Age-Related Macular Degeneration (AMD): Treatment, Symptoms & Diagnosis

What is age-related macular degeneration?

Age-related macular degeneration, also commonly referred to as AMD, is the most common eye condition in the older population. The disease is most common in the over 50’s and as we get older we are at more risk of developing the disease. By the time someone reaches 90 years old, there is a one is five chance that you may develop AMD.

The condition affects the macula – the part of the eye which is responsible for your central vision, and all the detail you see. It can affect one or both eyes, and over time can affect a person’s ability to see clearly. The level of impact on clear vision varies from person to person. It does not cause total blindness.

What are the types of macular degeneration?

There are two types of AMD: wet AMD and dry AMD. Dry AMD is caused by a build-up of a fatty substance called drusen which gradually deteriorates the macular. Wet AMD occurs when the cells in the macula change and new blood vessels start to grow. These blood vessels can bleed, which is why it is called ‘Wet’. The formation of the new vessels can cause scarring which has a significant effect on vision.

Dry Amd usually results in a gradual deterioration in your vision and these changes can be subtle. Because of this, it can be months or years before the disease may have an impact on your daily life.

Wet AMD affects the sight more rapidly and a deterioration can be seen overnight. If you have dry AMD, you can be at risk of developing wet AMD. Therefore, it is important to seek advice from a medical professional immediately you notice any changes to your vision.

What are the key risk factors and causes of age-related macular degeneration?

Smoking: By far the largest risk factor for increasing the risk of developing AMD - those that smoke are 3-4 times more likely to develop the condition with a potential onset of 5-10 years earlier than non-smokers). Not smoking is the best preventative measure you can take. Treatment for wet AMD in smokers can also be less impactful due to effects on the vascular system, so even if you already experience AMD, it's still worthwhile not smoking to help improve the condition.

Diet: A healthy diet can also have a huge impact on eye health. Eye-friendly foods include dark leafy greens, such as kale and spinach, which are high in lutein and zeaxanthin; two anti-oxidants that are present in a healthy macular. Other vegetables that contain these anti-oxidants (but not to the same high levels) include corn, peas, pumpkin, brussels sprouts, and eggs. Try to incorporate some of these items into your daily diet.

Omega 3 is also found to be important to eye health, as well as helping to reduce inflammation, and support heart and brain health. It can be found in oily fish, such as salmon, mackerel, and anchovies, as well as chia seeds, flaxseeds, walnuts and, again, brussels sprouts. You should aim to include these in your meals 2-3 times a week.

Vitamin E (found in nuts and grains), zinc (found in nuts and seafood), vitamin C (found in citrus food, berries, and tomatoes) and selenium (found in Brazil nuts) are also positive impacting foods on eye health.

Genetics: AMD can be hereditary, but there is minimal impact that a person can have on their own genetic makeup. Over 50 year olds of white ethnicity have the highest risk of developing AMD. Therefore, if you fall into this category, it's important you have regular check-ups with an eye specialist, and especially if you notice any changes to your vision.

High blood pressure and cholesterol: High blood pressure can damage blood vessels which feed the retina, whilst high levels of cholesterol collect under the retina to form drusen, which is associated with early and dry AMD. Ensuring controlled blood pressure and cholesterol can impact the progression of the macula’s degeneration. Blood pressure and cholesterol checks can be carried out at pharmacies or with your GP.

What are the symptoms of age-related macular degeneration?

Early symptoms of AMD can include:

• struggling to read small print and see detail;
• colour vision appearing more faded, blurry or distorted, for example:
  • a straight line may appear wavy,
  • you may notice a blurry spot in the centre of your vision, and
  • you may experience increased sensitivity to glare and bright light;
• struggling to read in low lighting environments, or due to parts or full words seeming to be missing or appearing to be distorted; and
• difficulty recognising faces from the blurry/distorted central vision.

Some people don't experience any visual symptoms at all which is why it's so important to link in with local optometrists for routine eye health checks every 2 years.

Veterans case studies

Veterans we support who have macular degeneration tell us they first noticed something was wrong with their vision to to a variety of circumstances, such as noticing the lines on the road or curbs look wavy while driving, noticing a black spot in their eye that doesn’t go away when rubbed, or noticing wavy lines when drawing or painting, or difficulty recognising faces. The most common difficulty for someone with AMD is that they may lose the ability to recognise someone. This happens because the macula is responsible for the detail we see and facial features have a lot of detail. You may experience one or all of these symptoms and, over time, you may notice them more.

I recall Sight Scotland Veterans veterans giving me examples like spotting slats in the venetian blinds on the sitting room no longer looking straight. One told me they had first realised something wasn’t quite right while driving – they had clipped the curb on a couple of occasions while going round corners and they were unable to tell the difference between the road and curb edge.

It is essential to visit your optician as soon as you feel there is something different about your vision.