Age-related Macular Degeneration (AMD) is a common eye condition that affects the central vision in one or both eyes.
Central vision is what allows us to perform most daily tasks that require the vision of details such as reading, watching TV, or distinguishing faces.
It normally occurs with increasing age when the cells in the retina that are responsible for removing the waste produced by the photoreceptor cells (these are responsible for vision) begin to break down.
Waste products begin to accumulate in the retina and this can lead to the death of the photoreceptor cells and hence a loss of vision.
There are two main forms of AMD: Dry AMD and Wet AMD and there are different available treatment options for both, depending on the progression of the disease. Continue reading here to find out more about this disease and what we could do to help you if you are affected by this condition.
Signs And Symptoms of AMD
Any of the following symptoms could be signs of the onset of AMD and should warrant further investigation by a retina-specialised ophthalmologist.
- Wavy or blurred vision
- Visual Distortion
- Loss of central vision, with dark or blurry spots in the middle of your vision
- A change in your perception of colour
- You find you need brighter lights to see
- You have trouble recognising faces
You should seek urgent medical advice: if your vision gets worse, you notice blind spots or, images become distorted.
How Is AMD Diagnosed?
Prof. Stanga and his team use only the latest technology for the early and accurate diagnosis of AMD including: new higher resolution Swept-Source Optical Coherence Tomography (OCT) and Angiography, as well as Optos® Ultra-Widefield Multi-Wavelength retinal imaging. These are just some of the large-range of devices we have onsite to diagnose and monitor your condition.
AMD is primarily diagnosed through:
- Fundus Fluorescein Angiography (FFA): A small amount of yellow fluorescein dye is injected into a vein in your arm. The dye travels to your eye, where it highlights the blood vessels. It is particularly useful in showing leaking blood vessels as well as highlighting areas of poor blood supply. Photographs of the back of the eye are taken while the fluorescein is flowing. Prof. Stanga uses Optos® Ultra-Widefield technology which allows for the visualisation of a significantly larger area of the retina compared to standard photography. FFA is primarily for those patients with suspect Wet AMD as this is the form of AMD that leads to leaking bloods vessels.
- Optical Coherence Tomography (OCT): This is a non-invasive test similar to an ultrasound that uses light instead of sound. An OCT scan can show several things in relation to macular degeneration. It can indicate in Dry AMD, the level of drusen in the macula. These are the waste deposits that clog the retina, causing cell-death and loss of vision. An OCT can also show whether there is fluid accumulating in the macula, as well as help to monitor progress after treatment by measuring the thickness of the retinal tissue. This test is performed at every visit. Prof. Stanga always uses the latest higher resolution Swept-Source OCT technology which also allows the visualisation of abnormalities in the retinal vessels.
- Fundus Auto Fluorescence (FAF): This is a non-invasive test which uses light of a specific wavelength or colour to highlight the presence of dry AMD before it is visible by normal examination and also the presence of geographic atrophy (GA) which is when retinal cells have begun to die causing vision loss. This test is also helpful in assessing the progression of the disease. Prof. Stanga also uses the Optos® Ultra-Widefield technology and Heidelberg Spectralis® for FAF imaging.
How is AMD treated?
Dry AMD
At The Retina Clinic London, for patients diagnosed with early and intermediate AMD, we offer photobiomodulation light therapy which aims to slow progression of the disease and prevent vision loss.
There are currently no treatments available in the UK for graphic atrophy caused by Dry AMD. This is the late stage of Dry AMD when the cells which generate vision have died. For these patients, we have clinical trials available to perhaps slow the progression of the ‘late’ Dry Age-related Macular degeneration (Geographic Atrophy).
If you are interested in partaking in research at The Retina Clinic London for Geographic Atrophy, then please navigate onto the ‘patient studies’ page for more information. Otherwise please note that Dry AMD must still be monitored regularly as it can change into the Wet form AMD.
Wet AMD
Wet AMD can be treated by injecting the eye with anti-vascular endothelial growth factor (anti-VEGF) drugs. These drugs can stabilise your vision and aim to reduce the amount of fluid in the retina which causes the disruption to your vision. Improvement in vision can sometimes be achieved if treatment is started early. Early detection of wet AMD is therefore paramount for reducing the risk of severe vision loss.
There are a variety of approved drugs available to treat Wet AMD, and at your consultation, Prof Stanga and his Team will go through all the available options including which drug they think is best for your specific case. In this way, patients are given the choice of treatment options.
We are also actively running clinical trials in Wet AMD. These trials offer the opportunity to have drugs that will mean less injections over the course of a year and/or cause a better response in vision compared to already approved drugs. Please visit our clinical trials page for more information on what trials are available.
Reducing your risk
It is not always possible to reduce the risk of developing macular degeneration as it is closely linked to your age and likely has a genetic factor. However, you may be able to reduce your risk of developing this condition by consuming a healthy and balanced diet and not smoking.
According to the Macular Society, smokers are more likely to develop AMD up to 10 years earlier than those who have never smoked. Their AMD is likely to progress faster and be less responsive to treatment. Second-hand smoke is also likely to increase the risk of AMD. People who are most in danger of getting AMD are people who smoke and who also have particular genes. For example, research suggests that smokers who have mutations to the HTRA1 gene are 20 times more likely to get AMD than non-smokers. Overall, it is estimated that as much as one third of all AMD is a result of the combination of genetics and smoking.
An autofluorescence picture of a retina with late stage 'dry' age-related macular degeneration with geographic atrophy (GA)
An OCT scan of a macula with 'Wet' Age-related Macular Degeneration