Macular Degeneration

What is the Macula?

The macula is the center of the inner lining of the eye called the retina. The macula is responsible for our central vision. This includes reading, driving, and anything that we see when “looking straight ahead”. The rest of the retina is used for peripheral vision.

What is Age-Related Macular Degeneration?

Macula degeneration (MD) causes a painless loss of central vision, with possible distortion (straight lines look bent, words jumbled) affecting the ability to see fine detail, drive, read and recognise faces. Peripheral vision (side vision) is not affected. There are many types of macular degeneration (MD).

The most common type is age-related macular degeneration (AMD, also called ARMD).

Age-related macula degeneration (AMD) is a condition that typically affects older people, usually over the age of 60 years. It is the leading cause of blindness for this age group.

There are two forms of AMD:

1. Dry macular degeneration

In dry AMD, the cells of the macula gradually deteriorate and die off. This leas to gradual loss of the central vision. It’s a progress over many years and does not cause a sudden loss of vision. So, if you have Dry AMD and you notice a sudden change in vision, then this may indicate you are developing wet AMD. It is important you see your Ophthalmologist within a week.

2. Wet macular degeneration

It is called wet because of the growth of abnormal blood vessels under the macula which leak fluid and may bleed.

Wet AMD can appear suddenly. If left untreated, rapid and severe loss of central vision can occur within a matter of weeks. Your ophthalmologist can provide you with treatment to reverse the leakage and slow the wet AMD.

Prompt Treatment of Wet AMD SAVES VISION

All patients with dry AMD are at risk of developing wet AMD. Everyone with wet AMD will experience some slow deterioration. Due to underlying dry AMD, this occurs even with treatment.

What are the symptoms?

Some possible symptoms include:

  • Blurred vision
  • Distorted (wavy) vision – straight lines will have a wave to them
  • Patches or shadows of missing areas of your vision
  • Loss of colour perception
  • Waking up with dark patches in central vision which gradually disappear

Risk Factors?

  • Age
  • Family history of AMD
  • Smoking

1. Age

Age-related macular degeneration generally affects people over the age of 50. The risk increases the older you get. According to MD foundation Australia, one in seven Australians over 50 have some signs of AMD.

2. Family history

People with a parent or sibling affected by AMD, have a 50% chance of developing the disease. Early detection can save vision, which is why we recommend regular eye examinations.

3. Smoking

Smokers are three or four times more likely to develop macular degeneration. Smokers also tend to develop the disease five to ten years earlier than non-smokers.

It is possible to reduce the risk and progression of Macular Degeneration by:

  • Stop smoking
  • Eating a diet rich in fresh fruit and dark green leafy vegetables (spinach, brussel sprouts, broccoli) as well as brightly coloured fruit and vegetables (corn, capsicum, carrots)
  • Increasing your uptake of omega 3 rich foods, such as fatty fish
  • Decreasing intake of omega 6 found in fried foods
  • In consultation with your ophthalmologist and GP, supplementing your diet with vitamins, minerals and antioxidants
  • Controlling cholesterol and blood pressure levels

How is Macular Degeneration detected?

  • At a routine eye check
  • At home monitoring with an Amsler grid
  • Monitoring of dry AMD by your ophthalmologist

Awareness of symptoms and early detection of wet AMD is crucial for a good prognosis.

At Home

People at risk of AMD need to be aware of the symptoms so they can seek help promptly. Monitor regularly using an Amsler Grid. Distortion of straight lines needs to be investigated urgently.

Treatment?

Wet AMD is usually treated with special drugs injected into the jelly (vitreous) of the eye. These injections are called Anti-VEGF injections. Early diagnosis and prompt treatment can save vision. As there is currently no treatment for dry AMD, preventative lifestyle measures for those at risk are important.

There is a lot of research underway exploring treatments for dry AMD. Unfortunately, no treatment is available as yet. A healthy lifestyle and good diet can reduce the risk of development of wet AMD from dry AMD.

Wet AMD treatment has been revolutionised since the introduction of anti-VEGF drugs over 10 years ago. Without treatment, most people with wet AMD are legally blind within 2 years. There is strong evidence that anti-VEGF treatment helps maintain vision long term in the vast majority of patient. Most people with early diagnosis will experience some improvement in vision.

Anti-VEGF treatment involves injection of the medicine into the eye, initially monthly, then depending on the response, less frequently. The treatment is usually long term.

Your ophthalmologist will discuss the risks and benefits of anti-VEGF treatment with you.

Other treatments such as laser and PDT are now rarely used and are reserved for particular types of AMD.

Visit MD Australia website to find out more about different types of anti-VEGF drugs and studies that support their use.

Find out more about macula degeneration at myeyespecialist’s specialty Macula Clinic.