Macular degeneration is most often related to aging. There are some unusual types of macular degeneration that start very early in life, however, most patients with macular degeneration begin to notice problems with eyesight sometimes after age 50. Macular degeneration may be hereditary and therefore may run in families.

Macular degeneration usually starts with the appearance of spots on the retina. These spots are called drusen (see above image). Drusen are like age spots and do not usually change vision very much themselves.

Most patients with drusen never have a serious loss of vision and only a few develop severe macular degeneration with loss of vision.

When macular degeneration does lead to loss of vision, that loss usually starts in just one eye and only later may affect the other eye. In some, it never affects the vision of the second eye. When a person loses vision from macular degeneration in one eye, the loss of vision may not even be noticed because the healthy eye can still see detail.

In general, it is important to discover any change in eyesight as early as possible because the chance that treatment will help is greatest in the early stages of any eye problem. That is why you should test the eyesight in each eye, each day, especially if your doctor has told you that you have drusen.

If macular degeneration has affected the vision of only one macula, you will still be able to see detail (to read, to drive, to thread a needle) with the other, healthy macula. It is only when macular degeneration severely affects both eyes that it will become difficult, or perhaps impossible to do the kind of work that requires detail vision.

A person with severe macular degeneration, who has lost the ability to see detail with each eye, rarely loses peripheral vision and will still be able to get along fairly well. It is very rare for someone with macular degeneration to lose both macular (detail) and peripheral (side) vision. Macular degeneration only very rarely causes total blindness. Almost all people with severe macular degeneration in each eye can see well enough to take care of themselves and continue those activities that do not require detail vision.

People with macular degeneration in each eye usually learn to make use of the areas just outside the macula to see detail better. This ability to look slightly off center usually improves with time, although eyesight will never be as good as it was before the macula was damaged. Once the macula has been severely damaged, treatment is usually no longer possible. For this reason everyone should test the vision in each eye, separately, each day.

One very good way to test the central vision in order to detect even the smallest changes when they first appear is to use the Amsler grid (see bellow). If you note any changes you should see your eye doctor promptly.

Instructions on using the Amsler grid:

1. Wear your reading glasses.
2. Cover one eye.
3. Look at the center dot and keep your eye focused on it at all times.
4. While looking directly at the center, and only the center, be sure that all the lines are straight and all the small squares are the same size.
5. If you should notice any area on the grid that becomes distorted, blurred, discolored, or otherwise abnormal, please call right away.
6. Do this test for each eye separately.