are a couple of things you can do at this stage to try to slow the progression of AMD:

• Take special vitamins called AREDS2 vitamins that your ophthalmologist prescribes for you.

• Follow recommendations about eye exams and self/home screenings.

How Long Does It Take Intermediate AMD to Progress?

If a person in the intermediate stage of AMD has large drusen in one eye, there is a 6.3% chance that they will develop late-stage AMD with vision loss within five years of diagnosis. If large drusen are present in both eyes, the chances of developing late-stage AMD increase to 26%.

In a 2014 study, approximately 37% of people in the intermediate stage of AMD with medium drusen in one eye went on to develop large drusen and 71% of people who had medium drusen at baseline developed large drusen at the 10-year follow-up.

Learn More: What Are the Risk Factors for AMD?

Late-Stage AMD

Late-stage AMD involves either the wet form of AMD or dry AMD. In the late stage, either form of AMD causes distortion of vision and/or vision loss. The wet form of AMD progresses much faster than the dry form, and wet AMD is much more likely to cause vision loss.

When central vision loss begins, objects may appear distorted or blurry at first. In the late stage of the disease, objects in the middle of your line of vision cannot be seen at all. In the peripheral field (side vision), objects are usually still visible but it might be difficult to figure out what they are.

In the late stage of the disease, you may no longer be able to recognize faces. Although you may still have your side vision, you might be considered legally blind at this point.

Things You Can Do During Late-Stage AMD

There are several treatment options for late-stage AMD, including treatment for wet or dry AMD.

Important steps to take after a diagnosis of late-stage AMD include:

• Talk to your provider about treatment options such as anti-VEGF therapy, given by injection into the eye. These drugs have become the most common form of treatment for wet AMD and are considered to have revolutionized wet AMD treatment.

• Ask your provider about your options for other types of treatment, including photodynamic therapy and surgery. For example, one surgery can be done to implant a lens that can magnify your view of images and enable the functional portions of your eye to take over from the damaged parts. The surgery does not work for everyone, but it’s a viable option for some people with late-stage AMD.

• If surgery is not an option for you, ask your provider for a referral to an occupational therapist. This provider helps people with low vision learn how to use adaptive equipment (such as audible clocks and computer programs that read web pages out loud) that can make it easier for them to live independently.
  

• If you have geographic atrophy (GA) secondary to dry AMD, ask your healthcare provider about Syfovre (pegcetacoplan) or Izervay (avacincaptad pegol). GA is atrophy that begins in the outer retina and spreads over the macula. It occurs in late-stage AMD.

• Be open and honest with your provider if you are experiencing symptoms of depression and anxiety. There are treatments, such as medication, professional counseling, or therapy, that can help. Studies have shown that it's common for people diagnosed with AMD to develop anxiety and/or depression as they try to cope with the many losses and challenges of having low vision.

Related: How to Talk About Age-Related Macular Degeneration (AMD)

How Does Late-Stage AMD Progress?

There are several factors that influence how long it takes for AMD to reach the late stage when vision loss takes place.

According to a study published by the National Center for Biotechnological Information, about 1 to 3 people out of 100 with small drusen have vision loss within the first five years of diagnosis and 50% of people with larger drusen experience late-stage vision loss within five years.

In a small percentage of cases, dry AMD can progress to wet AMD. According to the American Macular Degeneration Foundation, about 10% of all cases of age-related macular degeneration become wet AMD. Typically, a person has dry AMD first which progresses to wet.

Wet AMD usually progresses quickly and vision loss can occur within days if it's not untreated. That's why it's important to have your eyes checked frequently and to perform home screenings.

Learn More: Is AMD Treatable?

Summary

Age-related macular degeneration (AMD) is a progressive condition that can eventually lead to vision loss. There are several stages of AMD. How fast you will move through the stages depends on many factors. Some people do not lose their vision from macular degeneration, while others experience vision loss soon after they are diagnosed.

If you have been diagnosed with macular degeneration, talk to your eye health provider about what you can do to try to slow the progression of the condition. There are steps you can take at each stage of AMD. Know that you may not lose your vision. If you do, there are treatments and therapies that can help you learn to cope with the vision changes from AMD.

Read Next: Living With AMD

Read the original article on Verywell Health.