MACULAR DEGENERATION

Age-related macular degeneration (AMD) causes you to lose central vision (when you focus straight ahead). The macula is a tiny part of the retina, and as you get older, this can start to degenerate, affecting your sight.

The condition is painless but vision becomes increasingly blurred, leading to difficulties with day-to-day activities, such as reading or recognising faces. This change usually happens gradually, however, the sight loss can be rapid.

Your peripheral vision (side vision) is not affected, and while AMD sufferers will not experience complete blindness, it usually affects both eyes.

If you find your vision is getting worse, you have blind spots, or images are distorted it’s important to seek medical advice or visit an optometrist immediately. Those suspected of having AMD would then be referred to an ophthalmologist for tests and treatment.

AMD is most common in those over the age of 50 and is the leading cause of vision loss. An estimated 1 in 10 people over the age of 65 have some level of AMD and the condition affects at least 600,000 people across the United Kingdom.

TYPES OF AMD

Dry AMD – This develops over many years and occurs when the macula’s cells become damaged by tiny yellow deposits called drusen. This type of AMD is less serious and accounts for 90% of cases. However, roughly 10% of people with dry AMD will go on to develop wet AMD.
Wet AMD– also known as neovascular AMD, is more serious. Wet AMD develops when new, abnormally-formed blood vessels grow under the macula. These can leak blood and fluid, damaging the cells, and may cause scarring. This can happen suddenly and, if left untreated, can cause vision to deteriorate in a matter of days.

SIGNS & SYMPTOMS

AMD can often go unnoticed as it is a painless condition, and those with dry AMD can take 5-10 years before their vision loss significantly affects day-to-day life.

Macular degeneration causes blurring of your central vision (what you see straight ahead). This can cause a number of problems:

Driving, reading and anything with fine detail can be difficult to see.
Colours can be less vibrant.
The contrast between objects can appear diminished, making it difficult to distinguish between them.
People’s faces can become difficult to recognise.
Some people can become sensitive to bright lights.

Wet AMD can have some further effects, including:

Visual distortions - straight lines may appear wavy.
Blind spots – these can appear in the middle and become larger the longer they are left.
Hallucinations – shapes, people, or animals that aren’t there may appear.

Wet AMD needs to be treated as soon as possible to avoid vision getting worse, see below for information on treatment.

COMPLICATIONS OF AMD

AMD can significantly affect daily life, which can have both an emotional physical effect on sufferers - there are support groups to help those living with the condition. There are a few other effects it can have on you.

DEPRESSION & ANXIETY

An estimated one-third of people with AMD suffer from depression & anxiety. Losing part of your vision can be difficult to come to terms with, especially when coupled with a loss of some of your independence. Such impactful changes in your life can be tough, and if you find yourself struggling with depression or anxiety, speak to your GP to discuss treatment such as therapy.

DRIVING

The condition may affect your driving ability – so it is important to alert the proper authorities – such as the DVLA or your insurance company. If your vision is still quite strong, you may be able to continue driving but will need to pass certain tests to ensure it is up to safety standards. For the safety of yourself and other drivers, your central vision especially must meet the DVLA’s standards.

VISUAL HALLUCINATIONS

Some sufferers of macular degeneration may experience visual hallucinations. This condition is called Charles Bonnet Syndrome, and an estimated 10% of AMD sufferers will experience it. In the absence of visual stimuli, your brain will create hallucinations using images from your memory, these can include random shapes, patterns, faces, or familiar places. They can last minutes or hours and while they are not necessarily negative images, it can be frightening to experience something that is not really there.

It’s important to tell your GP about any visual hallucination, even if you are worried it is a sign of mental illness. Hallucinations with AMD are usually to do with your vision rather than a problematic mental state, and your GP will likely be able to help you deal with them. Hallucinations can often last for a year or two but have been known to go on longer in some people.

TREATMENTS FOR DRY AMD

Dry AMD treatments aim to help slow the development and provide visual aids to make day-to-day tasks a little bit easier. You may need to make some changes to your home, and a low vision clinic can help give you advice or practical support.

Such tools and changes can include:

Big-button telephone and computer keyboard.
Magnifying lenses for reading.
Large-print books, or eReaders with adjustable text size.
Bright Lighting.
Screen-reading computer software (helps with emails, documents & internet browsing).
Two-tone house décor – this can aid with finding your way around and may help make it easier to see the difference between nearby objects i.e. the stairs and the handrail.

Diet and nutrition may help slow the progression of dry AMD, and may even reduce the risk of wet AMD, however, evidence for this is limited and it should be discussed with an ophthalmologist whether these can help you.

A diet high in vitamins A, C & E are thought to help – these would include foods such as oranges, carrots, tomatoes, kiwis, and leafy green vegetables. Lutein and Zeaxanthin supplements are also considered to help.

TREATMENTS FOR WET AMD

Anti - Vascular Endothelial Growth Factor (Anti-VEGF) Injections in the eye
Laser Surgery- Photodynamic Therapy (PDT) and Laser Photocoagulation

REDUCING THE RISK

There are a few things that may be able to reduce your risk of developing the condition or help stop it from getting worse. These measures include:

Stopping smoking.
Keeping a healthy & balanced diet (see above on specifics).
Moderating alcohol and consuming the recommended units.
Achieving or maintaining a healthy weight.
Protecting your eyes from UV light by wearing appropriate Sunglasses when outdoors