What is Age-Related Macular Degeneration?

There are approximately 4 million people in the UK living with signs of Age-related macular degeneration (AMD), with around 700,000 people being affected by it, meaning Macular disease is the biggest cause of sight loss in the UK.

Most of those affected are over the age of 50 but it can happen earlier in life.

Overview

Age-related macular degeneration (AMD) is a prevalent condition that impacts the central area of your eyesight. Typically, individuals in their 50s and 60s experience the onset of the disease. While it does not lead to complete blindness, it can cause hindrance in daily activities such as facial recognition and reading. In the absence of treatment, the situation can worsen gradually over several years ("dry AMD") or rapidly over a few weeks or months ("wet AMD").

There are two forms of AMD – dry and wet.

Dry age-related macular degeneration

Dry age-related macular degeneration (AMD) is a gradual deterioration of the macula as the retinal cells die off and are not renewed which will impact central vision.

Wet age-related macular degeneration

Wet age-related macular degeneration (AMD) develops when abnormal blood vessels grow into the macula. These blood vessels are weaker and will leak blood or fluid which leads to scarring of the macula and rapid loss of central vision.

Causes of age-related macular degeneration

It is unknown what causes AMD but there are a number of factors that are linked with the development of this condition.

The main risk factor for AMD is age. The regeneration of cells reduces as we get older and in turn, increasing the chances of developing the condition.

If AMD is present in a family history, the likelihood of developing macular degeneration is increased.

Those who smoke are up to four times more likely to develop macular degeneration than those who do not smoke. Smoking damages the structure of the eye and the blood vessels that are in there. The risk of developing AMD is heightened if you smoke and you already have a common gene for AMD and you are twenty times more likely to develop the condition.

After getting diagnosed with macular degeneration, stopping smoking can reduce the risk of the condition getting worse.

A diet deficient in fruit and vegetables can increase your risk of developing AMD. The good things from fruits and vegetables, such as antioxidants and other substances, will help to protect the body from the effects of unstable molecules that will damage cells or prevent cells from repairing known as ‘free radicals’.

In addition to a poor diet, alcohol will destroy antioxidants. Similarly, a diet containing a lot of sugars, hydrogenated or saturated fats and obesity can increase the chances of developing AMD.

Those who live with a high blood pressure are one and a half times more at risk of having AMD than those who have a normal blood pressure.

AMD has no preference in those who it affects, affecting equal numbers of men and women. As women typically live longer, there are more women diagnosed with age-related macular degeneration.

Many thanks to our partners at the Macular Society for supplying the information to us.

Symptoms of AMD

Macular disease affects people in different ways.

Diagnosing Dry and Wet AMD

The optometrist at your local optician’s practice can test sight, prescribe glasses and check for eye disease. Some optometrists use photography or other imaging to detect early signs of macular degeneration. These might include Optical Coherence Tomography (OCT) scans which create cross-sectional images of the retina.

There is currently no treatment for dry AMD. That means that you might not be referred to hospital, unless the optometrist needs to confirm their diagnosis, or thinks you need to use the hospital’s low vision service. Your optometrist should make you aware that you have signs of dry AMD and provide information on what you can do to help preserve your vision and inform you on the services that can help you such as OcuPlan and Macular Society.

If your optometrist suspects you have wet AMD, you should be referred to a retinal specialist at a hospital directly and seen within one to two weeks, and if applicable be treated within two weeks after initial detection. You should not be sent to your GP. This causes unnecessary delay.

At hospital, further tests will be carried out to confirm the diagnosis. The specialist may use:

Eye drops to dilate the pupils to clearly see the back of the eye. These may make your vision blurred and sensitive to light for a short time, so consider taking someone with you to your appointment.
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. The dye will temporarily change the colour of your urine, so be prepared.

Treatment for AMD

There is no medical treatment for dry AMD, but there are things people can do to help preserve their vision. OcuPlan provides both paid and free memberships for patients. Our paid membership enables you to regularly see your optician and consultant for tests and in person consultations for bespoke advice. Our free memberships allows you to ask a consultant questions and receive regular tips and hints on living with dry AMD.

Around 10-15 per cent 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.

Wet AMD can be treated if caught early. Drugs are injected into the eye to stop the growth of the abnormal blood vessels. Following diagnosis people will usually have a loading dose of three injections, once a month for three months. A patient will then be assessed to see if more injections are required.

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.

A small number of people may respond better to a combination of injections and form of laser treatment. There are a range of treatments and options, although not all are available on the NHS.