Age-related macular degeneration (AMD)

This factsheet is for people who have age-related macular degeneration or who would like information about it.

Age-related macular degeneration (AMD) is a disease that affects a person’s ability to see what is directly in front of them – their central vision. It’s the most common cause of blindness in people over 60 in the Western world.

 
About age-related macular degeneration
Symptoms of age-related macular degeneration
Complications of age-related macular degeneration
Causes of age-related macular degeneration
Diagnosis of age-related macular degeneration
Treatment of age-related macular degeneration
Prevention of age-related 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 (about 0.5cm wide) spot in the centre of the retina that processes sharp, clear vision. When you look directly at something, the light is focused on the macula, allowing you to see fine detail and colour.

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

AMD affects about 20 to 25 million people worldwide. In the UK, around 500,000 people are thought to be affected by AMD. Around two in 100 people aged over 65 in the UK are blind in one or both eyes because of AMD.

Types of AMD

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 can mask the deterioration in your other eye.
Your 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 optician. AMD isn’t a painful condition. It also doesn’t usually lead to complete blindness because you still have your peripheral vision. This is what you can see to the sides.
 

Complications of  age-related macular degener ation

AMD can lead to blindness if it’s left untreated. This is why it’s very important to visit your GP or optician if you have any symptoms.
 

Causes of age-re lated macular degene ration

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 AMD more likely. These include:

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

Diagnosi s of age-related macular degenerat ion

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

AMD may be detected during routine eye tests by your optometrist. He or she will 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 doctor who specialises in identifying and treating eye conditions).

You may have other tests listed below.

• 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 making 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 o f age-related macular degene ration 

Dry AMD

Currently there is no cure for dry AMD.

Your treatment will focus on helping you live with AMD and preventing it from getting worse.

Self-help

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

An occupational therapist can help to make every day living easier around your home.

Some research has found that vitamins A, C and E and beta-carotene and the mineral zinc and omega-3 fatty acids help to slow down the progression of AMD. Ask your ophthalmologist for advice about the correct dose and their side effects.

Wet AMD

Medicines

Your ophthalmologist can inject anti-VEGF medicines into your eye which can help to prevent wet AMD from progressing and even restore some lost vision.
Anti-VEGF medicines work by stopping new blood vessels growing and include:

• ranibizumab – now available on the NHS
• bevacizumab – being assessed in clinical trials

However, these medicines are only thought to be effective if they’re used during the early stages of the disease and may need to be injected every month to begin with.

Always ask your ophthalmologist for advice and read the patient information leaflet that comes with your medicine.

Photodynamic therapy (PDT)

PDT doesn't restore vision, but it can help stop wet AMD from getting worse. Your ophthalmologist will inject a special light-sensitive dye into your arm, which then travels to your retina. He or she will then focus a low-power laser on the macular area of the retina, destroying the 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 is rarely used and only in the early stages of AMD to limit its progress. Heat from the laser destroys the blood vessels causing the AMD.

Researchers are 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 is 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, eggs, and at least two portions of oily fish a week
• avoiding a high-fat, high-cholesterol diet
• asking your doctor or ophthalmologist about the correct dose of vitamin and zinc supplements
• wearing sunglasses in bright sunlight
• having an eye examination every two years so that its early signs can be picked up