Macular degeneration in a grandparent: the Amsler grid, what the scan shows, and when to go sooner
A grandparent sees wavy lines or a smudge in the middle of the vision. Here is what macular degeneration is, how the home grid check works, what the eye check and scan look at, and which changes mean seeing an eye doctor within days.
See an eye doctor within days, or the same day, if…
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- Age-related macular degeneration blurs the central vision and not the side vision. About 80 percent of cases are the dry form, and wet AMD is less common but faster (American Academy of Ophthalmology).
- The risk rises with age, and the National Eye Institute lists age 55 and over, family history and smoking.
- The Amsler grid is a home check for wavy lines or blank spots, one eye at a time. A change means being examined, and a normal grid does not replace the eye check.
- An eye check uses dilating drops and an OCT scan, which gives detailed images of the macula. Wet AMD is treated with anti-VEGF medicine injected into the eye by an eye specialist.
- The AREDS2 formula lowered the risk of progression by about 25 percent in people with intermediate or advanced AMD. It does not prevent AMD in people who do not have it.
A grandparent says the words on the page look a bit wavy, or a face across the table has a smudge where the middle should be. Someone mentions macular degeneration, and nobody in the family is sure what it is, what the home grid test is for, or what the scan at the eye clinic actually looks at. This page explains it in plain words, and says which changes mean seeing an eye doctor within days and not waiting for the next routine visit.
It is written for the son or daughter who is booking the appointment, and for the grandparent who will sit in the chair.
What is age-related macular degeneration?
It is an eye disease that blurs the central vision. The National Eye Institute (NEI) says it "happens when aging causes damage to the macula", the part of the eye that controls sharp, straight-ahead vision. Losing central vision "can make it harder to see faces, read, drive, or do close-up work like cooking or fixing things around the house".
The American Academy of Ophthalmology (AAO) explains that it does not affect the side vision. Picture looking at a clock: the numbers around the edge may still be seen, while the hands in the middle are missing or blurred. Because the side vision stays, people can still move around the house, which is one reason the change can be missed for a while.
What are dry and wet macular degeneration?
Dry is the common form and wet is the less common but faster one. The AAO says about 80 percent of people with AMD have the dry form, in which the macula gets thinner with age. The NEI says early dry AMD does not cause symptoms, and that it moves through early, intermediate and late stages.
Wet AMD is a type of late AMD. It happens when abnormal blood vessels grow under the retina and damage the macula, and the NEI says it usually causes faster vision loss. The AAO calls it less common but much more serious. This is the form where the timing of seeing a doctor matters most.
Who is more likely to get it?
Age is the main factor. The NEI says the risk goes up with age and that people aged 55 and older are more likely to have AMD. It also lists family history and smoking. Smoking is the one factor a person can change, and a family can encourage a grandparent who smokes to speak to a doctor about stopping.
Having a risk factor does not mean a person will get AMD, and having no risk factor does not rule it out.
How is the Amsler grid used at home?
It is a small square of straight lines with a dot in the middle, used to notice changes in the central vision between check-ups. The AAO describes it as helping a person "notice any blurry, distorted, or blank spots in your field of vision". The grid is given or shown by the eye clinic, and it can also be found on eye hospital and charity websites.
The AAO steps are these. Hold the grid about 12 to 15 inches (30 to 38 cm) away in good light, wearing the reading glasses normally used. Cover one eye, look directly at the dot in the centre, and note whether any lines look bent or wavy, or whether any area looks blurry, dim or out of shape. Then do the other eye. Test each eye separately, because the better eye can hide a problem in the other.
What a change means: the AAO says to call the ophthalmologist right away if any lines or parts of the grid look wavy, blurry or dim. The grid does not diagnose anything. It is a prompt to be examined, and a normal grid does not replace the eye check.
What do an eye check and an OCT scan look at?
They look at the macula itself. In an AMD examination the AAO lists a dilated examination, in which drops widen the pupil so the doctor can look through a special lens at the retina and macula for changes. The AAO also lists optical coherence tomography (OCT), where "a machine scans the retina and provides very detailed images of the retina and macula".
The AAO says further imaging, such as fluorescein angiography and OCT angiography, may be used to show blood vessel changes in wet AMD. Which tests are needed is the doctor's decision. After dilating drops, vision is blurry and bright light is uncomfortable for some hours, so it helps if a family member comes along to take the grandparent home.
How is wet macular degeneration treated?
The NEI and AAO say wet AMD is treated with medicines called anti-VEGF drugs, which the eye doctor injects into the eye. The AAO says the treatment helps reduce leaking from abnormal blood vessels in the retina, and that it is delivered through a very thin needle. The NEI also mentions photodynamic therapy, a combination of an injection and laser treatment, as another option. An eye specialist decides which, if any, suits the person, and how often.
This page does not describe results or timing of treatment, because those depend on the individual and on what the scan shows. The point for the family is that wet AMD has treatment, and that it is the doctor who decides on it after examining the eye.
What did the AREDS2 trial find about supplements?
A specific supplement formula slowed progression in people who already had intermediate or advanced AMD, and it was not shown to prevent AMD in people who do not have it.
The NEI says that people with intermediate AMD in both eyes, or intermediate AMD in one eye and advanced AMD in the other, who took the AREDS2 formula (antioxidant vitamins and minerals, with lutein and zeaxanthin and without beta-carotene) had about a 25 percent lower risk of progressing from intermediate to advanced AMD than those on placebo. The NEI states that "AREDS and AREDS2 supplements do not prevent AMD onset".
The AREDS2 report in JAMA (2013) followed 4,203 people aged 50 to 85 who were at risk of advanced AMD, for a median of five years. Adding lutein and zeaxanthin, omega-3 fatty acids, or both to the original AREDS formula did not further reduce the risk of progression in the main analyses. The authors suggested lutein and zeaxanthin could replace beta-carotene, which had raised lung cancer concerns in former smokers. The AAO says beta carotene should not be used by smokers because it raised the risk of lung cancer.
So the supplement question is for the eye doctor to answer after examining the eye. The AAO says an ophthalmologist can tell a person whether vitamins and minerals are recommended for their dry AMD, as not all forms benefit. A grandparent should not start a high-dose supplement on a guess.
Which changes mean seeing an eye doctor within days?
Any new distortion or new dark or blank patch in the centre. That means straight lines suddenly looking wavy or bent, a new blurry or dim area in the middle of the vision, or a new dark or empty spot where the centre should be. The AAO says to call the ophthalmologist right away for any of these, and to seek prompt attention for sudden distortion or dark spots. Faster vision loss is typical of wet AMD, which is why the wait should be days, not weeks.
The action: write down which eye and when it was first noticed, ring the eye clinic, say "new distortion in the centre of the vision", and ask for the earliest appointment. If vision is lost suddenly in one eye, a curtain or shadow appears, or there is severe pain, go to an eye doctor or hospital the same day.
What can the family do now?
Book an eye check for any grandparent aged 55 or older who has not had one recently, ask them to check the grid at home on a regular day, and keep the eye clinic's number where they can see it.
A glaucoma check is a different set of tests with a different purpose, explained in glaucoma check for a parent. For who in the household needs which check, see eye checks for the whole family, and if there is diabetes in the family, diabetes in the family covers the retina check.
- Straight lines suddenly look wavy or bent, or any part of the Amsler grid looks wavy, blurry or dim.
- A new dark or blank patch appears in the centre of the vision.
- Vision in one eye is lost suddenly, or a curtain or shadow appears (go the same day).
- There is severe eye pain, especially with a red eye, headache or vomiting (go the same day).
Common questions
What is the difference between dry and wet macular degeneration?
How do I use an Amsler grid?
What does an OCT scan show?
Is wet macular degeneration treatable?
Can a supplement prevent macular degeneration?
Which changes mean I should not wait for the routine check?
Does macular degeneration cause total blindness?
- American Academy of Ophthalmology · Age-related macular degeneration symptoms · www.aao.org
- American Academy of Ophthalmology · AMD diagnosis · www.aao.org
- American Academy of Ophthalmology · AMD treatment · www.aao.org
- National Eye Institute · Age-related macular degeneration · www.nei.nih.gov
- National Eye Institute · About AREDS and AREDS2 · www.nei.nih.gov
- AREDS2 Research Group · Lutein + zeaxanthin and omega-3 fatty acids for AMD: the AREDS2 randomized clinical trial (JAMA 2013) · pubmed.ncbi.nlm.nih.gov