Age Related Macular Degeneration (AMD)

WHAT IS AMD ?

Age-related macular degeneration (AMD) is the most common cause of sight loss in the UK. 

The macula is the most sensitive part of the retina. It gives us our central vision and the fine detail of what we see.  When the macula is damaged, people may not be able to drive and find it hard to read, watch TV and recognise faces. 

There are two forms of AMD – WET AMD and DRY AMD

Professor Pearce has been involved in numerous global trials investigating the most effective ways of treating both WET AMD and DRY AMD. 

He provides a one-stop clinic for diagnosis, imaging, monitoring and treating of  these conditions. 

WET AMD

Wet age-related macular degeneration (AMD) develops when abnormal blood vessels grow into the macula. These leak blood or fluid which leads to scarring of the macula and rapid loss of central vision. Wet AMD can develop very suddenly but it can now be treated if caught quickly. Rapid referral to a hospital specialist such as Professor Pearce is essential.

Symptoms

Macular disease affects people in different ways:

• Gaps or dark spots (like a smudge on glasses) may appear in your vision, especially first thing in the morning. Objects in front of you might change shape, size or colour or seem to move or disappear.
• Colours can fade.
• You may find bright light glaring and uncomfortable or find it difficult to adapt when moving from dark to light environments.
• Words might disappear when you are reading.
• Straight lines such as door frames and lampposts may appear distorted or bent.

At your clinic appointment Professor Pearce will confirm the diagnosis using several simple tests. He may use:

• Eye drops to dilate the pupils to see the back of the eye clearly. These may make your vision blurred and sensitive to light for a short time so consider taking someone with you. You will not be able to drive for several hours after dilation.
• OCT scans - these are special scans of the back of the eye which are simple and painless to acquire
• Fluorescein dye angiography. A dye injected into a vein in the arm travels to the eye, highlighting the blood vessels in the retina so they can be photographed. The dye will temporarily change the colour of your urine, so be prepared.

Wet AMD can be treated if caught early. Drugs are injected into the eye to stop the growth of the abnormal blood vessels. Following diagnosis people will usually have a loading dose of three injections, once a month for three months. A patient will then be assessed to see if more are required.

The injections are not as bad as they might sound. The patient’s eye is anaesthetised and the needle goes into the corner of the eye so the patient does not see it.

Some people do not respond to the injections and may be offered a form of laser treatment instead. There are a range of treatments and options although not all are available on the NHS.

DRY AMD

Dry age-related macular degeneration (AMD) is a slow deterioration of the cells of the macula, as the retinal cells die off and are not renewed often over many years. The term dry does not mean the person has dry eyes, just that the condition is not wet AMD. The progression of dry AMD varies, but in most people it develops over many months or years. People often carry on as normal for some time.

Macular disease affects people in different ways:

• Gaps or dark spots (like a smudge on glasses) may appear in your vision, especially first thing in the morning. Objects in front of you might change shape, size or colour or seem to move or disappear.
• Colours can fade.
• You may find bright light glaring and uncomfortable or find it difficult to adapt when moving from dark to light environments.
• Words might disappear when you are reading.
• Straight lines such as door frames and lampposts may appear distorted or bent.

At your clinic appointment Professor Pearce will confirm the diagnosis using several simple tests. He may use:

• Eye drops to dilate the pupils to see the back of the eye clearly. These may make your vision blurred and sensitive to light for a short time so consider taking someone with you. You will not be able to drive for several hours after dilation.
• OCT scans - these are special scans of the back of the eye which are simple and painless to acquire
• Fluorescein dye angiography. A dye injected into a vein in the arm travels to the eye, highlighting the blood vessels in the retina so they can be photographed. The dye will temporarily change the colour of your urine, so be prepared.

Although there is no proven treatment for dry AMD at this stage Professor Pearce is actively involved in global trials investigating several medical and surgical approaches to treat this debilitating disease. In addition, he can assess and advise with regards to best supportive management and low visual aids to help his patients. 

Around 10-15% of people with dry AMD go on to develop wet AMD. If you have dry AMD and notice a sudden change in your vision, it is important that you contact your optometrist, or hospital eye specialist, urgently.