Explained: Age-related macular degeneration (AMD)

Age-related macular degeneration (AMD) is one of the world’s most common causes of sight loss. In the UK, there are currently over 600,000 people whose sight is affected by this disease. Understanding the condition and what a diagnosis of age-related macular degeneration means can go a long way to help adapt to life with this disease, should it affect you, or a relative or friend.

Fiona McCormick is a rehabilitation officer for Sight Scotland Veterans. She works with veterans with sight loss across Scotland – many of whom are older and are adapting to living with age-related macular generation. Here she answers some commonly asked questions about the disease.

 

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.

 

Can age-related macular degeneration be cured? Are there treatments available?

Unfortunately, dry AMD currently cannot be treated, although a healthy balanced diet and stopping smoking can help slow the disease. Treatment is available for wet AMD by way of an injection of a drug into the eye to try to stop these blood vessels growing and causing more damage and scarring. This sounds scary, but the procedure is painless as anaesthetic drops are inserted into the eye first. Sight loss cannot be reversed with this treatment, so the aim is to stop the vessels growing and subsequent scarring, which leads to sight loss. You may need to attend the hospital eye clinic every month or six weeks for a scan of the macula. If new vessels are growing, another injection may be needed. Treatment is very much on an individual basis, and can continue for a long time. Your ophthalmologist will determine the right course of treatment for you.

There is currently no cure for age-related macular degeneration. However, there is plenty of research going on into this condition that affects so many people across the world, with the hope that, one day, a cure will be found.

 

Is age-related macular degeneration hereditary?

AMD can be hereditary, but there are a number of factors that increase the risk of developing the condition. These include smoking, diet, and high blood pressure. Therefore, if you are diagnosed with macular degeneration, you can make changes to your lifestyle for example eating a healthy balanced diet including leafy green vegetables. Small changes can help.

 

What are the symptoms of age-related macular degeneration?

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

Early symptoms of AMD can include struggling to read small print and see detail. For some, a straight line may appear wavy, or you may notice a blurry spot in the centre of your vision.

Veterans with macular degeneration we support tell us they first noticed something was wrong with their vision to to a variety of circumstances, for example: 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.  

 

How long does it take sight to deteriorate?

With dry AMD, the disease progresses slowly, therefore the deterioration in central vision is gradual. It is important to stress that peripheral vision is not affected by AMD. Although peripheral vision does not provide you with as much detail, it can be very useful for navigation and reading, alongside magnification. 

Wet AMD can develop quickly, and can sometimes be stopped from progressing. The disease does not affect peripheral vision, so it does not lead to complete blindness.

What should you do if you notice any symptoms or think you might have macular degeneration?

It is important to visit an optometrist, GP or any health professional if you notice any change in your vision, however small. They can make a referral to the ophthalmologist quite urgently to get treatment started, if necessary.

 

How can you adapt to life and maintain independence with AMD?

There are many ways to remain independent if you are living with AMD and many different aids available. These include, Magnification, appropriate lighting, and colour contrast.

Sometimes, changing the lighting at home can be the difference between being able to read or not. For example, I visited one of our Sight Scotland Veterans members who was struggling to read the paper. It was taking him a long time to get it each day. I looked at the lighting in the kitchen, which appeared good, but the light was dispersed all over the room. I tried a table top lamp, which shone directly onto the newspaper, and then they were able to read the paper without the need for the magnifier.

A pair of filter glasses can enhance contrast and provide protection against glare. It’s important to get the balance correct: if the glasses are too dark they will remove any useful vision.

Assessing for magnification is a vital part of my role, and I have provided electronic magnification for many Sight Scotland Veterans veterans when using a hand held magnifier has become too difficult or frustrating. For example, I assessed a veteran with AMD who was having great difficulty reading textbooks. He was trying to do this with a hand held magnifier, but it was becoming increasingly difficult and he had lost enthusiasm. I provided him with a video magnifier that enabled him to see the whole text book on a large screen. He can now enjoy his hobby again.

It is important to get access to the right support and advice. You can contact the service provider in your area to ask for a low vision assessment. Sight Scotland and Sight Scotland Veterans are also here to support people with sight loss.