Age-related macular degeneration (AMD)

About age-related macular degeneration

When light travels through your pupil it's focused onto your retina, which is at the back of your eye. The retina sends signals to your brain that are interpreted as vision. The macula is a small area about the size of a pinhead, in the centre of your retina that processes sharp, clear vision. When you look directly at something, the light is focused on the macula, allowing you to see fine detail and colour.

With AMD, the macula cells become damaged which leads to a gradual loss of your central vision. Your peripheral (side) vision isn’t usually affected, which means it’s unusual to lose your sight completely if you have AMD.

In the UK, around 500,000 people are thought to be affected by AMD.

Types of age-related macular degeneration

There are two main types of AMD. You can have different types of AMD in each eye.
  • Dry AMD is the most common type. It affects around nine out of 10 people with AMD. Your eyesight gradually worsens, becoming more blurred, over a number of years.
  • Wet AMD happens when the macula becomes damaged and new blood vessels start to grow behind your retina. These can leak and cause scarring. It can cause rapid and severe loss of your central vision.

Symptoms of age-related macular degeneration

AMD often affects both eyes although it may affect one eye before the other. AMD isn't a painful condition and you may not notice any symptoms at first.

Your symptoms may develop slowly over several months, but sometimes this happens more quickly. Symptoms vary from person to person, but many people first notice a change in their ability to see detail, for example when reading.

Other symptoms include:

  • distorted vision – straight lines become wavy or look like they have a little bump in them
  • blurring in the centre of your vision – seeing shapes or colours that aren't there
  • being sensitive to bright lights
  • difficulty reading, recognising people's faces, driving, looking at small objects and watching television

If you have any of these symptoms, arrange to have an eye test with an optometrist (a registered health professional who examines eyes, tests sight and dispenses glasses and contact lenses).

Causes of age-related macular degeneration

No one knows exactly what causes AMD, although it's more common as you get older. However, there are a number of factors that can make AMD more likely. These include:

  • being female – more women than men develop AMD, although this may be because women tend to live longer
  • smoking
  • a family history of AMD
  • not eating enough foods containing vitamins and minerals, such as vitamins A and C and zinc

Diagnosis of age-related macular degeneration

If you notice any changes to your vision, make an appointment to see an optometrist. He or she will check your vision and examine your eyes. To get a good view of your eye your optometrist may use eye drops. These can blur your vision so don’t drive straight after the eye examination.

If your optometrist thinks you may have AMD, he or she will refer you to your GP or an ophthalmologist (a doctor who specialises in identifying and treating eye conditions).

You may have other tests listed below.

  • Amsler grid. This is a printed grid with a dot in the middle of it. You will be asked to describe any distortion, blank patches or blotches you can see on the grid when you look at the dot with one eye at a time.
  • Fluorescein angiography. A dye called fluorescein is injected into your arm. This travels through your bloodstream to your eyes making the blood vessels inside your eye visible on a photograph. These pictures can help your ophthalmologist to see which type of AMD you have.
  • Ocular coherence tomography (OCT). This is a scan that shows your ophthalmologist detailed pictures of your retina.

Treatment of age-related macular degeneration

Dry age-related macular degeneration

Currently there is no cure or treatment for dry AMD. Some research has shown that taking large doses of vitamin A, C, E and the mineral zinc may help to slow down the development of dry AMD.

There are a number of things you can try that may help with your AMD. If you carry out close, detailed work you can use visual aids, such as advanced magnifying glasses. By making things bigger, brighter and more colourful you will make things easier to see.

Wet age-related macular degeneration

There are a number of treatments available for wet AMD. These mainly work by stopping new blood vessels from growing. This means that it’s important to start treatment as soon as possible. If blood vessels grow for too long they can scar your retina and this scarring can’t be treated.

Medicines

Your ophthalmologist can inject medicines called anti-vascular endothelial growth factor (anti-VEGF) into your eye, which can help to prevent wet AMD from getting worse and even restore some lost vision. They work by stopping new blood vessels growing.

You will probably need to have more than one injection. Most people have three monthly injections, after which time your eye is monitored to see if you need further treatment.

The procedure is called an intravitreal injection. Before the injection, you will be given anaesthetic eye drops to make your eye numb. The injection shouldn't be painful but your eye may be sore after the anaesthetic wears off.

Anti-VEGF treatment usually works well and in most people it stops sight getting worse. About four out of 10 people also see an improvement in their vision.

The main complications of anti-VEGF treatment are a rise in pressure in your eye, a detached retina and eye infections. These happen to a small number of people (less than one in 100 people having the treatment).

Photodynamic therapy (PDT)

This doesn't restore your vision, but it can help stop wet AMD from getting worse. Your ophthalmologist will inject a special light-sensitive dye into your arm, which then travels to your retina. He or she will then focus a low-energy, cold laser on the macular area of your retina. This destroys the abnormal blood vessels, without affecting the surrounding tissue.

Prevention of age-related macular degeneration

You can help reduce your chances of developing AMD by:

  • stopping smoking
  • eating a healthy diet with plenty of fruit and vegetables, especially leafy green vegetables
  • having an eye examination every two years so that its early signs can be picked up

How close are we to a cure for dry age-related macular degeneration?

Answer

As yet there is no cure or treatment for dry AMD. However, there are many research projects looking for a cure or effective treatment, including stem cell therapy, laser therapy and nutrition.

Explanation

Scientists are investigating treatments for AMD all the time. Some researchers are looking into new medicines to treat dry AMD. Some are focusing on gene therapy.

All of these treatments need further trials to see how effective and safe they are before being made widely available.

My doctor told me I have age-related macular degeneration, will I go blind?

Answer

It's very unusual to lose all of your vision because of AMD.

Explanation

Both types of AMD affect the central part of your vision. This means that you will still have peripheral vision, or vision at the sides or the edges of your sight. So, AMD won’t usually cause you to lose all your sight.

Having peripheral vision means that you should still be able to get around on your own. However, you may need help to make the most of the vision you have. This may include using a person with sight as a guide and low vision aids. By using all the assistance that is available from an early stage, you can have a good quality of life and continue with most of you usual activities.

How will I cope with age-related macular degeneration?

Answer

Living with AMD can be challenging and you may find it hard to begin with to cope with the changes to your vision. There are support groups that can help you to learn from others in your situation. There are also lots of things you can do to help you make the most of the vision you have.

Explanation

Being diagnosed with AMD can be upsetting and overwhelming and you may find it difficult to come to terms with. Talking to other people in your position can help you to cope. Getting in touch with patient groups can be a valuable source of help and support. Some of these are listed under further information. Given time you will adapt to using your peripheral vision – what you see at the sides – and learn to make use of visual aids such as magnifying devices. Talk to your GP, ophthalmologist, occupational therapist or social worker for more advice about how to cope with daily living. It may be possible to register your condition and this may provide certain financial benefits and assistance with day-to-day living.