Welcome to the web site of The Age-related Macular Degeneration Project based in the Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham.

The purpose of this web site is to provide information to the public about age-related macular degeneration (AMD), the leading cause of irreversible blindness in the United States. Professionals such as ophthalmologists, other types of physicians, optometrists, researchers, rehabilitation specialists, and health educators may also find the site useful, especially for their patients.

There is no cure for AMD. Thus, there is an urgent need to develop treatments for this disease, especially for its earliest phases before severe and irreversible vision impairment occurs.

Despite the fact that 13 million Americans over age 40 have AMD, the public is largely unaware of AMD’s existence and its devastating impact on vision and the threat it poses to the enjoyment of everyday life. Unfortunately, this lack of public awareness about AMD may be serving as a barrier to progress in developing treatments for the disease. Here at The Age-related Macular Degeneration Project we believe that an informed public is a major motivator for identifying the resources to find a cure.

In this web site, you’ll find a wide variety of information about AMD. Topics covered are listed on the left and are just a mouse click away. We welcome your feedback. In fact, on each page there is a link to a brief survey that we hope you’ll consider completing. Your guidance will help us improve this web site and make it more successful in enhancing the public’s awareness of AMD so that together we can work towards effective treatments and preventions.

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The key word in the name of this disease, Age-related Macular Degeneration (AMD), is macula, because this is the part of the eye that becomes damaged in this disease.

First you need a little background on the structure of the eye before you can understand the macula. As you read this page, it might help you to glance over at the Figure from time to time.

A ray of light entering the eye passes through many layers of the eye. In the front of the eye are the cornea (clear layer on the outside front of the eye) and the lens. In the interior of the eye is the vitreous, a jelly-like material. In the back of the eye (called the fundus) are the retina, retinal pigment epithelium, Bruch’s membrane, choroid, and sclera. Actually the sclera surrounds most of the eyeball and is the white part of the eye that we easily notice when we look at someone.

The cornea and lens focus images (the rays of light) entering the eye on the retina in the back of the eye. The retina contains about 120 million nerve cells, which together act as a light-sensitive film that transmits information about the image to the brain.

The photoreceptors are on the side of the retina closest to the sclera, and light shines through the other retinal layers to reach them. There are two kinds of photoreceptors; the cones are sensitive to bright light and color, and the rods are sensitive to dim light.

The retinal pigment epithelium is a flat layer of pigmented cells that care for photoreceptors in several important ways, including delivering vitamin A and removing waste products. (All cells have waste products as part of their normal functioning.)

Bruch’s membrane is a thin flat vessel wall between the retinal pigment epithelium and the choroid.

The choroid is a dense network of capillaries that supply nutrients (“food”) and oxygen to the retinal pigment epithelium and photoreceptors. The photoreceptors must have adequate levels of nutrients and oxygen in order to live and function properly so vision is good.

Now finally we’re at the point where we can tell you what the macula is. The macula is the part of the retina that allows you to see the central 20 degrees of the visual field. When you look straight ahead, your point of fixation and the area immediately around it is your central vision. The macular area of the visual field is about 20 inches across at an arm’s length. In the center of the macula is the fovea. The fovea is enriched with cone photoreceptors that are used for reading and other activities requiring detailed vision like threading a needle.

The layers of the macula that are impacted by AMD are the photoreceptors, the retinal pigment epithelium (RPE), Bruch’s membrane, and choroid.

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AMD is a disorder of the retina that occurs in persons over 50 years old. AMD has characteristic lesions. By lesions we mean abnormal changes in the appearance and structure of retina. These lesions are not caused by other eye conditions, but are a unique feature of AMD.

To help you understand what AMD looks like when your ophthalmologist looks at the back of your eye, we refer you to the photographs below showing fundus photos of the retina. The top left (A) is from an older person who does not have AMD. Top right (B) is a person with early AMD. Lower left (C) is late non-exudative AMD (also called geographic atrophy), and finally lower right (D) is someone who has late exudative AMD ("wet" AMD). We will explain what we mean by these different types of AMD below.

The characteristic lesions in AMD are drusen and changes in pigmentation. A person does not have to have all these lesions to have AMD, but can have only one or just a few.

Drusen are well-defined lumps of fatty debris under the retinal pigment epithelium. They can be seen as yellow or white spots in the fundus, shown in panel B above. Most older persons have at least a few hard (discrete) drusen, as in panel A.

Similar debris also forms a thin layer under the retinal pigment epithelium and cannot be seen in the fundus.

The pigment content of individual retinal pigment epithelium cells increases or decreases, creating dark or light areas in the macula. Blood vessels grow in from the choriocapillaris under the retina (choroidal neovascularization). The consequences of abnormal vessel growth are hemorrhage and scar formation.

A person does not have to have all these lesions to have AMD, but can have only one or just a few.

AMD is known by several names, the most popular names being dry and wet.

Dry AMD consists of drusen and changes in the pigmentation of the retinal pigment epithelium that can be seen in the back of the eye. Some individuals with drusen and pigment changes may advance to extensive loss of the retinal pigment epithelium in the macula. This is often referred to as geographic atrophy (Panel C above).

Wet AMD is a complication of dry AMD in which blood vessels from the choriocapillaris break through Bruch’s membrane and spread under either the retinal pigment epithelium, the retina, or both. This process is called choroidal neovascularization (new vessels), and the result is a delicate tissue called a neovascular membrane. Vessels in neovascular membranes may leak or bleed, detaching the retina from the retinal pigment epithelium. See Panel D above for an eye with wet AMD. A scar may eventually form. Fluorescein angiography is a method to reveal blood vessels in the retina using a dye injected into the bloodstream and a special camera. This technique is used to diagnose neovascularization.

Neovascular membranes that are well defined in fluorescein angiography are described as classic, and those that are poorly defined are described as occult.

These are examples of the technical terms that your ophthalmologist or optometrist will use to characterize your condition from a medical standpoint. AMD itself is not physically painful to patients. What is most noticeable to the patient is decreased vision. This impaired vision in either dry or wet AMD is due to the degeneration and/or death of photoreceptors. Recall that photoreceptors capture light rays reflecting off the objects you look at. Photoreceptors convert the light to electrical energy so that information about your visual world can be transmitted to the brain. Without healthy photoreceptors, vision will be degraded.

One other thing we should mention is that age-related macular degeneration can be referred as ARM, ARMD, and AMD. These terms are interchangeable, and should not be a cause for confusion in your reading about this disease. An international panel of experts agreed to call early disease "ARM" and late disease (geographic atrophy or choroidal neovascularization) "AMD," but use of this terminology is by no means universal.

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It is not known what specifically causes AMD. There has been a great deal of research on AMD in recent years in order to understand the course of events that underlie its emergence. Below we summarize the major theories that scientists have developed and are evaluating.

Lack of anti-oxidants
Several characteristics of the retina make it potentially susceptible to damage from oxygen. Cellular membranes of the retina have a high concentration of polyunsaturated lipids, which are particularly prone to react with oxygen and form damaged molecules. The photoreceptors and retinal pigment epithelium are exposed to unusually high concentrations of oxygen in the choroidal circulation. Finally, the lifetime exposure to light may enhance the reactivity of normal components with oxygen, compared to other tissues. The fact that the retina, particularly the macula, has high concentrations of compounds like lutein and zinc, suggests that it has developed its own natural defense mechanisms against damage from oxygen. Oxygen-damaged lipids are known to be involved in other diseases, so it is possible that they play a role in initiating AMD. On the basis of this theory, scientists have sought evidence that damaged lipids are found in diseased retina and that anti-oxidant compounds (e.g., vitamin E) protect the retina from disease.

Build-up of abnormal material in the retinal pigment epithelium
An important function of the retinal pigment epithelium is to bite off and digest the outer tips of the photoreceptors everyday. Compared to other cells in the body, the retinal pigment epithelium has the largest amount of material to digest and dispose. Much of that material ends up in distinctive granules called lipofuscin, which shine upon exposure to the right color of light. Lipofuscin accumulates with age, and its fluorescence becomes more prominent in retinal pigment epithelium cells that eventually die. Therefore, it is thought that lipofuscin contains compounds directly toxic to cells.

Genetic factors
All diseases involve a balance of inherited susceptibility and environmental influences. The relative balance of genetics and environment is not yet known for AMD. Nevertheless, there are several ways in which genetics may play a role in AMD.

First, it is known that there is a hereditable component to the disease, because identical twins and close relatives of affected individuals are more likely to develop AMD than those without relatives with the disease. Therefore, scientists have sought to identify large families of older adults who exhibit signs of the disease, so that detailed analysis of their DNA may be performed. It is possible that there is a whole battery of genes whose activity differs in patients with AMD.

Second, there are many rare inherited retinal diseases that affect younger adults, and a substantial number of the mutated genes have been identified. It is possible that at least some cases of macular degeneration in older adults may involve mutations of the same genes that cause disease in younger adults. So far, this has not turned out to be true, but many other genes remained to be considered.

Neovascularization: angiogenic factors and damage to Bruch’s membrane
Because neovascularization (formation of new blood vessels) accounts for the most sudden and severe loss of vision due to AMD, scientists have been particularly interested in understanding the basis of abnormal growth of new blood vessels in the eye. Current evidence from animal studies indicates that the retinal pigment epithelium actively secretes growth factors to maintain the proper health of the choroidal vessels. However, choroidal vessels do not break through Bruch’s membrane unless it is damaged. Bruch’s membrane thickens with debris and becomes calcified in older adults, which may weaken its structure, but how this happens is not yet clear.

Hemodynamic model
The sclera (white of the eye) and Bruch’s membrane accumulate lipids with age. According to this theory, stiffening of sclera and Bruch’s membrane would increase blood pressure in the choriocapillaris, and the accumulated lipids damage Bruch’s membrane. Deficiencies in the choroidal vasculature or increased resistance in the capillaries could lead to ischemia (lack of oxygen) at the retinal pigment epithelium. These cells may respond by secreting factors that cause blood vessels to multiply to make up for the low oxygen. The combination of increased blood pressure, damage in Bruch’s membrane, and poor oxygenation of the retinal pigment epithelium could lead to neovascularization.

Response-to-retention of a “bad cholesterol” particle produced in the eye
This is a new theory based on work done here at UAB and also based on well-studied principles in cardiovascular disease. In the coronary arteries that supply the heart, cholesterol builds up in the vessel wall, due to the influx of cholesterol-carrying particles from the blood. Local cells respond to the build-up by secreting factors that destabilize the vessel wall, causing rupture and hemorrhage. Cholesterol also builds up in Bruch’s membrane and drusen, but it is possible that the cholesterol comes from the retinal pigment epithelium rather than the blood.

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A risk factor is a characteristic that increases a person’s chance of having a disease. A risk factor for a disease is not necessarily a cause of the disease, although at times it is. A disease is significantly more likely to occur in a person with the risk factor than those without the risk factor. However, just because a person has a risk factor, this does not mean that they will get the disease. It just means that they are more likely to get the disease than someone who does not have the risk factor.

Risk factors can be divided into two types. Non-modifiable risk factors are those that cannot be changed by any kind of medical treatment, intervention, or lifestyle change. Age is a good example. Modifiable risk factors can be changed by treatment, intervention, or changes in behavior and lifestyle.

Non-Modifiable Risk Factors

Age
Large studies of populations in the US, Europe, and Australia have shown that the strongest risk factor for AMD is advanced age. Very few persons younger than age 50 years have AMD, and the number of affected persons rises dramatically after age 60. Depending on the study, 15-30% of persons older than 75 years have dry AMD, and about 5% have advanced AMD (either dry or wet). People aged 90 years or over have an 8-10 times greater chance of developing AMD, compared to people aged 50 years.

Race
Large population studies have revealed that in the US, African-Americans and Causasians have similar prevalence rates of the early signs of dry AMD (i.e., drusen and changes in the retinal pigment epithelium). However, wet AMD is found less frequently among African-Americans than among Caucasians. Studies from around the world suggest that the type of AMD varies between countries. It is not yet known if these differences reflect genetic differences between populations, lifestyle differences between cultures, or both.

Gender
Women tend to live longer than men, and people who live longer are at greater risk of AMD. It is not yet clear if women are at greater risk for AMD for any reason besides their longevity.

Family history
Individuals with AMD are more likely to have siblings or other close relatives that also have the disease. Both members of identical twins tend to develop disease that looks similar in the fundus. Brothers and sisters of AMD patients have nearly 20 times greater risk of developing AMD, compared to the general population.

Characteristics of the eye
Hyperopia (far-sightedness) and having a light-colored iris have been investigated as possible risk factors for ARM. There is more evidence supporting increased risk due to hyperopia, but the effect is very small.

Modifiable Risk Factors

Smoking
Tobacco smoke has long been implicated in the development of cancers and heart disease. Tobacco smoke contains compounds that promote oxidative damage to tissues and cells, compounds that constrict blood vessels, and compounds that reduce helpful anti-oxidant substances in the blood stream. Most major studies have found a link between smoking and AMD. Further, some studies found that the risk increases with the number of cigarettes smoked. Finding that smoking is a major risk factor is important, because it suggests that a lifestyle change may be helpful in preventing AMD.

Cardiovascular disease and its risk factors:
Elevated plasma cholesterol
Elevated levels of cholesterol in the blood increase risk for heart disease. One study has shown a strong association between elevated plasma cholesterol and neovascular AMD, and other smaller studies have not. There is no evidence that high plasma cholesterol is a risk factor for dry ARM at this time.

Hypertension
Hypertension, or high blood pressure, is another aspect of personal health that increases one’s risk for cardiovascular disease. The data on hypertension and AMD are mixed, in that some studies have shown increased risk and others have not. The differences in the results may be due to how AMD was defined in each of these studies. However, the recently completed AREDS (Age-related Eye Disease Study), demonstrated the risk conferred by hypertension in a large number of ARMD patients.

Light exposure
Light exposure, particularly ultraviolet light, is thought to lead to a lifetime of chronic oxidative damage to the retina. This is an attractive hypothesis which has not yet been convincingly supported by studies of large populations.

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AMD causes problems for what is called “central vision”, or your “straight-ahead” vision. This is because the photoreceptors in your macula, located in the central area of your retina, are not functioning well or have died.

AMD never causes total blindness. Persons with AMD, even its most severe form, have normal “peripheral” or side vision. If you know of someone who has AMD and has lost peripheral vision, this is not because of AMD but because of another eye condition.

One of the early signs of AMD is that detail vision is not as good as it used to be, even after the ophthalmologist has corrected the person’s vision with new glasses or contact lenses. Detail vision is used for many visual activities. One of the very common things we do that depends on detail vision is reading. Surveys have shown that the most common visual complaint of AMD patients is difficulty in reading.

Another problem is a loss of contrast sensitivity. This means that the world looks more “washed out” and the borders between objects are indistinct. A heightened sensitivity to glare often goes hand in hand with contrast sensitivity problems. In addition, colors can appear less bold and not the way most other people see them. The ability to tell the difference between certain colors may also be hampered.

Recent research has shown that one of the earliest signs of AMD is difficulty seeing at night, such as during driving, or when the illumination is rather low, as in a dimly lit restaurant. People with AMD also need a much longer time to adapt to darkness, such as entering a darkened movie theater or when driving through a tunnel. These eyesight problems at night and under low illumination sometimes occur well before the AMD patient will notice any loss of detail vision.

Persons with AMD often notice that straight lines appear distorted or wavy especially in the center of vision. The medical term for this is “metamorphopsia”. Your ophthalmologist may ask you to use an Amsler Grid as a convenient screening test at home to determine if you are experiencing these distortions. An Amsler Grid is a simple pattern of vertical and horizontal lines, with a fixation point in the center to focus on. Persons with AMD will sometimes see a waviness or a disruption in the pattern.

You can have AMD and some or all of these symptoms, and just because you have these symptoms, this does not mean you have AMD. Remember that AMD can only be properly diagnosed through a comprehensive eye examination and in some cases, more specialized tests.

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We divide our discussion of treatments for AMD into two categories. This first category includes treatments that have proven effectiveness in clinical trials and that are also widely utilized by ophthalmologists throughout the U.S. This category will be the most useful to persons who have the disease now or will be diagnosed in the near future. In general, these treatments are applicable to specific groups of AMD patients with specific types of disease. Therefore, it is necessary for individual patients to be evaluated by an ophthalmologist to determine if they are suitable for these treatments. The second category consists of “experimental” treatments that are under evaluation in ongoing clinical trials or in other types of clinical investigations. The results of these studies are not yet published so it is unknown as to whether these treatments will be effective or not. This is a rapidly moving area of research.

At present there are no proven treatment strategies for preventing the early phases of AMD.  All proven treatment strategies are designed to prevent the “wet” form of the disease or to slow or arrest the progression of the “wet” form of the disease.

We strongly recommend that all patients consult with their ophthalmologists in making any decisions about undergoing treatments for AMD.


Proven

Laser photocoagulation treatment (“hot laser”) of blood vessels growing under the retina (CNV) has been the standard of care for many years for wet AMD.  This treatment involves identifying blood vessels under the retina using fluorescein angiography.  Because the laser also affects the retina overlying the blood vessels, this treatment cannot be used in patients whose CNV is present under the fovea.  Patients with poorly defined CNV, large CNV, or blister-like detachments of the retinal pigment epithelium are also not eligible for this treatment. Because of these restrictions, which were established by a series of clinical trials between 1982 and 1997 (Macular Photocoagulation Study), only 13% of patients with CNV qualify for this treatment.

Photodynamic therapy (“cold laser” or PDT) involves injecting a light-sensitive dye such as verteporfin, which is attached to a lipid-containing carrier molecule, into the circulating blood. The carrier molecule is taken up preferentially by growing cells like those that form CNV. Once the drug reaches the right concentration in these cells, a low-intensity laser light is shone into the area of the macula containing the CNV. The light activates the dye, converts oxygen that is normally present in tissue to a highly energized form that causes damage to cells. A clot forms in the blood vessels, which become occluded and eventually regress. The therapeutic effect of PDT does not occur until the drug and the laser are combined. Because the drug accumulates in the target tissue, and the laser is directed to the CNV, PDT involves less damage to surrounding tissues than “hot laser”. Therefore it can be administered again if CNV recurs. 

Anti-oxidant vitamin and mineral supplementation has long been thought to be a way to maintain the health of the retina. This is because the retina is normally exposed to high levels of oxygen, which may damage cells as it is utilized. Cells have naturally occurring defense mechanisms against this damage.  The recent Age-related Eye Disease Study, a large study sponsored by the National Eye Institute, part of the National Institutes of Health, examined the effect of an anti-oxidant mixture (vitamin C, vitamin E, beta-carotene, zinc, and copper) on AMD patients.  Patients received zinc, the vitamins, or both.  This study determined that a group of patients at high risk for developing CNV were about 20% less likely to suffer vision loss due to advanced AMD if they took zinc and vitamins.  These patients already had advanced AMD in one eye.  The supplements did not prevent the initial development of AMD, nor did they restore vision that was already lost.

Intravitreal Macugen Injection
Macugen is a drug that has been in use since December 2004 (also called pegaptanib sodium injection). It blocks a signal in the eye (VEGF) that causes the abnormal growth of blood vessels (CNV, also called “wet AMD”), and is thus called an anti-angiogenic agent. It is injected into the eye every 6 weeks for up to a 2-year period. With this treatment, for 80% of patients vision remains stable and they do not continue losing vision. About 6% of patients regain some of the vision they lost. Almost 20% of patients will continue to lose vision.

Intravitreal Avastin Injection
Avastin (also called bevacizumab) is a drug that has been in use since 2004 for the treatment of colon cancer. It is an anti-angiogenic agent. More recently, it has been shown that when it is injected into the eyes of persons with “wet” AMD every 1 to 3 months, vision is stabilized in 90-95% of patients. Almost 36% of patients regain some of the lost vision. 5-10% of patients continue to lose vision. Avastin is used an “off-label” manner by ophthalmologists to treat AMD since the drug was approved by the FDA for colon cancer not AMD.

Intravitreal Lucentis Injection
Lucentis is a fragment of the Avastin molecule (see above) and was approved by the FDA in June 2006 for the treatment of CNV in patients with AMD (“wet” type). With this treatment 95% of patients remain stable and do not continue losing vision, and 30-36% of patients regain some vision. Lucentis is intravitreally injected into the eye every 4 weeks for up to 2 years.


Experimental

Lutein, Zeaxanthin, and Long Chain Omega-3 Fatty Acids
A second phase of the Age-Related Eye Disease Study (see above) is examining the effects of oral supplementation of high doses of macular xanthophylls (lutein and zeaxanthin) and long chair omega-3 fatty acids (DHA and EPA) in slowing or arresting disease progression to advanced AMD. This second phase study is called AREDS2 and is sponsored by the National Eye Institute, one of the National Institutes of Health. Enrollment of new patients is now ongoing. For more information on participating in the study, click here.

Anecortave acetate
Also called Retaane, this steroid works by inducing the production of an enzyme called plasminogen activator inhibitor. This, in turn, prevents other enzymes from breaking down tissue around the walls of existing blood vessels. Without this breakdown process, new blood vessels cannot grow through tissue. For more information on anecortave acetate, click here.

External beam radiation
Ionizing radiation selectively destroys growing cells, and it has been used for years in treating tumors.  It is thought that applied to the eye, radiation could help shrink new blood vessels under the macula. For information on external beam radiation, click here.

Surgical translocation of retina
This surgical treatment involves detaching the retina from the retinal pigment epithelium and rotating the fovea away from the neovascular membrane. The neovascular membrane can be treated with laser photocoagulation after the surgery, since the fovea is no longer laying on top of it. For information on surgical translocation of the retina, click here.

Surgery for submacular hemorrhage
Some neovascular membranes may bleed under the retina.  Some surgeons drain the blood or inject tissue plasminogen activator, which breaks up clots. For more information on surgery for submacular hemorrhage, click here.

Transpupillary Thermotherapy (TTT)
A laser procedure called TTT is under investigation as a treatment for occult wet AMD and in some cases of classic AMD. This treatment is being evaluated for use in eyes with choroidal neovascular membranes that are right under the fovea. TTT uses a long-wavelength laser that is less intense than the laser used in conventional photocoagulation therapy. TTT does not use any external drugs in conjunction with the laser treatment. For information on transpupillary thermotherapy, click here.

Lasering drusen
Unlike the other treatments on this list, laser photocoagulation of drusen is meant to be preventative.  In some patients who had undergone laser treatment for CNV in wet AMD, drusen far away from the laser spots disappeared with time.  Since drusen that are large or “soft” lead to increased risk for neovascularization, doctors reasoned that spontaneous regression of drusen may be beneficial. Patients in two large studies, the Complications of AMD Prevention Trial (CAPT) and the Prophylactic Treatment of AMD study (PTAMD) underwent prophylactic (preventative) laser photocoagulation of drusen. The findings for each study are represented at the given links.

Lasering around the macula
Another approach being evaluated for preventing choroidal neovascularization in patients with dry AMD is a low-intensity, long-wavelength laser applied to a grid of 48 spots around the macula. The laser is said to be “sub-threshold” because it is not perceptible to the patient or the ophthalmologist. The rationale for this treatment stems from clinical observations that drusen sometimes disappear even though they are not directly the target of the laser or are distant from the laser spots.

Apheresis
Blood filtering (apheresis) is a process to remove large molecules (proteins and lipoproteins) from plasma. Microcirculation stimulation is thought to increase blood flow in the retina.  For more information on apheresis, click here.

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Visual rehabilitation refers to a process by which persons with vision impairment learn to maximize the use of their remaining vision in order to lead as independent and safe a lifestyle as possible.  This remaining vision is often referred to as a person’s “residual vision”.  The ultimate goal of visual rehabilitation is to help persons with visual impairment lead more personally satisfying and productive lives.

“Low vision” is a term that is commonly used to describe impaired vision that cannot be corrected with glasses or contact lenses.  A person with low vision typically has a loss in visual acuity or peripheral vision (visual field) that interferes with the ability to carry out everyday visual activities, like reading, driving, getting around, working, finding objects, and so on.

In some cases persons with low vision are also “legally blind”.  In the United States, a person is considered to be “legally” blind under the following conditions:  having central visual acuity of 20/200 or worse in the better eye, or having a visual field that extends to less than 10 degrees from the fixation point, or its greatest diameter is less than 20 degrees, or both.

However, for some people, their vision impairment may not be severe enough to meet the legal definition of blindness, but they still are considered to have “low vision” because their visual impairment causes difficulty in everyday visual activities.

It is important to keep in mind that visual rehabilitation is not just for persons who are legally blind, but also for others with low vision having minor to moderate visual impairment.   For example, it is not unusual for persons with visual acuity in the 20/40 to 20/100 range to seek visual rehabilitation services because they need assistance compensating for their difficulties.

The most common group of clients seen in visual rehabilitation centers are persons with macular degeneration, especially older adults with AMD.  Since the major problem in AMD is impairment in central vision, rehabilitation strategies for persons with AMD center on educating and training clients about compensatory strategies to overcome loss of central vision.  These compensations do not restore vision to normal.  Rather, these compensations are strategies for working around the vision impairment or enhancing the residual vision so that the person can perform visual tasks that previously had been impossible or exceedingly difficult.

Who provides visual rehabilitation services?
These services are provided by a number of professionals, who often work together as a team.  These professionals include ophthalmologists, optometrists, occupational therapists, and rehabilitation educators, who have undergone specialized training in visual rehabilitation.  Psychologists and social workers often participate in providing visual rehabilitation services, especially assisting in issues having to do with adjustment, coping, and family issues.


What are visual rehabilitation services for persons with AMD?

Magnification
Magnifying lenses and other special devices make what you’re looking at bigger so it’s usually easier to see.  However, they do not make vision clearer for the person with AMD.  Popular magnifying devices are microscopes, hand held magnifiers, stand magnifiers, telescopes and closed circuit televisions.  A vast array of these devices are available, with a few examples pictured here.  These types of devices can be  helpful in reading.  They are prescribed after a thorough evaluation of the patient’s visual function to meet their particular visual needs.  Although most of these devices are available without a prescription, we recommend that persons with AMD consult with a doctor specializing in low vision, thus affording them the widest possible range of low vision devices to determine which devices will be most helpful before making purchases.  Proper training in the use of these devices is also a key part of effectively using them.

Eccentric Viewing Training
Because persons with AMD have decreased central vision, they may benefit from training to enhance the use of their side (peripheral) vision.  This is called eccentric viewing training.  Eye “exercises” are prescribed to teach clients to use the best location in their peripheral vision to achieve maximal visual acuity or contrast sensitivity.

Environmental Adaptations
There are a variety of environmental adaptations and non-optical devices that the doctor or rehabilitation specialist will suggest after discussing the persons’s living or working environment.  These adaptations range from lighting improvements, visual design enhancements such as adjusting color, contrast, and texture, and convenient devices that help with carrying out specific visual tasks, such as check-writing, using the telephone, shopping, self-care activities, and driving.  Suggestions will also be provided on ways to make the home safe given the visibility problems the person may be facing.

Orientation and Mobility
Orientation refers to awareness of one’s position in the environment, and mobility refers to the ability to travel efficiently and safely from one location to another.  These skills are taught by specially trained visual rehabilitation professionals.  Persons most likely to benefit from this training include those with new onset blindness or severe visual impairment, including some patients with AMD.  This training can include the use of a long white cane.  The long cane is swept in front of the user in a systematic back and forth manner to detect obstacles and changes in the surface that they are traveling on (curbs or steps for example).  It also serves to identify the user as a person with vision impairment, which is useful information for other pedestrians or drivers moving in the same area.  Using a cane for mobility purposes is a sophisticated skill that requires a training program.

Another less sophisticated mobility enhancement technique is called sighted guide.  Many patients with AMD can benefit from this technique.  The person with vision impairment grasps a guide’s arm just above the elbow and walks just slightly behind and to the side of the guide whose arm rests naturally at their side.  The follower can then sense the movements of the guide to enhance their mobility through the environment.  The guide can also give verbal clues such as “we are approaching a curb.” This is most useful in unfamiliar environments and can be taught easily by most members of the rehabilitation team.  This technique does not require formal orientation and mobility instruction.

Guide dogs are rarely useful for AMD patients.  Both the guide dog and its user must receive rigorous training for the partnership to be effective.  Dogs are taught basic travel skills such as obstacle avoidance and safe crossing of streets, but they cannot independently guide their user through the environment.  They follow the verbal instructions of the user.  To receive a guide dog, the potential user must be legally blind and able to maintain the dog with proper exercise, feeding, grooming and veterinary care.  Since AMD spares the peripheral vision, most patients do not require the use of a guide dog to move safely about their environment.

Psychological and Social Services
Loss of vision can have varied effects on a person’s daily life, and as such, individuals with vision impairment may need guidance or assistance in adjusting to the loss of vision, People with functional vision loss from AMD may become angry, depressed, frustrated or simply deny the changes they are going through.  Patients experiencing these feelings should be evaluated by and if indicated, treated by a psychologist.  Local support groups for persons with AMD or vision impairment can also be very helpful.  Patients with AMD may also benefit from the services of social workers who can facilitate issues related to family relationships and community involvement like transportation.

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UAB Ophthalmology Services

UAB Center for Low Vision Rehabilitation

UAB Driving Assessment Clinic

Ophthalmology Services

The UAB Ophthalmology Clinic covers the entire field of medical and surgical eye care along with vision care.  The Clinic’s doctors are faculty in the Department of Ophthalmology, School of Medicine at UAB.

Our Services:
Comprehensive Ophthalmology
Pediatric Ophthalmology
Neuro-Ophthalmology
Cornea and External Disease
Retina and Vitreous
Oculoplastic Surgery
Glaucoma
Ophthalmic Pathology
Uveitis/Ocular Inflammatory Diseases
Laser Vision Corection


Our Doctors:
Martin S. Cogen, MD
R. Jeffrey Crain, MD
Andrew W. Everett, MD
Christopher A. Girkin, MD
Lanning B. Kline, MD
Rena C. Lewis, OD
Russell W. Read, MD
Carol E. Rosenstiel, OD
Jennifer T. Scruggs, MD
Harold W. Skalka, MD
Jason Swanner, MD
Michael S. Vaphiades, DO
Andrew Velazquez, MD
Jeffrey Yee, MD


Our Location:
The UAB Ophthalmology Clinic is located on the 6th floor in Suite 601 of the Callahan Eye Foundation Hospital at UAB.  Our address is 700 18th Street South, Birmingham, Alabama 35294-0009, Phone (205) 325-8625.  We have an attached parking deck for our patients.  Parking is free for those who get their parking tickets validated in the clinic.  Enter the deck from University Blvd.  For an area street map of the clinic location, please click here.

Center for Low Vision Rehabilitation

The UAB Center for Low Vision Rehabilitation is a multi-disciplinary rehabilitation center created to provide state of the art care for persons with vision impairment not correctable with glasses, contacts, or other treatments. Experts in ophthalmology, optometry, occupational therapy, and psychology combine their knowledge to meet the special needs of each patient. Together they help persons with low vision lead more satisfying and productive lives.

Our Doctors and Rehabilitation Professionals:
Jennifer Bell, OTR/L
Dawn K. DeCarlo, OD, MS
Laura Dreer, PhD
Marsha Swanson, OD


Our location:
The UAB Center for Visual Rehabilitation is located on the 3rd floor in Suite 380 of the Callahan Eye Foundation Hospital at UAB. Our address is 700 18th Street South, Birmingham, Alabama 35294-0009, Phone (205) 488-0736. We have an attached parking deck for our patients. Parking is free for those who get their parking tickets validated in the clinic. Enter the deck from University Blvd. For an area street map of the clinic location, please click here.

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The goals of research in The AMD Project at UAB are:

• To understand the causes of AMD.
• To use this knowledge to develop and evaluate new treatments and preventions.
• To focus research on the earliest phases of AMD before severe vision impairment has occurred.
• To improve the quality of life of persons with AMD who already have irreversible vision impairment.

Scientists in the Department of Ophthalmology at UAB are engaged in a wide variety of research projects toward achieving these goals.  Basic scientists are addressing underlying causes of early (dry) AMD, beginning with changes that occur in the retina, retinal pigment epithelium, and Bruch’s membrane of normal older adults.  Clinical scientists are addressing how these changes impact vision, whether they can serve as markers for the disease, what interventions can slow progression, and how visual rehabilitation can be optimized.

Dr. Christine Curcio has worked with the Alabama Eye Bank for 12 years to assemble a collection of human donor eyes at all stages of AMD from normal to advanced.  Using these valuable tissues, she has applied microscopic, biochemical, and molecular biological techniques to examine the earliest stages of AMD and the detailed structure of the characteristic lesions.  One line of work in her lab established that the rod photoreceptors, which surround the center of vision in the macula, in aging and AMD, before the cone photoreceptors.  The biology of rods and cones are very different, and these findings help direct studies about the earliest stages of disease towards understanding the loss of rods.  Another line of research from Dr. Curcio’s lab helped establish a very thin layer of debris in Bruch’s membrane as an important problem in AMD.  Further studies indicated that cholesterol accumulates markedly in Bruch’s membrane in normal elderly people, suggesting that Bruch’s membrane in AMD and the inner wall of large arteries with atherosclerosis may share similarities.  If this hypothesis is true, then this means that AMD research can draw on the sizeable knowledge gained in studying and treating atherosclerosis. 

The phototransduction process in patients with early AMD is being studied by Dr. Gregory Jackson and Dr. Cynthia Owsley.  Phototransduction refers to the process by which retinal cells in the eye convert light to electrical impulses.  The electrical activity of the rod photoreceptors is measured using a clinical test called the flash electroretinogram or ERG.  The ERG provides information about how the earliest phases of neural processing in AMD are affected by the condition.  Neural signals are carried to higher levels of the brain, thus permitting us to have an awareness of our visual world.  A disruption in this process from malfunctioning photoreceptors causes vision impairment in those with AMD.  Understanding how photoreceptors malfunction in AMD will help us understand the causes of the disease.

We focus on the earliest signs and symptoms of the disease so that treatments can be targeted at fighting the disease from early on, or in preventing it altogether, before severe vision loss has occurred.  Dr. Cynthia Owsley and Dr. Gregory Jackson’s work indicates that prolonged delays in adapting to darkness is one of the earliest signs of the disease, even before there are changes in the appearance of the macula and visual acuity is impaired.   Dr. Jackson and a multi-disciplinary team of scientists will be addressing this issue in detail in a longitudinal study on a large group of older adults at risk for disease.  Dr. Owsley and colleagues are evaluating whether a short course of Vitamin A improves the ability to adapt to darkness in patients with early AMD.  Even in the early phases of AMD, there are deposits and debris in Bruch’s membrane, which is a wall of tissue separating the photoreceptors and their support cells from their blood supply.  This debris may be impeding the transfer of important nutrients to the rod photoreceptors such as Vitamin A.  Rod photoreceptors make possible night vision and seeing under dim illumination.  Vitamin A is critical for the proper functioning of rod photoreceptors and for their ultimate survival.  This study will shed light on the role of this process in AMD disease process.

AMD has several risk factors in common with cardiovascular disease, such as high blood pressure, smoking, and elevated plasma cholesterol.  The lesions in Bruch’s membrane contain lipids including cholesterol.  For cardiovascular disease, physicians often prescribe a group of drugs called “statins” to reduce LDL cholesterol because a high level of LDL cholesterol places a person at high-risk for the development of cardiovascular disease.  Dr. Gerald McGwin and colleagues reasoned that if cholesterol excess is a common pathway for both cardiovascular disease and AMD, then statin use may also decrease the risk of AMD.  In a recent study on older adult veterans, Dr. McGwin’s group found that there was an association between statin use and the reduced incidence of AMD.  Further work will explore this association in more detail in order to determine if statins could be used for AMD prevention or slowing of its progression.

Persons with vision impairment from AMD can face a number of psychological and daily challenges.  Loss of vision is associated with increased risk for depression, stress, and social isolation.  Daily visual tasks are more difficult, and in the moderate to severe stages of AMD, successful reading and safe driving are often impossible.  In essence, the quality of life of persons with AMD can be seriously compromised.  As treatments for AMD are developed that prevent or slow the course of vision impairment, these treatments are evaluated not only in terms of prevention of vision loss, but also in terms of how the treatment and its effects impact the patient’s quality of life.  To get a grasp on this, researchers examine the patient’s own beliefs and attitudes about his/her quality of life before versus after treatment.  These beliefs are evaluated by questionnaires specifically designed for this purpose. 

Because vision impairment due to AMD is irreversible at present, visual rehabilitation is an important component of the ophthalmologist’s care for patients with AMD.  Visual rehabilitation’s goal is multi-faceted and includes enhancing the visually impaired person’s use of any remaining vision through assistive devices, psychological and family counseling to facilitate coping skills, and training in performing daily tasks in alternative ways to compensate for vision loss.  Surprisingly little is known about the effectiveness of different rehabilitation approaches on the well-being of persons with visual impairment.  Dr. Owsley is developing a program of research to address this large gap in our knowledge, in order that the most efficient and effective strategies for visual rehabilitation can be made available to patients.

To learn about opportunities to participate in clinical research studies on AMD at UAB, click here.

To learn about making a difference in AMD research at UAB through eye donation after death, click here.

To learn how you can make a charitable contribution to support AMD research at UAB, click here.

We gratefully acknowledge that funding for The Research Program is made possible by the following organizations:

The National Eye Institute of the National Institutes of Health
The National Institute on Aging of the National Institutes of Health
Research to Prevent Blindness, Inc.
The EyeSight Foundation of Alabama
The International Retinal Research Foundation
The U.S. Department of Veterans Affairs

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The following research studies are ongoing and open for enrollment for volunteers who meet the eligibility requirements. A few of the key eligibility requirements are listed below. If you are interested in possible participation, or have questions about the study, please address your inquiries to the contact person listed.

All research studies in The AMD Project take place in the Callahan Eye Foundation Hospital. The hospital is at 700 18th Street South covering the entire block between University Blvd. and 7th Avenue South. We have an attached parking deck for our visitors. Those participating in research studies receive free parking. Enter the parking deck from University Blvd. For an area street map of our location, please click here.

Thank you for your interest! Without research volunteers, scientific progress toward developing new and improved treatments would not be possible.
 

UAB’s Institutional Review Board for Human Use has approved all human research protocols carried out in The AMD Project at UAB.

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Alabama Eye Bank’s Donor Program for Age-related Macular Degeneration Research
                                . . . . . Give So Others May See

You Can Make a Difference
Each year thousands of older adults in the United States are told by their doctors that they have age-related macular degeneration (AMD). This condition affects the macula, part of the eye responsible for detailed vision such as reading. Macular degeneration is the major cause of vision loss in people over the age 60, although it does not lead to total blindness. Click here for more information about what AMD is.

Why Donate Eye Tissue?
Scientists know it isn’t enough to study the symptoms of a disease. In order to discover the underlying causes of a medical problem, one must examine the diseased tissue. Important advances in medicine have been made through the generosity of people willing to donate tissue after death. Much of what we know about eye disease comes directly from studying donated eyes. Having access to this tissue helps researchers in search of new treatments answer basic questions.

Who is Eligible?
All adults are eligible to enroll. Your eyes are especially valuable to researchers if you have been diagnosed with macular degeneration. Regardless of your degree of vision, from normal to blind, previous eye surgery, or cause of death, eyes can be donated and will be used. Be sure to tell your family that you want to donate your eyes for research in macular degeneration.

How It Works
At the time of death, the donor’s family, physician, nurse, clergy, or funeral director contacts the Eye Bank. Eye donation does not interfere with funeral arrangements. The Eye Bank then collects the tissue and delivers it to researchers.

For more information regarding eye donation please contact The Alabama Eye Bank.

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Below are links to other sources of information about AMD and about services for persons with AMD. 

Some of the web sites below are targeted at those who live in Alabama.  For information on services nationwide for persons with AMD, click on these links for the web sites of the American Academy of Ophthalmology, the American Foundation for the Blind, or Lighthouse International.

Clinical Resources in Alabama
Federal Government Agencies
Professional Organizations
Private Agencies and Organizations
Other Resources in Alabama
Other Resources
Industry
Social Resources and Other Sites of Interest to Seniors

Clinical Resources in Alabama

Department of Ophthalmology, University of Alabama at Birmingham

UAB Center for Low Vision Rehabilitation

Callahan Eye Foundation Hospital

To find an Ophthalmologist in your area of Alabama, click here.

To find an Optometrist in your area of Alabama, click here.


Federal Government Agencies

National Eye Institute of the National Institutes of Health

National Institute on Aging of the National Institutes of Health

Administration of Aging

National Institute on Disability and Rehabilitation Research

Social Security Administration – Disability Programs

Department of Veterans Affairs – Blind Rehabilitation Service

Indian Health Service

 
Professional Organizations

American Academy of Ophthalmology

American Optometric Association

American Occupational Therapy Association

Association for Education and Rehabilitation of the Blind and Visually Impaired

 
Private Agencies and Organizations

Macular Degeneration Support

Lighthouse International

Eye Care Foundation

Macular Degeneration Network

American Health Assistance Foundation

Macular Degeneration Foundation

AMD Alliance

Association for Macular Diseases

Macular Degeneration International

Macular Degeneration Partnership

Macula Vision Research Foundation

Foundation Fighting Blindness

Prevent Blindness America

Check Yearly, See Clearly.

American Council of the Blind

Infocus: Interprofessional Fostering of Ophthalmic Care for Underserved Sectors

VSA Arts National

 
Other Resources in Alabama

Alabama Lions Sight Conservation Association, Inc

Birmingham-Jefferson Transit Authority, Special Services

Alabama Department of Rehabilitative Services

Easter Seals Alabama

Workshops Inc.

United Way of Central Alabama

Alabama Department of Senior Services

Birmingham Museum of Art – Tours for Sight-Impaired Individuals

VSA Arts Alabama

 
Other Resources

Financial Aid for Eye Care Resource List

US Government Sources List

Eye Health Organizations List

Low Vision Resources List

National Library Service for the Blind and Physically Handicapped (NLS), The Library of Congress

American Foundation for the Blind

The Center for the Partially Sighted, Santa Monica, CA

The Low Vision Gateway

Access for All

AgingEye.com

Assistive Media

Computer Center for Visually Impaired People

Vision Connection

 
Industry

Novartis Ophthalmics

Iridex

Pfizer Ophthalmics

Merck

OSI Pharmaceuticals

Alcon

Genentech
 

Social Resources and Other Sites of Interest to Seniors

American Association of Retired Persons

Shepherd’s Centers of America

Gray Panthers

SeniorNet

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The major purpose of the AMD Project at UAB is to develop effective treatments for AMD through basic and clinical research. At present there is no cure for AMD. This is true in spite of the fact it is the leading cause of vision impairment and blindness among adults over age 50 in the United States and many other countries. Our research here in The AMD Project at UAB is made possible by the generous support of our donors. By funding innovative ideas, dedicated scientists, and purchasing state-of-the-art equipment, The AMD Project supporters provide seed money to fund exciting research toward developing novel therapies.

The AMD Project at UAB is pleased to offer our prospective donors a variety of ways to support the research activities and programs of the Project. These options are described below. To have information sent to you, click here.

Cash or Check
This is the simplest – and most frequently used – form of giving. You can deduct allowable contributions in the year they are paid.

Multi-year Pledges
We are pleased to work with donors who wish to contribute at periodic intervals or spread their payments over several years. Pledges are payable over a period of up to five years in equal or varying amounts according to the donor’s wishes. At the donor’s request, the university will issue a pledge reminder on a quarterly or annual basis.

Appreciated Market Securities (Including Stock in a Closely Held Corporation)
Giving highly appreciated securities can provide special tax advantages. The donor gets a charitable deduction for the full fair market value of the securities on the date they are given and generally avoids any tax on the appreciation, as well. Donating securities on which you have experienced a loss is discouraged. It is better to sell those outright and donate the proceeds to the charity.
Owners of stock in a closely held corporation are uniquely positioned to benefit from giving the stock to a qualified charity. Most often, the stock has appreciated in value but pays no dividend. A planning method approved by the IRS allows the stockholder to give some of the closely held stock to a qualified charity. The charity may then sell the stock to the corporation, which may use its retained earnings for the purchase. There cannot be any prearranged contracts or written agreements requiring the charity to sell the stock or the corporation to purchase it. But, if this happens, the results of the transaction are: (1) no capital gains to the stockholder; (2) an income tax deduction for the current value of the shares donated; (3) avoidance of tax on distribution of retained earnings; and (4) control of the corporation is retained by the donor.

Charitable Gft Annuity
This is an easy way to make a gift to charity and receive supplemental income for life. A minimum gift of $10,000 is required and you must be at least 55 years old. To learn how rates are determined, call our Development office today at 325-8361.

Real Estate or Other Property
An outright gift of real property allows the donor to obtain for income tax purposes a charitable deduction equal to the property's full fair market value on the date of the gift. Certain limitations and rules for mortgaged property or property subject to debt may apply.

Deferred or Planned Gifts
"Deferred" or "planned" gifts consist of several types of giving arrangements in which benefits to the organization receiving the gift may not be immediate, but delayed or deferred. In addition to providing donors with potentially significant tax advantages, these gifts may also provide them with the opportunity to make a substantially larger gift than they originally thought possible. Deferred or planned gift opportunities include:

• Life insurance naming the charity as a beneficiary;
• Bequest, a gift of cash, securities, or property specified by a donor's will;
• Life income gift invested to yield income for the donor's designees, including Charitable remainder trusts and Charitable remainder annuity trusts, or a
• Charitable lead trust allowing the charity to use the property in trust for a period of time with the donor retaining the remainder at the end of the term.

Special Occasion Gift
Gifts can be designated in memory of a loved one or in honor of a special occasion.


UAB is a qualified, tax-exempt organization under Section 501(c)(3) of the Internal Revenue Code and all gifts are fully tax deductible as provided by law. Because of the technical and changing nature of philanthropy, we encourage you to consult with an attorney, accountant, or other qualified advisor when making large gifts. We welcome the opportunity to work with these professionals to help you achieve your charitable objectives.

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What is The Age-related Macular Degeneration Project at UAB?
The Age-related Macular Degeneration Project at UAB is research and public education with the goal of developing effective treatments for age-related macular degeneration (AMD).  We believe that public education goes hand-in-hand with medical research because research priorities in the U.S. are stimulated by the public’s expression of its needs.
 
Where are you located?
Our main office is in the UAB Department of Ophthalmology on the 6th floor in Suite 609 of the Callahan Eye Foundation Hospital.  The Department of Ophthalmology is one of 17 clinical academic departments of the UAB School of Medicine.  The Callahan Eye Foundation Hospital is part of the UAB Health System and is in the center of the UAB medical center campus in Birmingham, Alabama.  The hospital is at 700 18th Street South covering the entire block between University Blvd. and 7th Avenue South. We have an attached parking deck for our visitors.  Enter the parking deck from University Blvd.  For an area street map of our location, please click here.
 
I have age-related macular degeneration (ARMD) and am interested in participating in clinical trials and other clinical studies. How do I find out if you have studies open for patient enrollment?
We appreciate all inquiries about participation in our research projects!  Click here for a list of studies on AMD with ongoing enrollment in the UAB Department of Ophthalmology, or phone us at (205) 325-8521.
 
I have an eye problem and want to see an ophthalmologist. Do you provide these services?
The AMD Project itself does not provide clinical services to patients. However, we are affiliated with the UAB Department of Ophthalmology’s clinic, which is directly next door to us in Suite 601. We work closely with the physicians who practice there.  For an appointment or for general information, please phone (205) 325-8620 or visit their web site by clicking here.
 
What is the difference between an ophthalmologist, optometrist and optician?
 
An Ophthalmologist is a medical doctor (M.D.) who specializes in eye and vision care. Ophthalmology is a branch of medicine specializing in the anatomy, function and diseases of the eye. Ophthalmologists are specially trained to provide the full spectrum of eye care, from prescribing glasses and contact lenses to complex and delicate eye surgery. Many ophthalmologists are also involved in scientific research into the causes and cures for eye diseases and vision problems.   Ophthalmologists attend four years of medical school and one year of internship, and then spend a minimum of three years of residency (hospital-based training) in ophthalmology. During residency, ophthalmologists receive special training in all aspects of eye care, including prevention, diagnosis and medical and surgical treatment of eye conditions anddiseases.   Often, an ophthalmologist spends an additional one to two years training in a subspecialty, that is, a specific area of eye care (for example, retinal diseases, glaucoma or pediatric ophthalmology.)   Most ophthalmologists are board certified. A board certified ophthalmologist has passed a rigorous two-part examination given by the American Board of Ophthalmology designed to assess his/her knowledge, experience and skills. For more detailed information on the profession of Ophthalmology, click here.
 
An Optometrist is an independent primary health care provider who examines, diagnoses, treats, and manages diseases and disorders of the visual system, the eye and associated structures. Among the services optometrists provide are prescribing glasses and contact lenses, rehabilitating the visually impaired, and diagnosing and treating ocular diseases.  Professional Optometric Degree programs are courses of study leading to a doctor of optometry (O.D.) degree. Doctors of Optometry must successfully complete a four-year accredited degree program at one of the schools or colleges of optometry. Most students accepted by a school or college of optometry have completed an undergraduate degree.  In order to practice optometry, you must be state licensed. All states require graduation from an accredited professional optometric degree program as a prerequisite for licensure. In most states the written examination has been replaced with the examinations that are given during the student's academic career by the National Board of Examiners in Optometry.  For more detailed information on the profession of Optometry, click here.
 
An Optician is a professional who fits and dispenses eyewear directly to the consumer. They analyze and interpret prescriptions written by ophthalmologists or optometrists to determine which eyeglasses are best suited to the patient's lifestyle and visual needs.   The optician takes eye measurements to insure proper lens placement in the eyeglasses' frame and verifies the accuracy of the finished product.  He/she also may manufacture (grind) lenses from raw materials and cut them to fit into the frame.  Opticians may hold an associate opticianry degree or may have apprenticed for a required number of hours. In most states that require an optician to be licensed, candidates must pass an examination given by the American Board of Opticianry (ABO). Some states also require that candidates pass a state board exam. For more information on the optician profession, click here.
 
Is AMD curable?
No. Currently there is no cure for AMD.  This is why research programs on AMD are so important.  Although not curable, there are a few treatments available that slow the progression of the disease for persons with specific types of the disease.  Click here for more information regarding current treatment options.
 
How many people have AMD?
Over 1.6 million Americans over age 60 have advanced AMD, and considering all cases of AMD, from early to late phases, 13 million Americans have the condition.  AMD is the leading cause of irreversible blindness in the U.S. and also the leading cause of legal blindness among older Americans.
 
If I have AMD in one eye, will I have it in the other?
In the early phases of AMD, sometimes the signs and symptoms may appear in only one eye. However, AMD is a “bilateral” disease meaning that you have it in both eyes.  In other words, the signs of the disease eventually appear in both eyes.
 
Will I go completely blind as a result of having AMD?
No. Although AMD is the leading cause of legal blindness in older adults, AMD affects your central vision only. Someone with AMD will still retain “peripheral” or side vision.
 
What is Legal Blindness?
People often refer to visual impairment that meets the legislative and Social Security Administration definition of blindness as “statutory” blindness, or “legal blindness.”  A person is considered to be “legally” blind under the following conditions:  having central visual acuity of 20/200 or worse in the better eye, or having a visual field that extends to less than 10 degrees from the fixation point, or its greatest diameter is less than 20 degrees, or both. A person can be legally blind and still have some sight.  For example, a person who is legally blind from AMD, will have normal peripheral vision (unless they have another eye condition that affects peripheral vision).  For detailed information on vision impairment and qualifications for disability benefits, click here for the Social Security Administration’s web site.  For further information about federal income tax exemptions for those who are legally blind, click here for the Internal Revenue Service’s web site.
 
I have had dry AMD for years. Does this mean that I am going to get wet AMD too?
The course and timing of the disease is different for every person. Someone could have dry AMD for years, and it will never turn into the wet form.  However, once you have the dry form, you are at increased risk for developing the wet form of AMD, as compared to someone who does not have the dry form of AMD.  
 
I have a cataract. Is removing the cataract going to make my AMD worse?
Whether to have a cataract surgically removed is a decision you should make in direct consultation with your ophthalmologist.  Your ophthalmologist will discuss the risks and benefits of cataract surgery and your expectations for improved vision.
 
How often should I have my eyes checked?
How often you should have your eyes checked depends on your age and the health of your eyes. Your ophthalmologist should recommend a schedule for you to keep during your initial visit with him/her, whether you are in good eye health or whether you have been diagnosed with an eye condition. Most ophthalmologists recommend yearly comprehensive eye exams once you have reached the age of 50 or 60.  Until that time, approximately every 2 years may be adequate unless you experience unusual symptoms or changes in your vision or you have already been diagnosed with an eye problem that requires more frequent monitoring.
 
How do I know if I have AMD? How is AMD detected?
The initial symptoms of AMD can take a variety of forms.  You may notice a loss of visual acuity (the ability to see small details) that cannot be corrected by the glasses your doctor prescribes.  You may notice night vision problems or problems seeing under dim lighting.  You may notice that straight lines appear distorted or wavy especially in the center of your vision, that a dark or blurry area always seems to be in your central vision, or that your perception of color changes. You may notice these changes in your vision have occurred abruptly or you may gradually notice them over time. Click here to read more about the visual signs and symptoms of AMD.
 
However, it’s important to keep in mind that you can have none of these symptoms and have AMD, and even if you have these symptoms, you may not have AMD.
 
If you notice any of these symptoms or other changes in your vision, you should report them to your ophthalmologist.  By doing a comprehensive eye examination, and sometimes more specialized tests, your ophthalmologist will be able to diagnose whether you have AMD.  Because the above signs and symptoms of the disease do not always occur, it is important for persons age 50 and over to have a comprehensive eye examination every year, as discussed in the previous question.  That way your ophthalmologist can monitor you for the onset of AMD and other eye problems that are common among older adults.
 
So the real answer to the question above is that the only valid way to know whether you have AMD is to consult with your ophthalmologist at least once a year when you are over age 50-60.  
 
 
Will it be helpful to donate my eyes after my death in hopes of playing a role in research toward finding a cure?
Yes. Donated eyes are in short supply, especially eyes donated for research on AMD.  AMD eyes, eyes with other diseases, and healthy eyes are all extremely important for eye research.  Click here to read more about Eye Donation here at UAB for AMD research.

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We are very grateful to the EyeSight Foundation of Alabama for their financial support of The Age-related Macular Degeneration Project and its web site.  A special thanks to Torrey Smitherman, EyeSight’s Executive Director, for her guidance and patience as the web site has unfolded.
 
Our deep appreciation is also extended to the following public and private organizations that support our research activities on AMD:

The National Eye Institute of the National Institutes of Health
The National Institute on Aging of the National Institutes of Health
Research to Prevent Blindness, Inc.
The International Retinal Research Foundation
American Health Assistance Foundation

We extend a special note of appreciation to both Lanning B. Kline, MD, Chairman of the UAB Department of Ophthalmology and Robert Rich, MD, PhD, Dean of the UAB School of Medicine for their support of our efforts.

Finally, we were fortunate to have a team of very talented people who helped us create the web site’s content and design.  Many thanks to . . .

Joel Valencia for overall site design.
Deidre Seker for content development.
Dina Payne for content development.
Sloane Bibb of Mindvolt for logo design.
Gregory Jackson, PhD for technical consultation.
Lisa Keene for information systems support.

For the AMD Project at UAB, we thank you for visiting the site.

Cynthia Owsley, MSPH, PhD
Principal Investigator

Christine Curcio, PhD
Co-Investigator

Department of Ophthalmology
School of Medicine
University of Alabama at Birmingham

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UAB Main Page

UAB Ophthalmology Clinical Research Unit

UAB Department of Ophthalmology

UAB School of Medicine

Callahan Eye Foundation Hospital

Alabama Eye Bank

EyeSight Foundation of Alabama

UAB Electronic Phonebook

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The Age-related Macular Degeneration Project
Department of Ophthalmology
School of Medicine
University of Alabama at Birmingham
700 S. 18th Street, Suite 609
Birmingham, AL 35294-0009

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