Macular Degeneration 101—Symptoms, Solutions, and Prevention

Luis Vivas
2025-07-30T09:00:24-07:00

By William Clearfield, DO, F.A.A.M.A., D.A.B.M.A., F.A.A.R.F.M. Executive Director, American Osteopathic Society of Integrative Medicine

Introduction-The Amsler Grid

Quick. Put your reading glasses on. Position this chart at eye level, 14 inches from your face. Cover one eye at a time with your hand. • Stare at the dot in the center. Do not let your eye drift from the center dot.

Amsler’s Chart ⁽¹⁾

Are the lines straight? Do any of them appear wavy or bent? Are the boxes the same or different sizes and shapes from one to another? Are any of the lines missing, blurry or discolored?

Abnormal Amsler Grids (2)

If the answer to any of the above questions, other than ‘Are the lines straight and the boxes the same size and shape,’ is yes, get thee, quick, to an ophthalmologist. You have a problem with the central portion of the back of your eye, the macula. This is nothing to fool with. You, along with 20 million other Americans over the age of 60, are at risk for irreversible central vision loss due to age-related macular degeneration (AMD). (3)

Eye Basics

Like a camera that focuses light onto film, our eyes focus light onto our retina, a light-sensitive tissue layer in the back of the eye. The retina converts incoming light into electrical signals, sending them to the brain. (52)

The macula, a small yellow, oval-shaped area at the retina’s center, plays a vital role in central vision, color vision, and fine detail. The macula contains photoreceptor cells, rods, and cones that work together to deliver clear central vision. The rods process black and white, enabling night vision, while the cones handle color detection. (5)

What is Macular Degeneration?

As we age, the light-sensitive cells in the macula deteriorate. (Age-related macular degeneration (AMD) is rare under age 50). Etiologies contributing to the development of macular degeneration, including: ⁽⁶⁻⁷⁾

Oxidative stress from wear and tear on our bodies

Being overweight

Consuming a highly saturated fat diet

Smoking

High blood pressure

High cholesterol

Having cardiovascular disease

Being female (changes in estrogen levels during menopause play a role)

Genetic predispositions

Being Caucasian

Having light-colored eyes, which provide less UV protection over a lifetime

Damage to the macula results in a loss of central, but not peripheral, vision. ⁽⁸⁾ Assume we are traveling over a bridge on a country road. You see the guardrails and the mountains in the distance at the periphery of your vision. However, the core of your attention oncoming cars, faces, figures, shapes, or letters on a sign appears as a black smudge. ⁽⁹⁾

This is trouble with a capital T.

Types of Macular Degeneration

Dry (Atrophic) Macular Degeneration (10-13)

Dry AMD, the most common type of age-related macular degeneration, accounts for 90% of all cases. It develops when the macula thins over time, resulting in a loss of central vision. Dry AMD occurs when small yellow deposits, known as drusen, composed of cellular debris accumulate under the retina.

Initially, patients experience no symptoms. As AMD progresses, more and more drusen appear, distorting fine details and impacting the patient’s vision.

In the later stages of dry AMD, retinal thinning continues and causes geographic atrophy. People first notice geographic atrophy as a gradual blurring of central vision. Left unchecked, it progresses into a blind spot, causing objects to appear hazy or completely invisible.

As many daily activities—such as reading, watching television, using a computer, or driving—depend on central vision, dry macular degeneration poses significant quality-of-life risks. Patients struggle with recognizing faces or telling the time on a clock. End-stage advanced geographic atrophy affects both eyes, altering one’s ability to engage in everyday activities.

Wet Macular Degeneration (14-15)

Dry AMD, the most common type of age-related macular degeneration, accounts for 90% of all cases. It develops when the macula thins over time, resulting in a loss of central vision. Dry AMD occurs when small yellow deposits, known as drusen, composed of cellular debris accumulate under the retina.

Initially, patients experience no symptoms. As AMD progresses, more and more drusen appear, distorting fine details and impacting the patient’s vision.

In the later stages of dry AMD, retinal thinning continues and causes geographic atrophy. People first notice geographic atrophy as a gradual blurring of central vision. Left unchecked, it progresses into a blind spot, causing objects to appear hazy or completely invisible.

As many daily activities—such as reading, watching television, using a computer, or driving—depend on central vision, dry macular degeneration poses significant quality-of-life risks. Patients struggle with recognizing faces or telling the time on a clock. End-stage advanced geographic atrophy affects both eyes, altering one’s ability to engage in everyday activities.⁽¹⁶⁾

Signs and Symptoms of Macular Degeneration

Dry Macular Degeneration: Symptoms develop slowly over many years. They include: ⁽¹⁷⁾

Blurry or distorted vision, particularly when reading or seeing faces.

Gradually reduced central vision in one or both eyes.

There is a need for brighter light when reading or doing close-up work.

Increased difficulty adapting to low light levels, such as entering a dimly lit restaurant or theater.

Increased blurriness of printed words.

Yellow deposits, termed drusen, develop under the retina. Drusen indicates dry AMD.

A well-defined blurry spot or blind spot in the field of vision.

Slow progression of symptoms.

Drusen

Wet Macular Degeneration: Symptoms appear suddenly and worsen quickly. They include: ⁽¹⁸⁾

Visual distortions, such as straight lines seeming bent.

Reduced central vision in one or both eyes.

A need for brighter light when reading or doing close-up work.

Difficulty adjusting to low light levels, such as when entering a dimly lit restaurant or theater.

Increased blurriness of printed words.

Difficulty recognizing faces.

A well-defined blurry spot or blind spot in the field of vision.

Wet Macular Degeneration

Diagnosis of Macular Degeneration ⁽¹⁹⁾

Aside from the home-based Amsler Grid noted in our introduction, an ophthalmologist will perform the following examinations:

Visual Acuity Test: Measures the sharpness of vision using an eye chart.

Dilated eye exam: Eye drops dilate or widen your pupils. Your ophthalmologist uses a special lens to look inside your eyes.

Fluorescein angiography: Fluorescein, a yellow dye, is injected into an arm vein. A special camera tracks the dye as it travels through blood vessels in the eye. The photos reveal if there is leakage under the macula.

Indocyanine green angiography. Like fluorescein angiography, this test uses an injected dye. It is used alongside a fluorescein angiogram to identify specific types of macular degeneration.

Optical coherence tomography (OCT): This imaging device takes detailed images of the back of the eye, including the retina and macula. It is non-invasive and painless. The patient looks into a lens while the machine takes pictures.Optical coherence tomography angiography (OCTA): The OCT scanning device uses laser light reflection (instead of fluorescein dye) to produce 3D images of blood flow through the eye.

Macular Degeneration and Your Hormones

Hormones are the juice of life. They affect every action, every system, and every living cell. We constantly study the hormonal effects of all disease entities and find that hormone optimization can improve almost any human condition. Knowing hormonal patterns allows us to propose unique treatment protocols.

Several hormones play a role in macular degeneration as a preventive agent or adjunct treatment.

1. Melatonin, best known for its regulatory function on our circadian (daily) rhythm, is an antioxidant and anti-inflammatory agent. Melatonin slows the progression of AMD by reducing inflammation, thus protecting retinal cells from oxidative damage. ⁽⁴³⁾

2. Estrogen protects the retina, particularly in the postmenopausal era. Estrogen maintains blood vessel integrity in the eye and reduces inflammation while stimulating blood flow throughout the brain. Estrogen optimization is associated with a lower risk of AMD. ⁽⁴⁴⁾

3. DHEA (Dehydroepiandrosterone), a precursor to estrogen and testosterone, is associated with anti-aging effects. Patients with AMD have abnormally low DHEA-S levels, and an inverse correlation exists between serum DHEA-S levels and AMD severity. (Of note, the same inverse relationship exists between DHEA-S and cortisol, the stress hormone). Low DHEA-S levels are associated with the accumulation of cholesterol plaques in the retina and carotid arteries. DHEA protects those structures from oxidative stress, a significant contributor to the progression of AMD. ⁽⁴⁵⁾

4. Thyroid sufficiency plays a critical role in metabolism and energy production. Patients with hyperthyroidism, those on levothyroxine replacement therapy for hypothyroidism, thyroid cancer patients, and individuals with high levels of T4 are at a heightened risk of age-related macular degeneration (AMD). Mechanisms contributing to this well-defined increased risk include accelerated retinal oxidative stress due to thyroid dysfunction, lipid and vascular issues resulting from long-standing thyroid disease, and inadequate replacement of all thyroid hormones—T1, T2, T3, T4, and calcitonin—produced naturally by the thyroid gland. According to the Endocrine Society, the standard of care is to replace T4 only. ⁽⁴⁶⁾

5. Excess Cortisol leads to inflammation, resulting in retinal fluid accumulation. Cortisol abnormalities contribute to oxidative stress, which is a precursor of AMD. Managing stress through lifestyle changes, such as exercise, meditation, or therapy, helps lower cortisol levels, reducing AMD incidence. The Perceived Stress Scale (PSS) is a 10-question, easy-to-administer stress rating scale that can predict objective biological stress markers. ⁽⁴⁷⁾

6. Insulin and IGF-1 are critical for regulating glucose metabolism and promoting cellular growth. Insulin resistance, as seen in diabetes mellitus type 2, is linked to an increased risk of AMD. Conversely, IGF-1, the active metabolite of Growth Hormone, is neuroprotective, benefiting retinal cells. Be aware, dear reader, that IGF-1 levels are significantly higher in neovascular wet AMD vs. dry AMD and controls. Too much IGF-1 (and subsequently Growth Hormone) is not necessarily better for eye health. ⁽⁴⁸⁻⁴⁹⁾

7. Progesterone is neuroprotective and anti-inflammatory, saving retinal cells from oxidative damage. Progesterone decreases photoreceptor cell death, diminishes reactive gliosis, and increases microglial cells caused by retinal diseases. Progesterone increases the production of nitric oxide. Nitric Oxide is responsible for endovascular tissue enhancement. ⁽⁵⁰⁾

As my original acupuncture teacher, Dr. Kim, long, long ago (1988), in a land far, far away (Wilkes Barre, Pennsylvania), taught me, “Progesterone for the eyes is ‘Good Stuff!”

8. Testosterone has no direct link to AMD. Low T is related to insulin resistance, increased oxidative stress, and metabolic syndrome. Low testosterone is also known for contributing to dry eye syndrome. ⁽⁵¹⁾

Conventional Medical Treatments for Macular Degeneration

Dry Macular Degeneration

Currently, there is no cure for dry AMD. Despair not, though, fair reader. Lifestyle changes and, curiously, for “real medical doctors,” several over-the-counter supplement therapies slow its progression.

1. Lifestyle Changes

1. Follow a low saturated fat diet

2. Exercise 5 times a week – aerobic exercise increases blood flow, improving oxygenation to the retina

3. Quit smoking

4. Avoid alcohol consumption

5. Stop using narcotics

6. Prioritize quality sleep

7. Maintain social connections

8. Participate regularly in any number of relaxation techniques. For instance:

Yoga

Tai Chi

Qi Gong

Walking, hiking, or biking

2. AREDS Supplements:(20-21)

It is a miracle that the initial treatment recommended by mainstream medicine, the Cleveland and Mayo Clinics, combines vitamins and minerals for early to moderately advanced dry macular degeneration. The Age-Related Eye Disease Studies (AREDS and AREDS2 trials demonstrated that an antioxidant mixture slows the progression of AMD in individuals with intermediate or late-stage AMD. The supplements include:

500 milligrams (mg) of vitamin C.

400 international units (IU) of vitamin E.

10 mg of lutein.

2 mg of zeaxanthin.

80 mg of zinc (as zinc oxide).

2 mg of copper (as cupric oxide).

Our favorite antioxidant supplements containing the ingredients in the AREDS2 study are Longevinex® and Advantage® and T-Cell Zinc™ from Longevinex.

These powerful Trans-Resveratrol Supplements contain: ⁽²²⁾

1. Quercetin: Antioxidant, supports immune system health

2. Trans-resveratrol: Antioxidant, anti-inflammatory

3. Rice Bran IP6: Antioxidant, helps lower cholesterol and blood sugar, anti-cancer properties

4. Vitamin D3: Supports bone health and immune function

5. Nucleotides: Building blocks of DNA and RNA

6. Beta Cyclodextrin: Encapsulation and drug delivery system

7. Fisetin: Antioxidant, promotes anti-aging

8. Beta Glucan: Modulates the immune system

9. Vitamin B1 (Benfotiamine): Supports nerve health and energy metabolism

10. Lutein/Zeaxanthin: Protects eye health and offers antioxidant protection

11. Hyaluronic Acid: Hydrates the skin and supports joint health (included in the Advantage Formula).

Longevinex’s trans-resveratrol safeguardes retinal cells from oxidative stress. Trans-resveratrol not only slows the progression of age-related macular degeneration (AMD) but, in some cases, helps prevent it by reducing inflammation and oxidative damage. Its antioxidant, anti-inflammatory, and circulation-enhancing properties benefit the heart, brain, and eyes, particularly in supporting healthy aging and guarding against conditions like AMD. The Advantage formula also includes additional ingredients, such as lutein and zeaxanthin, that help protect the eyes from solar radiation, which may aid in preventing cataracts.

T-Cell Zinc™ (25) contains:

1. Vitamin C: Supports the immune system’s ability to fend off disease.

2. Vitamin B6 (Pyridoxal-5-Phosphate): Synthesizes neurotransmitters and aids in the formation of red blood cells, white blood cells, and immune-regulating T-cells.

3. Zinc: Vital for immune function and helps relieve oxidative stress.

4. Selenium: Acts as an antioxidant and anti-inflammatory.

5. Royal Jelly: Provides antioxidant, anti-inflammatory, and antimicrobial properties.

6. Cyclodextrin: A carrier agent that modifies the release of active ingredients to prolong efficacy, reduce potential side effects, lower cholesterol, enhance weight loss, and improve the taste and sensation of bitter compounds.

Raising zinc, copper, and vitamin C levels of those at high risk for AMD decreases its incidence by 25%. Of those with intermediate or advanced AMD in one eye but not the other eye—our nutrient combo reduced the risk of vision loss caused by advanced AMD by 19 percent. ⁽²⁶⁾

Wet Macular Degeneration

Wet AMD requires more aggressive treatment to stop the growth of abnormal blood vessels:

1. Anti-VEGF Injections: ⁽²⁷⁾

1. VEGF is a substance that stimulates the formation of new blood vessels.

2. Anti-vascular endothelial growth factor (anti-VEGF) is injected into the eye to block abnormal blood vessels from leaking or bleeding.

3. Injections are q month x 3, then every 1-4 months.

4. Results: In 9 out of 10 people, vision stops getting worse, and in 3 out of 10 people, vision improves.

5. Side effects are eye bleeding, redness, irritation, and the feeling of something in the eye.

6. Examples of anti-VEGF medications include:

Bevacizumab (Avastin)

Ranibizumab (Lucentis)

Aflibercept (Eylea)

Brolucizumab (Beovu)

Faricimab-svoa (Vabysmo)

2. Laser Therapy: ⁽²⁸⁾

1. Laser treatments are indicated when abnormal blood vessels are grouped tightly together, or vision loss suddenly occurs.

2. Use anti-VEGF and laser therapy together.

3. Photodynamic Therapy (PDT) ⁽²⁹⁾

1. When patients with wet AMD develop new neovascular blood vessels but retain some visual acuity, a photosensitive drug, verteporfin, and a low-powered laser may be employed. This treatment aims to stop further vision loss rather than restore lost vision.

Supporting Therapies for Macular Degeneration of All Stripes

Anti-inflammatory and antioxidant herbal remedies, supplements, vitamins, minerals, Chinese herbs, and homeopathic treatments prevent and delay the onset and ease the burden of macular degeneration. Always consult a healthcare provider for specific recommendations tailored to your condition. The remedies we review here are for your consideration and should not be considered treatment protocols for anybody.

1. Herbal Remedies and Supplements

Bilberry: Bilberry’s active ingredient, anthocyanosides, improves night vision, reduces inflammation, and protects the retina. Bilberry protects retinal cells from oxidative damage. ⁽³⁰⁾

Ginkgo biloba: Ginkgo contains anti-inflammatory flavonoids and terpenoids that improve circulation, increase blood flow to the retina, and deliver essential nutrients. ⁽³¹⁾

Turmeric: Curcumin, the active compound in turmeric, reduces ROS and inhibits apoptosis-inducing proteins and cellular inflammatory genes. ⁽³²⁾

2. Vitamins and Minerals

Lutein and Zeaxanthin are carotenoids found in high concentrations in the macula. They act as a protective filter absorbing harmful blue light, slowing the progression of macular degeneration. ⁽³³⁾

Omega-3 Fatty Acids reduce inflammation, which, in turn, supports retinal health. Diets high in omega-3 fatty acids, salmon, mackerel, herring, and sardines, lower the risk of AMD and slow its progression. ⁽³⁴⁾

Vitamin C, Vitamin E, and Zinc are critical for neutralizing free radicals in the retina. Zinc transports vitamin A to the retina, vital for eye health. ⁽³⁵⁾

3. Chinese Herbal Remedies

Goji berries (Lycium barbarum) support liver health and are associated with better eye health in Traditional Chinese Medicine. Goji berries are rich in antioxidants to improve vision and support retinal preservation. ⁽³⁶⁾

Chrysanthemum Flower is used to reduce inflammation and improve vision. It helps alleviate eye strain and protects the retina from damage. ⁽³⁷⁾

Rehmannia Root strengthens the kidneys and liver while exhibiting antioxidant, anti-inflammatory, antiapoptosis, and antiangiogenesis (anti-new blood vessel formation properties.) ⁽³⁸⁾

4. Homeopathic Remedies

Calcarea carbonica is helpful for patients whose vision worsens or who have trouble adjusting to dim light. It is also for those who experience fatigue after visual tasks. ⁽³⁹⁾

Sepia benefits individuals experiencing blurred vision, flashes of light, or sensitivity to bright lights. ⁽⁴⁰⁾

Natrum muriaticum redistributes fluids commonly experienced in macular degeneration due to light sensitivity. ⁽⁴¹⁾

Ruta graveolens: Often prescribed for eye strain and blurred vision due to overuse of the eyes, Ruta is helpful in macular degeneration when the patient experiences vision difficulties in low light. ⁽⁴²⁾

Summary

Your eyes function like cameras, focusing light onto the retina, particularly the macula, which is essential for central and color vision. The macula contains photoreceptor cells that help convert light into electrical signals sent to the brain.

Age-related macular degeneration (AMD) is a condition characterized by the deterioration of the macula, primarily affecting those over 50. Risk factors include oxidative stress, obesity, poor diet, smoking, high blood pressure, and genetic predispositions. Patients experience loss of central vision while peripheral vision remains intact.

Types of Macular Degeneration

1. Dry AMD is the most common form of AMD, affecting 90% of patients. It develops slowly due to the thinning of the macula and accumulation of drusen (yellow deposits) on the retina. Symptoms include blurry vision and gradual vision loss, culminating in a significantly declining quality of life.

2. Wet AMD: Characterized by abnormal blood vessel growth beneath the retina, wet AMD can quickly lead to vision loss. Symptoms include sudden visual distortions and significant vision impairment.

Signs and Symptoms

Dry AMD: Slow development of blurry, distorted vision, increased difficulty with low light, and presence of drusen.

Wet AMD: Abrupt changes in vision, including distortions and blind spots.

Diagnosis

Diagnosis includes the Amsler Grid, visual acuity tests, dilated eye exams, angiography (using fluorescein or indocyanine green), and optical coherence tomography (OCT), which yield detailed retina images.

Hormonal Factors Affecting AMD

Substance/Hormone | Function/Effect | Impact on AMD
Melatonin | Regulates circadian rhythm,antioxidant/anti-inflammatory | Anti-inflammatory effect slows AMD progression; Reduces oxidative stress (ROS)
Estrogen | Anti-inflammatory maintains blood vessel integrity, protects the retina | Promotes blood flow to the brain, including retina, reduces inflammation
DHEA | Anti-aging effectPrecursor to Estrogen and Testosterone | DHEA levels are inversely related to AMD risk; Protect from ROS and cholesterol plaque buildup
Thyroid Hormones | Critical for metabolism, energy production | High levels of thyroid dysfunction and inadequate replacement of thyroid hormone when low increase the risk of AMD due to ROS and vascular dysfunction
Cortisol | Regulates stressElevated levels lead to inflammation | Excess cortisol leads to inflammation and ROS linked to neovascular AMD
Insulin and IGF-1 | Regulates glucose metabolism IGF-1=Active component ofGrowth Hormone | Insulin resistance linked to increased AMD risk; Excess IGF-1 linked to neovascular AMD
Progesterone | Neuroprotective, anti-inflammatory | Reduces retinal cell death, increases nitric oxide production (increasing blood flow to the retina)
Testosterone | Anti-aging, anti-inflammatory | No direct link to AMD; Low levels contribute to ROS, insulin resistance, dry eye syndrome

Conventional Treatments

Dry AMD: No cure exists, but lifestyle changes and AREDS supplements (vitamins C and E, lutein, zeaxanthin, zinc, and copper) can slow progression. Recommendations include a low-fat diet, regular exercise, sleep hygiene, and social engagement.

Wet AMD: Treatments include anti-VEGF injections to inhibit abnormal blood vessel growth, laser therapy, and photodynamic therapy.

Complementary Therapies

Herbal Remedies, Supplements, Chinese Herbs, and Homeopathic Remedies for Eye Health & AMD

Category | Remedy/Supplement | Effect on Eye Health/AMD
RecommendedLongevinex Supplements | Longevinex Advantage | A trans-resveratrol-based supplementProtects retinal cells from ROSAnti-inflammatory Slows progression of AMD.
| T-Cell Zinc | Supports the immune systemBolsters T-cell function Anti-inflammatory
Herbal Remedies | Bilberry | Improves night vision, reduces inflammation, protects the retina from ROS
| Ginko biloba | Increases blood flow to the retina, delivers essential nutrients, anti-inflammatory
| Turmeric | Reduces ROS, inhibits apoptosis (cell death)Anti-inflammatory
Vitamins and Minerals | Lutein & Zeaxanthin | Absorbs harmful blue lightSlows progression of macular degeneration
| Omega 3 Fatty Acids | Anti-inflammatory, anti-plateletImproves blood flow to the retina
| Vitamin C, E, & Zinc | Neutralizes free radicals,Zinc supports Vitamin A transportMaintains retinal integrity
Chinese Herbal Remedies | Goji Berries | Antioxidant,Nourishes the liverPreserves retina
| Chrysanthemum Flower | Anti-inflammatoryAlleviates eye strainRetinal protection
| Rehmannia Root | Strengthens liver and kidneysAntioxidant, anti-inflammatory, antiapoptosis
Homeopathic Remedies | Calcarean carbonica | Aids with vision in dim lightReduces eye strain and fatigue after visual tasks
| Sepia | Eases blurred vision, light flashes, light sensitivity
| Natrum muriaticum | Eases light sensitivity, Regulates fluid buildup in the eye
| Ruta graveolens | Eases low light accommodation, Eases eye strain and Blurred vision.

Conclusion

While there is currently no official cure for macular degeneration, early detection and a combination of medical treatments, lifestyle adjustments, and complementary therapies can significantly impact the quality of life for individuals at risk. Continuous research and preventative strategies are vital to managing this condition effectively.

Disclaimer:

This blog is for informational purposes only and does not constitute medical advice. The content is not intended to establish a patient-doctor relationship. Consult a qualified healthcare provider before deciding on your health or treatments.

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