Age-related macular degeneration

What is Age-related Macular Degeneration (AMD)?

AMD stands for Age-related Macular Degeneration, a condition that affects your eyesight as you grow older. AMD can affect people in their 40s to 50s, but often develops from 60 years old, onwards. AMD is the most common cause of sight problems in people aged 50 and over.

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What causes AMD?

AMD happens when the cells in your macula (an area about 5mm in diameter), degenerate, reducing your ability to see clearly anything that is in the centre of your vision.

There are two forms of AMD, dry and wet. Dry AMD is by far the more common of the two types. About 9 out of 10 cases of this condition are dry AMD. Of the two types, wet AMD is the more serious version, however, unlike the dry version, there is treatment that can stop or slow down the loss of vision.

In some cases dry AMD can progress to wet AMD.

How does AMD affect your sight?

The macula is a very small part of your inner eye, right at the back, in the centre of your retina. If you have AMD it causes the cells in this part of your eye to degenerate. The speed at which this happens, varies. It usually happens slowly, but it can also happen quite quickly.

Because of the location of the macula, AMD affects your central vision. This means that when you read, look out of a window, or watch TV, you won’t be able to see anything in the central part of your vision clearly. Instead, to start with it may look wavy or blurred, and as the condition progresses, you may not be able to see anything in that central area. AMD also affects the brightness of colours, and, ultimately, your ability to see and recognise faces.

In many cases, people with dry AMD aren’t badly affected, sight loss is gradual, and they aren’t likely to have serious sight loss. However, this can vary from person to person. In some cases, loss of sight can happen quite rapidly, although with this condition, you won’t lose your sight entirely.

However, AMD only affects your central vision, not your sight around the centre part of your eye.

Wet AMD, on the other hand, can develop quite quickly, and have a pretty serious effect on your eyesight in just a short time. Like Dry AMD, Wet AMD only affects your central vision, and will not cause complete blindness.

Read one woman’s personal story of living with AMD

What causes AMD?

So far, we don’t know exactly what causes AMD. The RNIB (Royal National Institute for the Blind), have a list of possible causes, although these aren’t set in stone.

Age is a factor, as the development of AMD is most common in people over 65. However, it can also affect people at a younger age – their 40s and 50s. Also, women develop AMD more often than men, but that may be because they live longer than men. Genetics may be linked to the development of AMD in some cases, but not all.

The findings of some studies indicate that spending a lot of time in strong sunlight may put you at greater risk of AMD. You can provide your eyes with some protection UV light by making sure that you always wear UV protective sunglasses in sunlight.

As well as protecting your eyesight with sunglasses, eating a diet that includes a wide range of fresh fruit and vegetables, and not smoking (or giving up if you do smoke), will be good for your overall health, and may help you have healthy eyes.

How to protect your eyes in bright sunlight

Types of AMD

There are two types of AMD, dry and wet.

Dry AMD

Dry AMD is the most common form, with about 75% of people having this type. This develops when waste material under the macula builds up, and the retina becomes thinner in the area of the macula.

In most cases, people who have this condition aren’t severely affected. They may have almost normal vision, or mild loss of eyesight. Those who are more affected, will find it harder to read, to see faces against a wall or other kinds of background, and may have to give up driving because of AMD.

Dry AMD may progress slowly. It can take up to 10 years before the effect of this condition makes a major difference to your vision and how you live your life.

A small percentage of people with dry AMD can develop Wet AMD, which has a more serious effect on eyesight.

Signs of dry AMD

Signs to watch out for include:

• hazy vision
• colours seeming less vivid
• blurred text, which is harder to read
• trouble recognizing faces you know well

Wet AMD

This is the more serious type of AMD, however, unlike Dry AMD, there is treatment for this form of the condition. Wet AMD usually affects around 10 to 15 percent of those who already have dry AMD. Wet AMD happens when unhealthy blood vessels grow under the retina, and leak blood and other fluids, that can stop the retina functioning as it should.

If left untreated, the bleeding and the scarring that follows, can cause serious and permanent loss of central vision, although you would still be able to see, through the periphery, outer area of your eye.

Signs of wet AMD

Wet AMD can affect your eyes very quickly. Symptoms to watch out for include;

• sudden worsening of the blurring of your central vision,
• distorted vision – straight lines looking wavy or crooked to you 
• hallucinations – seeing things, such as people or shapes, that don’t actually exist. (This is also known as Charles Bonnet syndrome. If you do have these hallucinations (which do not mean that you are mentally ill), they tend to improve after 18 months)

Although most people who have AMD tend to have the same type – wet or dry – in both eyes, it is possible to have wet AMD in one eye and dry AMD in the other.

What happens at the eye examination

If you notice any of these symptoms, it is important that you see an optometrist straight away. Book an emergency appointment if you need to, explaining why you need to see them urgently. Wet AMD needs treating as quickly as possible, to prevent further damage to your eyesight.

Your optometrist may charge a fee for carrying out tests, depending on which tests you have. Optical Coherence Tomography (OCT scans) can create cross-section images of your retina, giving your optician more information about the condition of your retina. Ask at the beginning of your sight test whether you will be charged for any tests, and what the cost will be.

You should also ask your optometrist whether you should be referred for an appointment with a retinal specialist at a local hospital. You shouldn’t need to see your GP if you have seen an optometrist.

If you have dry AMD you may not need a hospital referral, unless your optometrist feels that a hospital low vision service would help you. (See the section on Treatment, below)

If your optometrist feels that you may have wet AMD, they should refer you to a hospital retinal specialist. You should be seen in one to two weeks, and if you need treatment you should have this as soon as possible - ideally two weeks after your appointment with your optometrist.

The hospital retinal specialist will carry our further tests, so that they can be sure about your diagnosis. The tests may include using eye drops to dilate (enlarge) your pupils. This allows the specialist to take a good look at the back of your eye.

You may also have an optical coherence tomography (OCT). This scans your retina so the specialist can see a detailed image of your macula, and see if it has any signs of damage.

Fluorescein dye angiography involves having dye injected into a vein in your arm. This travels to the blood vessels in your retina, highlighting them, so that your specialist can photograph them.

The images will show whether the dye is leaking out of the blood vessels behind your macula. Using this method they may be able to confirm whether or not you have wet AMD.

How an optometrist can help your health

Treatment for Age Related Macular Degeneration

Dry AMD treatment

There isn’t any treatment currently available for dry AMD. However, there is some help available to make living with this condition easier.

You may, for instance, be referred for low vision rehabilitation and low vision services, which are offered at some hospital eye departments. If you haven’t already been referred to a low vision centre, ask your ophthalmologist or retinal specialist for advice on referral to the nearest centre.

Wet AMD treatment

There is a treatment for wet AMD, called anti-vascular endothelial growth factor, or anti-VEGF, which may stop or slow down the rate at which you are losing sight. These medicines are injected (with a very fine needle), into the globe of your eye, to stop the abnormal vessels from growing. This may sound alarming, but your eye is anaesthetized before the treatment starts, and the injection is given in the corner of the affected eye, so that you can’t see what’s happening.

These are usually given once every four weeks, for two years at most. Not everyone with wet AMD is eligible for this treatment, but it is worth talking to your eye specialist about it, if you have wet AMD.

Around one in three of the people treated with these injections will have their vision improved. In most patients having this treatment, their vision will stay the same, and won’t deteriorate further. Generally, about one in ten people who have Anti-VEGF injections won’t see any change in their sight.

Learn more about treatments for AMD

How to protect your eyesight

Smoking is connected to many illnesses and health problems, including AMD. If you smoke, try to stop. Your GP or pharmacist will let you know what support there is for quitting smoking.

Help for giving up smoking

Eating healthily will make a difference too. Make sure you eat a healthy diet, with a wide range of vitamin and antioxidant-rich foods, that are good for keeping your eyes healthy. These include broccoli, peas, spinach and kale, along with other vegetables.

The best foods for eye health

If you notice any changes to your vision, that don’t go away, see your GP, optometrist, or, if you are already being treated, your retinal specialist team.

Is it time for an eye test?

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