Age-related Macular Degeneration

What is AMD?

Age-related macular degeneration (AMD) is a leading cause of blindness worldwide and the most common cause of blindness in the UK affecting older people.

AMD is a condition that affects the central part of the retina called the “macula”. This can lead to loss of the central vision. If you have AMD, you may lose the ability to see fine details, both close-up and at a distance. Your central vision can become distorted or blurry, and over time, a blank patch may appear in the centre of your vision. However, AMD doesn’t normally affect your peripheral (side) vision.

There are 2 main types of AMD:

  • Dry AMD, sometimes referred to as “wear and tear” with age. It is caused by a build-up of waste material within the cells of the eye that react to light, these are called drusen. Drusen stop the cells from reacting properly to light. There is also gradual damage or atrophy of retinal cells.
  • Wet AMD happens when abnormal blood vessels grow underneath the macula. These abnormal blood vessels can leak (hence the name “wet”) fluid which can damage the cells in the macula or they may bleed causing a sudden loss of vision. If untreated, the macula becomes damaged and scarred.

Risk factors for AMD

  • Age is the main risk factor for developing AMD and it is more common in people over 65.
  • Smoking significantly increases the risk of getting AMD. So, stopping smoking is the greatest change you can make to protect yourself from AMD.
  • Genes: research found that certain genes have been linked to the development of AMD in some people.
  • Lifestyle: high blood pressure and lack of exercise have been identified as possible risk factors for AMD.
  • Sunlight: some research suggested that exposure to high levels of sunlight (particularly UV light) throughout your life may increase your risk of developing AMD, but this has not been proven.
  • Diet: some research found that a diet high in fat and low in vitamins and minerals have may be associated with the risk of developing AMD, but this has not been proven.

Unfortunately, the exact cause of AMD is unknown, therefore you may develop AMD even if you do not have any of these risk factors.

Symptoms of AMD

Dry AMD

In the early stages, it may have little effect on your vision. If the disease develops, your central vision may gradually become more blurred and you will notice that it is harder to see details. As the AMD builds up, you may find it difficult to recognise faces and read things directly in front of you.

Wet AMD

It will normally cause distorted vision, with straight lines becoming wavy and blurred. Some people also see a sudden blank spot in their central vision. Sometimes these changes can happen quickly and if so, you should see a retina specialist urgently.

How is AMD diagnosed?

Diagnosis of AMD is based on clinical assessment and certain tests. If you notice any deterioration in your central vision, you should see a retina specialist for assessment.

This examination often involves;

  • Vision check.
  • Detailed back of the eye examination
  • Picture of the back of the eye
  • Retinal scans called Optical Coherence Tomography (OCT). This machine takes cross-section scans of the retina to identify the changes in the structure of the retinal layers.
  • Fluorescein angiography. In this test, a dye is injected into a vein in your arm, then pictures are taken as the dye passes through the blood vessels of the eye. The retina specialist may recommend this test for some cases to help in making the diagnosis.

Treatment

Dry AMD

At present, there is no specific treatment for dry AMD. It may be possible to see better with the help of special magnifiers and good lighting. There’s some evidence taking high doses of vitamin A, C, E, the minerals zinc and copper, and the micro-nutrient lutein when taken together may help slow down the progression of dry AMD.

A balanced diet with plenty of fresh fruits and vegetables is good for your general health and may also help your eye health.

Research in this field is ongoing with some promising new drugs may show up in the future.

Wet AMD

It can be treated with a group of medication called anti-vascular endothelial growth factor (anti-VEGF). These medications are given as injections into the eye, called Intravitreal injection.

The injections work by stopping the growth of new blood vessels and can help to save your vision and reduce the risk of the disease getting any worse. Treatment for wet AMD needs to be given quickly to stop further blood vessels forming in the eye and reduce the risk of the disease getting any worse. The retina specialist will discuss with you in details the details of this treatment.

The Anti-VEGF currently in uses are:

  • Aflibercept (Eyelea)
  • Ranibizumab (Lucentis)
  • Brolucizmab (Bevou)
  • Bevacizumab (Avastin)

If you notice any change in symptoms, you should contact your eye specilist immediately for an eye assessment.

How to protect my eyes?

In general, you can decrease the risk of developing AMD or slow the progression of AMD if you:

  • Quit smoking.
  • Keep an active and healthy weight.
  • Eat a balanced diet, with plenty of fresh fruits and vegetables. Certain multivitamin and mineral formulas may offer some benefit for some patients (ask a retina specialist for advice).
  • Protect your eyes from the sun.
  • Regular eye examination. It is important to regularly monitor your vision and get a regular eye examination.

However, the exact cause of AMD is unknown, therefore you may still develop AMD even despite following maximum protection.

How to monitor my vision?

Once diagnosed with AMD it is important to regularly check your central vision with a certain grid called “Amsler grid”. This is a simple square containing a grid pattern and a dot in the middle. This design, when used correctly, can show problem spots in your field of vision.

How to use Amsler Grid?

  • Wear your reading glasses and hold the grid 12 to 15 inches (30 cm) in good light.
  • Cover one eye.
  • Look directly at the center dot with your uncovered eye and keep your eye focused on it.
  • While looking directly at the center dot, notice in your side vision if all grid lines look straight or if any lines or areas look blurry, wavy, dark or blank.
  • Follow the same steps with the other eye.
  • You can repeat this test at-home every day.

If you notice any areas of the grid that appear darker, wavy, or blurry, contact a retina speciist right away. He will check you to examine the back of the eye.

FAQ

Can AMD affect both eyes?

Yes. AMD usually affects both eyes but often one eye affected more than the other.

Will I go blind?

No. AMD mainly damages the central vision (reading and writing vision). This means that the peripheral, outside vision is not affected so you should be able to maintain your independence, but may need time to adapt. There are multiple low vision aids and magnifiers that can help in that situation.

Do I need regular checks for AMD?

If you have AMD symptoms or diagnosed with AMD. It is advisable to do a regular self-check with Amsler grid . You are recommended to see your optician and eye doctor at regular intervals to monitor the AMD changes with retina scans. The doctor will advise you on how often you need to be seen which may vary from one person to another.

What supplements should I use for AMD?

A large study called age-related eye disease study (AREDS) looked into the potential benefit of taking a certain combination of supplements and AMD. The study found that for people diagnosed as being at medium or high risk of progression of AMD, the supplement may reduce the risk of AMD progression by 25 %. However, the study did not find a beneficial effect of taking the supplement in those who have no AMD or diagnosed with early AMD.

Mr Ellabban will be able to advise you in relation to which supplement to use and whether they can be beneficial in your condition.

In general, a healthy diet full of fruits and vegetables is thought to be beneficial in keeping our eyes as healthy as possible. Fresh fruits and vegetables are good sources of vitamins and antioxidants as well.

Can supplements prevent AMD?

Several types of research looked at the role of supplements in the prevention of developing AMD. At present there is no evidence to suggest that people who don’t have AMD should take these supplements, to prevent them from developing AMD in the future.