macular degeneration

Age-related Macular Degeneration

What is AMD?

AMD is a common eye condition and a leading cause of vision loss among people age 50 and older. It causes damage to the macula, a small spot near the center of the retina and the part of the eye needed for sharp, central vision, which lets us see objects that are straight ahead.In some people, AMD advances so slowly that vision loss does not occur for a long time.

In others, the disease progresses faster and may lead to a loss of vision in one or both eyes. As AMD progresses, a blurred area near the center of vision is a common symptom. Over time, the blurred area may grow larger or you may develop blank spots in your central vision. Objects also may not appear to be as bright as they used to be. AMD by itself does not lead to complete blindness, with no ability to see. However, the loss of central vision in AMD can interfere with simple everyday activities, such as the ability to see faces, drive, read, write, or do close work, such as cooking or fixing things around the house.

The Macula

The macula is made up of millions of light-sensing cells that provide sharp, central vision. It is the most sensitive part of the retina, which is located at the back of the eye. The retina turns light into electrical signals and then sends these electrical signals through the optic nerve to the brain, where they are translated into the images we see. When the macula is damaged, the center of your field of view may appear blurry, distorted, or dark.

Who is at risk?

Age is a major risk factor for AMD. The disease is most likely to occur after age 60, but it can occur earlier.

Other risk factors for AMD include:

Smoking. Research shows that smoking doubles the risk of AMD.

Race. AMD is more common among Caucasians than among African-Americans or Hispanics/Latinos.

Family history. People with a family history of AMD are at higher risk.Does lifestyle make a difference?

Types of AMD

Early AMD

All parts of the body change as we age and it's normal to see differences in the way the retina looks in older people. There may be changes to the colour of the retina or tiny, fatty deposits called drusen may appear.

Some people have more significant changes to their retina, for example, quite a lot of small drusen, several large drusen or bigger areas of colour abnormality. These people may be diagnosed with ‘early’ age-related macular degeneration (AMD).

It’s important to note that many people with early AMD will never develop sight loss, as the progress of the disease varies considerably between individuals.

Detecting early AMD

Until quite recently, most people with AMD would not know they had it until it began to affect their sight. Nowadays, very sophisticated eye scanning machines are increasingly available in high street opticians and this is leading to more diagnoses of early AMD.

People over 60 are entitled to free eye tests. An eye test is recommended every two years if you are over 60, and every year if you are over 70. Examination of the macula is a part of this free examination.

How can I stop early AMD developing?

If you are told you have early AMD, there are some things you can do to reduce the likelihood of the disease progressing.

If you smoke, stop. Smokers are four times more likely to develop AMD than non-smokers. Smoking kills the cells of the retina, reduces the delivery of oxygen and nutrients to the eye and damages blood vessels. Smoking causes AMD to progress faster and makes treatment less effective.
Take moderate exercise to maintain a healthy weight and normal blood pressure.
Eat a healthy diet with plenty of fruit and vegetables, especially green, leafy vegetables. These contain nutrients that are thought to be important to eye health.

Diet Supplements

Some experts recommend nutritional supplements for people with AMD. However, the evidence for this is considered weak by other experts. The best evidence is from two large studies, the Age-Related Eye Disease Studies (AREDS) 1 and 2.

Please see the ‘Nutrition and eye health’ page for more about AREDS, diet and supplements.

Click for more on

If you decide to take a supplement, consult your GP first, especially if you are taking other medication.

Monitoring your vision

If you have early AMD it is a good idea to monitor your vision every week or so to spot changes early. You can do this very simply by closing one eye and looking at window frames or door posts to see if there is any distortion.

You may also use the Amsler Chart to monitor changes to your vision.

Please click the button below for a downloadable Amsler Chart

Dry AMD

Dry age-related macular degeneration (AMD) is a slow deterioration of the cells of the macula, as the retinal cells die off and are not renewed often over many years. The term dry does not mean the person has dry eyes, just that the condition is not wet AMD. The progression of dry AMD varies, but in most people it develops over many months or years. People often carry on as normal for some time.

What are the symptoms?

Macular disease affects people in different ways:

Gaps or dark spots (like a smudge on glasses) may appear in your vision, especially first thing in the morning. Objects in front of you might change shape, size or colour or seem to move or disappear.
Colours can fade.
You may find bright light glaring and uncomfortable or find it difficult to adapt when moving from dark to light environments.
Words might disappear when you are reading.
Straight lines such as door frames and lampposts may appear distorted or bent.

Diagnosing dry AMD

Diagnosis is usually possible by examining the retina- the back of the eye. Photography or other imaging is sometimes needed to detect early signs of macular degeneration. These might include Optical Coherence Tomography (OCT) scans which create cross-sectional images of the retina.

Around 10-15% of people with dry AMD go on to develop wet AMD. If you have dry AMD and notice a sudden change in your vision, it is important that you contact your optometrist, or hospital eye specialist, urgently. If you have AMD in one eye, the other eye may also be affected within a few years.

Monitoring your vision

If you have Dry AMD it is a good idea to monitor your vision every day to spot changes early. This best done using theAmsler Chart to monitor changes to your vision.

Please click the button below for a downloadable Amsler Chart

Treatment for dry AMD

There is no curative medical treatment for dry AMD.

Dry AMD encompasses a rather broad spectrum of visual limitation/disability and as such it may be better to use diet supplements recommended by the AREDS 2 study.

Many of the supplements have different ingredients, or different doses, from those tested in the research trials. Mr. David will advise you about which supplement, if any, is right for you. For example, if you smoke regularly, or used to, Mr. David may recommend that you avoid supplements containing beta-carotene.

Even if you take a daily multivitamin, you should consider taking a supplement if you are at risk for late AMD. The formulations tested in the research trials contain much higher doses of vitamins and minerals than what is found in multivitamins.

Finally, remember that these supplements are not a cure. They are meant to slow the progression of AMD.

Wet AMD

Wet age-related macular degeneration (AMD) develops when abnormal blood vessels grow into the macula. These leak blood or fluid which leads to scarring of the macula and rapid loss of central vision. Wet AMD can develop very suddenly but it can now be treated if caught quickly. Fast referral to a hospital specialist is essential.

What are the symptoms

Macular disease affects people in different ways:

Gaps or dark spots (like a smudge on glasses) may appear in your vision, especially first thing in the morning. Objects in front of you might change shape, size or colour or seem to move or disappear.
Colours can fade.
You may find bright light glaring and uncomfortable or find it difficult to adapt when moving from dark to light environments.
Words might disappear when you are reading.
Straight lines such as door frames and lampposts may appear distorted or bent.

Diagnosing wet AMD

This may include the following

Eye drops to dilate the pupils to see the back of the eye clearly. These may make your vision blurred and sensitive to light for a short time so consider taking someone with you.
OCT scans.
Fluorescein dye angiography. A dye injected into a vein in the arm travels to the eye, highlighting the blood vessels in the retina so they can be photographed.

Treatment for Wet AMD

Treatment is now available in the form of anti growth factor injections (Lucentis, Eylea or Avastin). In most cases these offer around a 30% chance of visual improvement and a 95% chance of stabilistaion. Therefore, urgent diagnosis and treatment gives a better visual outcome.

If you get this treatment, you may need monthly injections. Before each injection, your eye will be numbed and cleaned with antiseptics. To further reduce the risk of infection, you may be prescribed antibiotic drops. A few different anti-VEGF drugs are available. They vary in how often they need to be injected, so you may wish to discuss these issues with Mr. David.

The injections are not as bad as they might sound. The patient’s eye is anaesthetised and the needle goes into the corner of the eye so the patient does not see it.

Some people do not respond to the injections and may be offered a form of laser treatment instead. There are a range of treatments and options although not all are available on the NHS.

Special Lens implants for AMD

These devices have been used for sometime now with variable success. Mr. David no longer advises the use of these nor does he implant them.

Rehabilitation

Partial Sighted and Blind Registration - For those whose vision is badly affected registration brings many benefits. The support team will visit you in your own home and assess whether you need any additional help or appliances. They can arrange the talking book and other support services which you may find very helpful.

Mr. David can organise a Low Vision Clinic Appointment to help with rehabilitation.

The Royal National Institute for the Blind has an online shop with gadgets that may be helpful. It is best if one purchased such gadgets or devices with the help of your local visual rehabilitation team.

Click here for the RNIB shop

Useful Addresses

The Macular Disease Society

Darwin House, 13a Bridge Street,

Andover, Hampshire, SP10 1BE

Tel. 0845 2412041

Website. www.maculardisease.org

Talking Newspaper Association of the United Kingdom

90 High Street Heathfield,

East Sussex TN21 8JD

Tel. 01435 866102

Website. www.tnauk.org.uk