Age-related macular degeneration

There are many different problems that can affect our eye health and vision, with one of the most common being age-related macular degeneration.

Age-related macular degeneration is estimated to affect more than 600,000 people in the UK, which is a number that is expected to grow in the future. 

Although there isn’t currently an effective treatment that can reverse the effects of dry age-related macular degeneration, there are steps that you can take to minimise your risks and live with the condition should you develop it. Wet age-related macular degeneration, on the other hand, can develop suddenly leading to rapid visual decline, but can be treated if caught early. Treatment entails a course of injections into the eye. This is why a prompt referral to a retinal specialist is necessary if wet age-related macular degeneration is suspected.

Age-related macular degeneration (AMD) is a very common eye condition and the leading cause of severe and permanent vision loss affecting people aged 60 and over.

Contrary to what many people believe, age-related macular degeneration doesn’t cause total blindness. However, it can significantly impair your vision, and many people with the condition find that it makes their day-to-day lives much harder.

Macular degeneration affects a part of the eye called the macula. This is an area of cells found within the retina — the section of the eye that senses light and turns it into signals that are sent to the brain to tell us what we can see.

The macular is only around 5mm across but it is essential for our central vision, our ability to see colour and to see fine details.

Many people are surprised to learn that there are two different types of age-related macular degeneration. These are referred to as ‘dry’ and ‘wet’.

Dry age-related macular degeneration (Dry AMD)

Atrophic or dry AMD is by far the most common type of age-related macular degeneration, accounting for around 85-90% of cases.

This type of AMD occurs when the macula becomes thinner with age, causing the cells to deteriorate and eventually die. Some people with dry AMD will also develop yellow deposits on the macula, called drusen. These deposits can distort your vision, making it harder to make out details.

Unfortunately, the cells of the macula won’t regenerate after they die, meaning that if you are affected, your vision will get progressively worse.

Wet age-related macular degeneration (Wet AMD)

Far less common, but no less serious, is the ‘wet’ type of AMD. It is characterised by abnormal blood vessel growth. These blood vessels leak blood and fluid into the retina, distorting and interrupting your vision.

Over time, this bleeding can cause scarring which permanently damages your vision. Wet AMD can only develop if you have the dry variety first. Fortunately, only around 10-15% of cases of dry eye lead to the wet form of the condition.

Another difference is that the symptoms of wet AMD can cause much more rapid vision loss. For this reason, if you have any indication of wet AMD, or your ophthalmologist diagnoses it, it’s crucial that you start treatment to preserve your sight right away.

One of the biggest challenges of age-related macular degeneration is actually spotting signs that you are affected. That’s because in the majority of cases, AMD develops very slowly over a number of months and years.

As such, the symptoms also take a long time to manifest and are very subtle at first. Most people with age-related macular degeneration won’t be diagnosed as a result of a visit to their eye doctor prompted by symptoms. However, if you attend regular comprehensive eye exams, the condition will almost certainly be picked up at one of these appointments.

That’s not to say that there aren’t any age-related symptoms to be aware of. Some signs of AMD include the following:

• Distorted vision: lines that should be straight, such as lampposts or rulers appear wavy or bent
• Blurred vision, especially when reading. You may also find that words appear to disappear and reappear or move around the page
• Faded colours: colours appear less bright than before, and it can be harder to tell certain shades apart
• Blurry spots: in your field of vision. This could even be a blind spot, where you can’t see anything at all
• Difficulty with seeing fine details: this can make things like watching television, reading, driving and even recognising faces more difficult
• Difficulty adapting to low light levels: when you move into a dark room, it could take a long time for your eyes to adjust
• Needing brighter lighting: especially for close-up tasks like reading, using a smartphone or sewing

Age-related macular degeneration can affect one or both eyes, and may develop at different rates in each eye. If only one eye is affected, it may be harder to notice since the healthy eye may overcompensate for vision problems in the other.

It’s not clear exactly what causes age-related macular degeneration to develop, and why it affects some people and not others.

Nevertheless, research indicates that there are some risk factors that could increase the likelihood that you will be affected by this condition. These include:

Age

Age-related macular degeneration is most often seen in people who are over the age of 60.

Family history

Some research suggests that AMD runs in families, and if you have blood relatives with AMD, chances are you will experience it too. Studies have identified over 30 genes associated with the risk of developing AMD. The presence of these genes doesn’t guarantee that you will definitely develop AMD, but just that you may have a higher risk of doing so.

Race

Macular degeneration has been found to be more common in Caucasians, followed by Chinese and Hispanic people. Those who are of African descent are the least likely to suffer from AMD.

Smoking

Smoking isn’t only bad for your general health — it can also have a negative effect on the health of your eyes and vision. Smoking tobacco products or even being regularly exposed to tobacco smoke significantly increases your risk of age-related macular degeneration.

Current smokers are up to four times more likely to have AMD than people who have never smoked, and smokers are also more likely to develop AMD up to 10 years earlier than those who have never smoked. 

Obesity

If you are overweight or obese, you will automatically increase your risk of developing a variety of different health conditions, from diabetes and high blood pressure to heart disease and arthritis. Studies have also found that people who are obese are more likely to develop moderate to severe age-related macular degeneration.

Cardiovascular diseases

Cardiovascular diseases are fairly common and refer to conditions that affect the heart and blood vessels, such as hypertension, angina, heart disease and stroke. Research indicates that cardiovascular diseases are a significant risk factor for developing AMD.

Your eye doctor will recommend that you attend a comprehensive eye exam at least once every two years, which will enable them to closely monitor the health of your eyes and your vision.

If you do this, it’s highly likely that your age-related macular degeneration will be detected at one of these appointments.

However, if you notice any of the symptoms of age-related macular degeneration listed above, you should schedule an appointment to see your eye doctor as soon as possible.

This is particularly true if you are over the age of 50, and if your vision starts to decline quite suddenly.

If you are concerned about the health of your eyes, getting a diagnosis of age-related macular degeneration at a Circle Health Group hospital couldn’t be easier.

Once you’ve made an appointment for a consultation, you’ll meet with one of our expert ophthalmologists who will perform the necessary examinations to determine if you are affected by AMD and how severe your condition is.

AMD assessments

The main assessment will be a dilated eye exam. This will involve eye drops being placed into your eyes a short while before the exam.

These will cause your pupils to dilate, enabling your ophthalmologist to see through them and into the back of your eyes. They can then check for any abnormalities, including signs of age-related macular degeneration.

Your ophthalmologist may also recommend a test called optical coherence tomography, or OCT for short.

This is where a special machine is used to take a picture of the inside of your eye, which can then be assessed for signs of AMD. The records can also be stored so that they can be compared in the future to see how your AMD is progressing.

In rarer cases, patients with signs of macular degeneration are given a test called angiography.

This is where dye is injected into a vein in the arm, where it then travels around the body — including into the retina's blood vessels. Your ophthalmologist will then take photographs as the dye flows through the blood vessels to determine how it moves, and whether the blood vessels are leaking fluid or blood into the retina.

Unfortunately, there is currently no cure for dry age-related macular degeneration. However, there are things that you can do to slow it down and preserve your vision for as long as possible.

Eat a healthy, balanced diet

What we eat directly impacts our health and wellbeing, and getting the right nutrition is essential for good eye health.

There are certain nutrients that are proven to be beneficial for the health of our eyes, including zinc, vitamin E, vitamin C, lutein and zeaxanthin. These can be found in things like green leafy vegetables, fruits and nuts.

Quit smoking

If you smoke, you are much more likely to develop age-related macular degeneration.

You could significantly slow down the rate at which your AMD progresses by giving up smoking and limiting your exposure to second-hand smoke.

Maintain a healthy weight

Similarly, obesity is an identified risk factor for age-related macular degeneration, as well as many other conditions that affect the eyes, including diabetic retinopathy.

If you are currently overweight, altering your diet and exercise routine to reach a healthy weight can be extremely beneficial.

Using low vision aids

Patients who are living with dry age-related macular degeneration are often recommended to use low vision aids to help them live with their condition. There is a variety of different low vision aids to choose from, including:

• Magnifying lenses
• Screen readers
• Audio-description tools
• Reading glasses
• Assistive technology such as eSight
• Brighter lighting

The most common treatment for wet AMD is a type of eye injection, though in some cases it may be possible to use photodynamic therapy or laser therapy to treat the condition.

Your consultant will look to your personal circumstances to decide whether photodynamic or laser therapy are suitable for you, and share details on the process with you ahead of your treatment. They might recommend a combination of two approaches.

Eye injections for macular degeneration

Eye injections for macular degeneration deliver medication directly into your eye. This medication aims to reduce the symptoms of AMD and to slow its progression.

The main benefit of eye injections for macular degeneration is the prevention of further deterioration of your vision. In some cases, there may also be an improvement in your vision. Eye injections for AMD are quick, relatively painless and have a low risk of complications.

Photodynamic therapy for age-related macular degeneration

Photodynamic therapy (PDT) is another type of laser therapy where a light-activated drug is injected into your bloodstream. It is then activated in the eye using a low-energy laser, which should shut down the abnormal blood vessels without damaging the macula.

PDT is only suitable for certain patterns of damage. It usually involves more than one outpatient appointment for treatment. Your consultant might recommend a combined therapy of laser treatment and another AMD treatment, such as eye injections.

PDT is an outpatient procedure, so you should be able to go home the same day. Your eye might need to be covered up with a pad until the next day. Your vision might be blurry for a while after treatment, and your doctor will organise follow-up care to ensure that your eye is healing as it should.

Although very rare, the risks and side effects of laser therapy include:

• Loss of sight
• Bleeding
• Issues with eye pressure
• Infection
• Formation of cataracts

Laser therapy for age-related macular degeneration

During laser therapy for AMD, your eye will be numbed using an anaesthetic eye drop, then a doctor will use a laser to seal off the leaking blood vessels below the macula.

As with PDT, laser therapy is an outpatient procedure, so you should be able to go home the same day. Your eye might need to be covered up with a pad until the next day. Your vision might be blurry for a while after treatment, and your doctor will organise follow-up care to ensure that your eye is healing as it should.

Although very rare, the risks and side effects of laser therapy include:

• Loss of sight
• Bleeding
• Issues with eye pressure
• Infection
• Formation of cataracts

One of the best ways to minimise your risk of age-related macular degeneration and preserve your long-term vision is to make sure that you attend regular comprehensive eye exams with your usual eye doctor.

They will closely monitor the health and condition of your eyes and vision, which will enable them to spot any developing problems, such as AMD, glaucoma or cataracts early on — ensuring that you get treatment as promptly as possible. As with any health issue, early diagnosis can be crucial in preventing avoidable vision loss.

The suggestions for slowing down the rate of macular degeneration are also recommended as the best way to potentially prevent the condition from developing too. These include eating a healthy, balanced diet, losing or maintaining a healthy weight, regular exercise and giving up smoking.

A diagnosis of age-related macular degeneration can be worrying, but with advice, support and treatment from Circle Health Group hospital teams, patients can quickly learn to manage their condition and learn to live with low vision.

If you would like more information about age-related macular degeneration, or if you have concerns about your vision, please make an ophthalmology appointment with the friendly ophthalmology teams at a Circle Health Group hospital today.

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times and locations to fit your routine
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Support by the same compassionate clinical team from beginning to end
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to learn more about this procedure, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in March 2023. Next review due March 2026.

1. Treatments: Age-related macular degeneration (AMD), NHS
2. Age-related macular degeneration, NICE
3. Age-related macular degeneration, Moorfields Eye Hospital NHS Foundation Trust
4. Injections for macular degeneration: What to expect, Medical News Today