What is Age-Related Macular Degeneration?

Age-related macular degeneration (AMD) is a condition that causes progressive damage to the macula and is the most common cause of visual impairment in people over sixty-five years old.

There are two forms of age related macular degeneration. These are dry macular degeneration and wet macular degeneration. Dry macular degeneration develops slowly over time, while wet macular degeneration can cause problems more rapidly.

AMD may be present in both eyes, but may progress at a different rate in each eye.

The retina in our eye captures the light that has been focused by the lens so that it can be transformed by the brain into images. At the heart of the retina is the macula. The macula is made up of special nerve cells which give us our clear central vision and colour.

Age-Related Macular Degeneration Eye Wales

How Might AMD Affect my Sight?

Age-Related Macular Degeneration is painless, and does not affect the appearance of the eye, so the first signs will be that you will start noticing changes in your vision. These changes can develop very slowly or quickly. You may find only one eye or both eyes are affected.

Visual changes will vary from individual to individual.

You may experience increasing difficulty reading small print, seeing clearly while driving, or seeing the detail on the TV screen.

You may have reduced central vision, and your central vision may become increasingly blurry, or in more severe cases a blank or dark spot may develop in your central vision.

You may perceive straight lines as wavy or crooked in the middle, and when you’re reading, the lines in the middle of the page may become very blurred and distorted.

You may notice that colours appear less vibrant than they used to.

What is Dry (Atrophic) Macular Degeneration?

The earliest sign of dry macular degeneration is often the presence of small yellow deposits called drusen beneath the retina.

These drusen are formed by waste products from the retina accumulating beneath the retina. As the drusen become larger, they reduce the flow of nutrients to the retina while at the same time causing the layer of supporting cells beneath the retina to become very thin. The macula which depends on them degenerates and loses its visual function.

Drusen can be found in young people too, and their presence alone does not mean that you will have visual problems.

There will be no leaking of blood or fluid so this type of degeneration is called dry macular degeneration. Of the two types of AMD, dry is much more common, but it allows many people to maintain a useful degree of vision. Dry AMD can develop into wet AMD over time.

What is Wet (Exudative) Macular Degeneration?

As the retina ages and degenerates, the eye will sometimes produce new blood vessels beneath the retina in a process called neovascularisation. These new blood vessels can leak and bleed easily because they are very fragile, and may over time result in the formation of a disc shaped scar in the centre of the visual field. This will irreversibly destroy all retinal tissue in its area creating a large central blind spot. 

Wet AMD nearly always starts off with the dry form of AMD. Around ten percent of sufferers of dry AMD will go on to develop wet AMD.

Although wet AMD is a great deal less common than dry AMD, it is generally the more aggressive form and can cause much more rapid and more extensive visual loss.

What is the treatment for Wet AMD?

The most successful treatment for wet AMD currently is ‘Anti-VEGF’ injections into the eye.

VEGF stands for ‘vascular endothelial growth factor’ which is protein that stimulates formation of new blood vessels. Anti-VEGF works by blocking this protein in the eye which in turn inhibits the growth of abnormal new blood vessels in your eye. If there are fewer abnormal blood vessels it follows that there will be less bleeding and leakage from them.

This treatment is administered under a local anaesthetic so most people have minimal discomfort.

This treatment prevents worsening of AMD in ninety percent of patients and improves vision in thirty percent of patients. The treatment is usually given every eight weeks or so for as long as is necessary.

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