Macular Degeneration

Macular degeneration is also known as, age related macula degeneration, ARMD or AMD. The macula is the central area of the retina; the macula gives you your central vision; where you can see colour and fine detail.

Dry or Early Macular degeneration is when there is a build up of waste products (drusen) and thinning of the macula tissue. The buildup of waste products (drusen) and/or thinning causes you to slowly lose the ability to see fine detail; your peripheral vision remains unaffected. Dry macular degeneration can progress with time to late stage geographic atrophy or geographic macular degeneration. Geographic atrophy is where there is permanent degradation of the macula retinal cells and causes more severe central vision loss.

Wet macula degeneration is where new blood vessels grow from beneath the retina and leak fluid & blood into the macula. This causes permanent damage to the retinal cells in the macula and will create a blind spot in the central vision. The new abnormal blood vessel growth is known as choroidal neovascularisation, where the new blood vessels grow in an attempt to supply the macula with oxygen and nutrients. However the new abnormal blood vessels are weak and leak, causing permanent damage to the macula. Wet macula degeneration is further categorised as either: Occult; were vision loss is less severe, as the new blood vessel growth and leakage is not as significant & pronounced OR Classic; were vision loss is more severe; there is significant distinct, new abnormal blood vessel growth, leakage and scarring.

Wet macular degeneration develops in (some) people who have dry macular degeneration.

Dry Macular Degeneration

• Slow painless loss of central vision

• Straight lines may appear slightly distorted

• Slight blurring of the vision (worse in geographic macula atrophy)

• More difficulty in seeing small print or reading

• You require a bright light to read

• Colours may look less bright

• Using your peripheral vision to see better (more common in geographic macular atrophy)

Wet Macular Degeneration

• Sudden loss of central vision or part of central vision

• Objects in your vision may appear to change size, shape, colour or seem to move

• Straight lines appear bent

• Gaps or dark patches in you vision

• Reading is extremely difficult

• Colours appear very dull

• Cannot recognise faces

• Using your peripheral vision to see better

• Visual hallucinations Charles Bonnet syndrome

The exact cause is unknown. However there are risk factors associated with the development of macular degeneration.

• Age, macular degeneration is common in people over 50 years of age

• Family history, there is hereditary link to macular degeneration

• Caucasians are more at risk of macular degeneration

• Smoking increases your risk of developing macular degeneration

• Research has indicated that being overweight may increase the risk of early macular degeneration to progress

• Cardiovascular disease may give you a higher risk of developing macular degeneration.

• Exposure to UV from sunlight or other sources increases your risk in developing macular degeneration.

Dry macula degeneration currently has no treatment available and is usually monitored by your opticians unless it progresses significantly. You may require low vision aids if your dry macular degeneration is impeding your vision.

However there are preventive measures you can take to guard against the development of any type of macular degeneration.

• Protect your eyes from UV light from the sun and high-energy visible radiation HEV with good quality polarising sunglasses. We recommend Maui Jim polarising sunglasses.

• Eat a healthy diet rich in green leafy vegetables, colourful fruit and vegetables; they are higher in antioxidants. Good quality dark chocolate is also high in antioxidants. Antioxidants help guard against free radicals that cause macula degeneration.

• Include fish and nuts in your diet to get your essential omega 3 fatty acids

• Macular degeneration vitamin & antioxidant supplements (that are AREDS2 research supported)

• Stop smoking

• Exercise & maintain your weight, reduce refined carbohydrates

• Manage all your other medical conditions

• Contact the RNIB or macular society for further support, visual aids and practical advice

• Notify the DVLA of your eye condition if you drive

• It may be beneficial for you to work with a low vision rehabilitation specialist and an occupational therapist to help you find ways to adapt to your changing vision.

Wet macular degeneration

Wet macular degeneration can be treated in the following ways

• Injections to the eye (intravitreal injections) with anti- VEGF drug called ranibizumab (Lucentis), Ranibizumab helps stop the growth of abnormal blood vessels, stops leakage from abnormal blood vessels and bleeding at the macula. The injections have to be administered on a regular basis. Other anti-VEGF drugs are Aflibercept (Eylea) and Bevacizumab (Avastin).  The hope is that we can recover some of your vision using the anti-VEGF injections.

• New blood vessels can also be treated with a laser treatment called photodynamic therapy (PDT); you are injected with a drug called Verteporfin (into your arm), the drug travels to the blood vessels in the eye, this helps the ophthalmologist locate the new blood vessels in the eyes, the laser then stunts their growth by activating the drug and stops any further leakage. This may help improve your vision.

• Photocoagulation is a laser used to seal off any abnormal blood vessels. The laser causes a blind spot in the area it has treated but stops any further bleeding and consequent damage from the blood vessels. It is not used for blood vessels directly under the macula as this can cause further deterioration to your vision; therefore it is not used regularly on wet macula degeneration patients.

Detection of macula degeneration at your eye test

At your eye test we will always assess the back of your eyes (retina) and check the health of your macula (& optic nerve), we usually do this with a 2D or 3D viewing technique. If we do see any changes to macula we will conduct an Amsler test, this allows us to chart any distortion or changes in your central vision. A copy of the Amsler chart is given to you so you can check your central vision at home, on a weekly basis. We would also recommend an OCT scan to anyone that we suspect, has a family history or has clear signs of macular degeneration present. The scan allows us to investigate the retina and macula in more detail. All changes to the macular can be monitored more closely with an OCT scan. If we feel your macular degeneration is progressing significantly or you have had further complications we will refer you on to an Ophthalmologist for further review.

For further help contact the RNIB, 0303 123 9999, helpline@rnib.org.uk, or visit the RNIB at 105 Judd St, London WC1H 9NE

Macular Society: PO Box 1870, Andover, SP10 9AD. Tel: 0300 3030 111  Web: www.macularsociety.org

Driver and Vehicle Licensing Agency (DVLA), Drivers Medical Enquiries: DVLA, Swansea SA99 1TU

Tel: 0300 790 6806  Web: www.dvla.gov.uk