Age-related macular degeneration (AMD)

Age-related Macular Degeneration (AMD or AMRD) is a common eye disorder that damages the macula at the back of the eye and is the most common cause of severe loss of vision in patients over the age of 50. The macula is a tiny central area of the retina (the photographic plate at the back of the eye) which we use to see fine print, and colours. AMD can make it difficult for affected patients to read, recognise people, drive, or perform tasks that require the use of accurate central vision. Common early symptoms of AMD are blurring or distortion of central vision. Without treatment, vision loss may be quick, severe and irreversible.

It is sometimes necessary to carry out investigations, both at the time of referral and at regular intervals to determine whether you present the dry or the wet form of AMD, and whether the disease  is active and treatable or not. In the wet form abnormal blood vessels grow at the macula and leak fluid. The tests most commonly performed are fundus fluorescein angiography (FFA) and Optical Coherence Tomography (OCT scan). During FFA a yellow dye is injected into a vein in the arm and photographs are taken of the back of the eye.  This allows a detailed view of the blood vessels at the macula. An OCT scan is a simple test that uses a beam of light to produce pictures of the macula. OCT is commonly used to determine the thickness of the macula and the response to treatment.

Age Related Macular Degeneration

Treatments for wet AMD most commonly include the injection into the eye of a special drug referred to as anti-vascular endothelial growth factor (anti-VEGF) and/or Photodynamic Therapy (PDT).

Photodynamic Therapy (PDT)

During PDT a special dye called Visudyne® is injected into an arm vein. A special contact lens is placed on the eye. A specific laser beam is then applied to the eye and this activates the dye within the abnormal macular blood vessels with the aim of destroying them. 

Lucentis or Avastin (Anti-VEGF Drugs)

The aim of treatment with these drugs is to prevent further loss of vision although some fortunate patients have actually regained vision following the use of these drugs.  A tiny quantity of fluid containing the drug is injected into the vitreous, a jelly-like substance in the middle of the eye, after the eye has been numbed with anaesthetic drops.These drugs need to be injected into the eye at regular intervals (about every 4-6 weeks).  How long this is continued for depends upon the individual patient’s clinical circumstances.

At Face & Eye these injections are only given in the sterile conditions of our dedicated operating theatre and not in a room in a clinic. The injections are given by Mr Mike Lavin, consultant ophthalmic surgeon with expertise in vitreo-retinal surgery. "Twilight" anaesthesia can be offered for this procedure.

The main risk factors for AMD are:

  • Smoking
  • Family history
  • Family history – this doubles the baseline AMD risk and smoking more than triples it. Any patient with both is therefore at more than 6 times the baseline risk.

Other risk factors include:

  • Light hair & blue eye colour
  • Obesity
  • Lightly pigmented skin and female gender

(all of which increase AMD risk, but to a lesser extent than smoking & family history).

The baseline risk of developing AMD from 55yrs age onwards is 1.3% over 5 years. In patients with medium size drusen (small yellow deposits at the macular) this rises to a 26% 5yr risk of developing advanced AMD.  Therefore, patients who have medium sized, soft drusen & those with multiple risk factors would significantly increase their chances of maintaining retinal health by taking supplement such as Ocuvite Complete (OC) or Nutrof Total. The antioxidants have been shown to reduce risk by up to 25%, the pigments (lutein & zeaxanthin by 30-40%) and omega 3 oils, specifically DHA, by 34-64%. Ocuvite Complete and Nutrof Total contain all of the above.

These supplements can be obtained from the Face & Eye shop.

 

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