What is macular degeneration?
Sometimes the delicate cells of the macula become damaged and stop working, and there are many different conditions which can cause this. If it occurs later in life, it is called “age-related macular degeneration”, also often known as AMD.

Broadly speaking, there are two types of macular degeneration or AMD, usually referred to as “wet” and “dry”. This is not a description of what the eye feels like but what the ophthalmologist (eye specialist) can see when looking at the macula.

“Dry” AMD is the most common form of the condition. It develops very slowly causing gradual loss of central vision. Many people find that the vision cells simply stop working like the colours fading in an old photograph. There is no medical treatment for this type. However, aids such as magnifiers can be helpful with reading and other small detailed tasks.

“Wet” AMD results in new blood vessels growing behind the retina, this causes bleeding and scarring, which can lead to sight loss. “Wet” AMD can develop quickly and sometimes responds to treatment in the early stages. It accounts for about 10 per cent of all people with AMD.

Both “wet” and “dry” AMD usually involve both eyes, although one may be affected long before the other. This sometimes makes the condition difficult to notice at first because the sight in the “good” eye is compensating for the loss of sight in the affected eye. You cannot wear out your sight, so do not be afraid to continue to use the “good” eye as normal.

The good news is that AMD is not painful, and almost never leads to total blindness. It is the most common cause of poor sight in people over 60 but very rarely leads to complete sight loss because only the central vision is affected. This means that almost everyone with AMD will have enough side (or peripheral) vision to get around and keep his or her independence.

 

What causes AMD?
At the moment the exact cause for AMD is not known. However there are a number of risk factors which have been identified.

Age – AMD is an age related condition so growing older makes the condition more likely.

Gender – Women seem more likely to develop macular degeneration than men.

Genetics – There appear to be a number of genes which can be passed through families which may have an impact on whether someone develops AMD or not.

Smoking – Smoking has been linked by a number of studies to the development of AMD. It has also been shown that stopping smoking can reduce the risk of AMD developing.

Sunlight – Some research suggests that lifetime exposure to sunlight may affect the retina. It is a good idea to wear sunglasses to protect the eyes.

Nutrition – Research suggests some vitamins and minerals can help protect against AMD.

Although nothing can be done about age, gender and the genes we inherit, it is possible to control the other more environmental factors that seem to be linked to AMD. Protecting your eyes from the sun, eating a well balanced diet with plenty of fresh fruits and vegetables and stopping smoking may all help to delay the progress of AMD.

 

What are the symptoms of AMD?
In the early stages your central vision may be blurred or distorted, with objects looking an unusual size or shape and straight lines appearing wavy or fuzzy. This may happen quickly or develop over several months. You may be very sensitive to light or actually see lights, shapes and colours that are not there. This may cause occasional discomfort. AMD is not painful.

Because AMD affects the centre of the retina, people with the advanced condition will often notice a blank patch or dark spot in the centre of their sight. This makes reading, writing and recognising small objects or faces very difficult.

 

What should I do if I think I have macular degeneration?
If you suspect that you may have AMD but there are no sudden symptoms, you should see us or your family doctor who will refer you to an eye specialist. If there is a rapid change in vision, you should consult your doctor or hospital’s Accident and Emergency department immediately.

If you have AMD in one eye, and you start getting sudden symptoms in your other eye, then you should go to your hospital or ask your GP to arrange an emergency appointment, as soon as possible. This will ensure that you get treatment within a few days.

 

What does an eye examination involve?
First, there will be an assessment of your vision in both eyes. Then you will be given eye drops, which enlarge your pupil so that the eye specialist can look into your eye. The drops take about 30 minutes to work although their effect may last for several hours. Your vision will become blurred for a while and your eyes will become sensitive to light, but this is nothing to worry about. Many patients with AMD do not meet the visual requirements for driving and it is certainly preferable that you do not drive to the hospital for this examination. It would be helpful if someone can come with you to help you home.

An OCT scan will be able to determine if there is AMD, and what sort if there is.

 

What is fluorescein angiography?
In some cases your eye specialist may decide that a fluorescein angiogram will also be needed. This involves taking a rapid series of photographs of your retina with bright flashes of blue light. These photographs give an accurate map of the changes occurring in the macula and help your eye specialist to decide what is the best treatment for you.

For the angiogram you will be given a small injection of special dye in your arm which then travels through your blood stream to your eye. This is not painful but you may feel a bit sick. There are few side effects, although some people find that they are dazzled for a while afterwards. You may also notice that the injection has left your skin with a faint yellow tinge from the fluorescein dye but this soon passes into your urine.

The angiogram helps the ophthalmologist decide what type of AMD is affecting your sight and what can be done to help.

 

Can macular degeneration be treated?
If you have “wet” AMD affecting the middle of the macula, in some cases, photodynamic therapy (PDT) is possible. This treatment involves infusing a light sensitive drug through your blood stream similar to a fluorescein angiogram. This drug is able to identify the new blood vessels, growing in the wrong place behind the retina, that form with “wet” AMD.

A “cold laser” is then shone into the eye which activates the drug stopping the new blood vessels from growing and helping to prevent them causing too much damage to the macular area. This treatment is available on the NHS and has been shown to be effective for many people with “wet” AMD. It can help stop the “wet” AMD progressing to its worst stages though more than one treatment may be needed.

 

Are any other treatments available for “wet” type macular degeneration?
New treatments for “wet” macular degeneration are being developed all the time. Anti VEGF therapies are now available in the UK.

There are a number of different treatments being tested but all of them involve an injection into the eye that stops the development of the new leaky blood vessels. This has to be repeated about every six weeks for as long as your doctor thinks is necessary. Like PDT this type of treatment is limited to people whose “wet AMD” affects the middle of the macula and its main aim is to stop “wet AMD” from getting worse. However, in some cases it has been shown to restore some of the vision already lost and it can help with a wider range of people than PDT.

At the moment these anti VEGF treatments are not available on the NHS. However local Primary Care Trusts can decide on a case-by-case basis whether or not to provide this treatment through the NHS. The treatment may also be available privately. To find out if anti VEGF treatment would help your eye condition and if it is available in your area, please speak to your eye specialist.

More treatments for “wet” AMD are likely to become available in the near future adding to the treatment choices available.

Find out about new developments in the treatment of wet AMD using the drug Lucentis.

 

What can be done to help with “dry” AMD?
At the moment there aren’t any medical treatments for “dry” AMD. There is some research which suggests that vitamin supplements can help slow down the progression of “dry” AMD. They do not restore sight, but they may have a preventative role to play.

 

How will I cope?
A natural reaction to being diagnosed with AMD is to feel upset or worried about the future. Adjusting to any major change in life can feel difficult, so you may need some support especially at first.

If you would like to talk things over with someone outside your circle of friends or family, support is available. You can contact RNIB Helpline to ask about emotional support services. Email helpline@rnib.org.uk or phone 0845 766 9999 / 020 7388 2525 some callers may find it cheaper to call a landline, so we have detailed both 08 prefixed numbers and landline equivalents where available.

Alternatively you could talk to someone from your local society for people with sight loss. Your family doctor or social worker may also be able to help you find a counsellor if you feel that would be helpful.

The Macular Disease Society has local groups and a telephone counselling service. Talking about and sharing experiences can be a good way of learning to cope with feelings and problems that other people with the same condition may also have come across before.

 

Can I be helped to see better?
Don’t be discouraged – you can be helped to see many of the things you used to by making the best use of your remaining sight. This means learning to use your side (or peripheral) vision. Low vision services can help you find the best magnifiers for you.

They can also give advice and training on the many ways, often quite simple, in which you can make the most of your remaining sight. Ask your eye specialist, optometrist (optician), GP, social worker or local society for people with a sight loss about how to get referred to a low vision service near you.

 

Click here for more information about AMD

Click here to download The College of Optometrists's leaflet about Macular Degeneration