Overview

Macular degeneration
Macular degeneration

What is AMD?

Age-related macular degeneration (AMD)

Age-related macular degeneration (AMD) is a common condition that affects the central part of your vision. It can happen younger but it becomes much more common to have a degree of it over the age of 65.

It doesn't cause total blindness. But it can make everyday activities like reading and recognising faces difficult.

Without treatment, your vision may get worse. The vast majority of cases are what is known as “dry” AMD and changes happen gradually over a number of years. There is a risk in a smaller number of cases that AMD becomes “wet” where a bleed at the back of the eye occurs which means vision changes quickly over a matter of days or months.

The exact cause is unknown. It is more common in women but its's been linked to smoking, high blood pressure, being overweight, exposure to UV light and having a family history of AMD. The biggest risk factor is increasing age. .

Symptoms

AMD affects the central part of your vision, not the edges (peripheral vision).

You can get it in one eye or both.

It is important to attend regular eye examinations (free on the NHS for over 60s) as for a number of years, early stage AMD is often symptomless.

Over time you may be aware of a blurred or distorted patch towards the centre of your vision. It is important to note that if you only have AMD in one eye you may not even be aware of this as it progresses, unless you regularly check your vision one eye at a time. If an optician tells you that you have early AMD, this is something they may advise you do, to make sure that you pick up on any changes to your vision that needs medical attention.

If it gets worse, you might struggle to see anything in the middle of your vision.

AMD can make things like reading, watching TV, driving or recognising faces difficult.

Other symptoms include:

  • seeing straight lines as wavy or crooked
  • objects looking smaller than normal
  • colours seeming less bright than they used to
  • seeing things that aren't there (hallucinations)

AMD isn't painful and doesn't affect the appearance of your eyes.

See an optometrist/optician if you are worried about your vision. If you have a problem with your eyes, early diagnosis and treatment may help stop your vision getting worse. Find an optometrist/optician here.

Get an urgent opticians appointment if:

  • your vision gets suddenly worse, all over or just in a central patch.
  • you have a dark "curtain" or shadow moving across your vision
  • your eye is red and painful

These aren't all symptoms of AMD but can be signs of other eye problems that need to be treated immediately.

Go to A&E or call 111,  if you can't get an urgent appointment.

Find an A&E department here.

Diagnosis

What happens at your opticians appointment

You'll be seen by a specialist called an optometrist.

They will use various methods to look inside your eyes which may include, taking photos of the back of your eyes, offering you 3D type scans of the back of your eyes, and using special lenses to look at the back of your eyes.They may put drops in your eyes to make it easier for them to spot any problems. These can make your vision blurry for a few hours. They may ask you to return on another day to carry this out if you have driven to your appointment as it takes a number of hours for your vision to return to normal. It can also make you sensitive to light so your optician might recommend you bring a pair of sunglasses to your appointment

Referral to a specialist

Sometimes you may be referred to an eye doctor (ophthalmologist) or specialist AMD service. This is normally only necessary if they think you are at high risk of wet AMD or that you already have wet AMD. You will normally be referred and seen within a matter of days or weeks.

You may have more tests, such as a scan of the back of your eyes.

What happens if you're diagnosed with AMD

If you're diagnosed with AMD, the specialist will talk to you about what it is, what type you have an what the treatment options are.

Types of AMD

Dry AMD

  • Caused by a build-up of a fatty substance called drusen at the back of the eyes
  • Common
  • Gets worse gradually - usually over several years
  • No treatment - unless it develops into wet AMD
  • Some evidence that certain nutrient supplements may help slow progression but these are not available or endorsed by the NHS. As below the macular society can provide more information on this research so you can make an informed decision. There is no evidence that it can stop you getting dry AMD
  • Some evidence that wearing sunglasses may be helpful after diagnosis as the back of the eyes may be less able to cope with the possible harmful effects of UV. (See macular society for more detail)

Wet AMD

  • Caused by the growth of abnormal blood vessels at the back of the eyes
  • Less common
  • Often gets worse quickly - sometimes in days or weeks
  • Treatment can help stop vision getting worse

It might be difficult to take in everything the specialist tells you.

If you're unsure about something later, write down any questions you have and make another appointment to go over them.

The Macular Society has information you might find useful. It also has a helpline on 0300 3030 111.

Treatment

Treatment depends on the type of AMD you have.

  • Dry AMD - there's no treatment, but vision aids can help reduce the effect on your life.
  • Wet AMD - you may need regular eye injections and, very occasionally, a light treatment called "photodynamic therapy" to stop your vision getting worse.

Eye injections

Anti-VEGF medicines - ranibizumab (Lucentis) and aflibercept (Eylea)

Injections given directly into the eyes.

  • Stops vision getting worse in 9 out of 10 people and improves vision in 3 out of 10 people
  • Usually given every 1 or 2 months for as long as necessary
  • Drops numb the eyes before treatment - most people have minimal discomfort
  • Side effects include bleeding in the eye, feeling like there's something in the eye, and eyes being red and irritated

The Macular Society has more on injections for wet AMD.

Light treatment

Photodynamic therapy (PDT)

A light is shined at the back of the eyes to destroy the abnormal blood vessels that cause wet AMD.

  • May be recommended alongside eye injections if injections alone don't help
  • Usually needs to be repeated every few months
  • Side effects include temporary vision problems, and the eyes and skin being sensitive to light for a few days or weeks

Read more about photodynamic therapy.

Research into new treatments

Research into new treatments for AMD is ongoing. Your specialist can let you know if there are any studies you could take part in.

You can also search the UK Clinical Trials Gateway (UKCTG) to find studies.

Living with

 Help with low vision

Speak to your eye specialist about a referral to a low-vision clinic if you're having difficulty with daily activities.

Staff at the clinic can give useful advice and practical support. For example, they can talk to you about:

  • useful devices - such as magnifying lenses
  • changes you can make to your home - such as brighter lighting
  • software and mobile apps that can make computers and phones easier to use

If you have poor vision in both eyes, your specialist may refer you for a type of training called eccentric viewing training.

This involves learning techniques that help make the most of your remaining vision.

It is likely that you will be offered an appointment with an optometrist/opticians practice that has specially trained staff who can loan you nhs devices to help you as detailed above.

Staying healthy

AMD is often linked to an unhealthy lifestyle. If you have it, try to:

  • eat a balanced diet
  • exercise regularly
  • lose weight if you're overweight
  • stop smoking if you smoke

There's some evidence to suggest that certain health supplements might help stop AMD getting worse, but this isn't definitive.

Important - Speak to your GP or specialist if you're considering taking supplements for AMD. They're not suitable for everyone.

The Macular Society has more on diet and nutrition for AMD.

Driving

AMD can make it unsafe for you to drive. Ask your specialist if they think you should stop driving.

You're required by law to tell DVLA about your condition if:

Find out how to tell DVLA about a medical condition.

Monitoring and check-ups

If you have wet AMD or at high risk of getting wet AMD you are likely to have regular check-ups with your specialist to monitor your condition

Contact your specialist as soon as possible if your vision gets worse or you notice any new symptoms.

If you have been diagnosed with dry AMD you are likely to carry on being seeing by your regular local optometrist/optician

Keep having routine eye tests (usually every 2 years but could be more often on advice from your optometrist/optician). They can pick up other eye problems that your check-ups don't look for.

Registering as sight impaired

If your vision continues to get worse, you may want to consider registering your sight loss.

This can make it easier to claim financial benefits, such as help with health costs.

Your specialist can check your vision and complete an official certificate if you meet the requirements to be registered.

RNIB has more on registering your sight loss.

Getting more help and support

Living with AMD can be very difficult.

In addition to support from your specialist, you may find it useful to use support groups such as:

Important - See a GP if you've been feeling low for more than 2 weeks. They can offer support and treatment if you need it.



The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 10/03/2022 14:07:16