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Age-related macular degeneration (AMD)

Age-related macular degeneration (AMD) is a disease that affects a person's central vision (their ability to see what is directly in front of them). AMD affects about 20 to 25 million people worldwide. It's the leading cause of blindness and major vision loss in Australia, with approximately 1 in 7 Australians over 50 having some evidence of macular degeneration.

About age-related macular degeneration 

When light travels through your pupil it's focused onto your retina, which is located at the back of your eye. The retina sends signals to your brain that are interpreted as vision.

The macula is a small spot (about 0.5 cm wide) in the centre of the retina that processes sharp, clear vision. When you look directly at something, light is focused on the macula, allowing you to see fine detail and colour.

If you develop AMD, the macula cells become damaged, leading to gradual loss of your central vision.

Eye parts

Types of age-related macular degeneration

There are two main types of AMD.

  • 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 the course of five to 10 years. However, you may experience a slower deterioration in your sight.
  • Wet AMD happens when new blood vessels start to grow behind your retina. These can leak and cause scarring, damaging the macula. It may cause rapid and severe loss of your central vision.

Symptoms of age-related macular degeneration 

AMD often affects both your eyes although it may affect one eye before the other. You may not notice at first as the ‘good’ eye compensates for the ‘bad’ eye. This masks any deterioration in vision .

AMD isn't a painful condition. Symptoms may happen slowly over several months, but sometimes they develop more quickly. They include:

  • distorted vision – straight lines become wavy or objects appear to be the wrong size
  • blurry central vision
  • seeing shapes or colours that aren't there
  • seeing a dark patch or shadow when you wake, which then fades
  • difficulty reading, recognising people's faces, driving, looking at small objects and watching television.

If you have any of these symptoms, see your GP or optometrist.

Complications of age-related macular degeneration 

AMD doesn't usually lead to complete blindness. You still have your peripheral vision, the ability to see to the sides. However, it can lead to substantial vision loss if it's left untreated. This is why it's very important to visit your GP or optometrist if you have any symptoms.

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 you more likely to develop AMD. These include:

  • smoking
  • family history
  • poor diet
  • high blood pressure
  • being of Caucasian ethnic origin.

Diagnosis of age-related macular degeneration 

Your doctor or optometrist will ask about your symptoms and examine you. They may also ask you about your medical history.

AMD may be detected during routine eye tests by your optometrist. They can check your level of vision and examine your macula using instruments to look inside your eye, sometimes using eye drops.

If AMD is suspected, you will be referred to an ophthalmologist (a specialist in identifying and treating eye conditions).

You may have other tests, including:

  • 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. It makes the blood vessels inside your eye visible on a photograph so your ophthalmologist can identify the type of AMD.
  • Ocular coherence tomography (OCT). This is a scan that shows your ophthalmologist detailed information about your macula.

Treatment of age-related macular degeneration 

Dry AMD

Treatment for dry AMD focuses on helping you live with AMD and preventing it from getting worse.

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 to make the best use of your vision. This includes equipment such as advanced magnifying glasses and reading lights. You may also find software that reads out text or displays large text helpful.

An occupational therapist can help identify suitable aids to make every day activities easier in and around your home.

Vitamins A, C and E, beta-carotene and the mineral zinc may help to slow down the progression of AMD. Ask your ophthalmologist whether these supplements are suitable for you. They or your pharmacist can also provide advice about the correct dose and any potential side effects.

Wet AMD

Medicines

Anti-VEGF medicines are injected into your eye. They work by stopping new blood vessels growing, which can help prevent wet AMD from progressing and may even restore some lost vision.

Anti-VEGF medicines available in Australia include:

  • Lucentis (ranibizumab) - some people may be eligible for treatment with this medicine under the Pharmaceutical Benefits Scheme (PBS).
  • Eylea (aflibercept) - this new medicine has been approved for use in Australia to treat wet AMD. Some people may be eligible for treatment with this medicines under the PBS.
  • Avastin (bevacizumab) is not officially approved to treat AMD in Australia. Research suggests it works as well as ranibizumab for treating wet AMD. Your ophthalmologist may prescribe it for you as an alternative if you cannot get ranibizumab through the PBS.

These medicines are only thought to be effective if they're used during the early stages of the disease. You may need to have injections every one to two months to begin with.

Always ask your ophthalmologist or pharmacist for advice.  Read the consumer medicines information leaflet that comes with your medicine.

Photodynamic therapy (PDT)

PDT doesn't restore vision, but it helps stop wet AMD from getting worse. Your ophthalmologist injects a special light-sensitive dye into your arm, which travels to your retina. They can then focus a low-power laser on the macular area of the retina, destroying abnormal blood vessels without affecting the surrounding tissue.

You may need to have this treatment every three months if the blood vessels behind your retina continue to bleed.

Other treatments

Laser treatment may be used rarely in the early stages of AMD to try and limit its progress. Heat from the laser destroys the blood vessels causing wet AMD.

Researchers are also looking into the benefits of stem cell therapy, combined therapy, gene therapy and surgical treatments for AMD. Your ophthalmologist will be able to provide more information on which treatment may be right for you.

Prevention of age-related macular degeneration 

You can help reduce your chances of developing AMD by:

  • stopping smoking
  • eating plenty of brightly-coloured fruit and vegetables, especially leafy green vegetables, as they are a good source of vitamins A, C and E, and zinc
  • avoiding a diet high in saturated fat as this can increase your cholesterol levels and affect the health of your blood vessels
  • wearing sunglasses in bright light and to avoid glare (eg when out in the sun, when near reflective surfaces such as water or snow)
  • having an eye examination at least every two years so that any early signs of AMD or other eye conditions can be picked up.

Further information 

The Macular Degeneration Foundation

http://www.mdfoundation.com.au

 

Vision Australia

http://www.visionaustralia.org.au

Sources 

The Age-Related Eye Disease Study 2 (AREDS2) Research Group. Lutein Zeaxanthin and Omega-3 Fatty Acids for Age-Related Macular Degeneration: The Age-Related Eye Disease Study 2 (AREDS2) Randomized Clinical Trial. JAMA. 2013;309(19):2005-2015.

Bayer Australia Ltd. EYLEA® (aflibercept) consumer medicines information. Pymble, NSW: Bayer Australia Ltd. 2013.

Better Health Channel. Smoking and eye disease. [online] Melbourne, VIC: State Government of Victoria. [Last updated February 2012, accessed 8 March 2012]. Available from: http://www.betterhealth.vic.gov.au

BMJ Clinical Evidence. Age related macular degeneration. http://clinicalevidence.bmj.com, accessed 2 June 2010

CATT Research Group Martin DF Maguire MG et al. Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med. 2011; 364: 1897-1908.

Chopdar A Chakravarthy U Verma D. Age related macular degeneration. BMJ. 2003; 326: 485-88.

Clinical Knowledge Summaries. Age related macular degeneration. [online] London: National Institute for Health and Clinical Excellence. 2010 [last updated Mar 2010, accessed June 2010]. Available from: www.cks.nhs.uk

Macular Degeneration Foundation. [online]. Sydney, NSW: Macular Degeneration Foundation. Available from: http://www.mdfoundation.com.au

Rossi S ed. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd. 2012.

Smith TC. Age related macular degeneration: new developments in treatment. Aust Fam Physician. 2007; 36(5): 359-61.

Simon C Everitt H van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press. 2010: 972.

Talks J Koshy Z Chatzinikolas K. Use of optical coherence tomography, fluorescein angiography and indocyanine green angiography in a screening clinic for wet age-related macular degeneration. Br J Ophthalmol. 2007; 91: 600-601.

Vision Australia. Age-related macular degeneration factsheet. [online] [Last updated August 2012, accessed March 2013]. Available from: http://www.visionaustralia.org 

Last updated: 31 July 2013

Tags: macular degeneration, eye health, AMD

 

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