Age-related macular degeneration
Age-related macular degeneration (AMD) is an eye condition that affects the central part of your vision
Age-related macular degeneration (AMD) is the most common cause of visual loss in the UK affecting older people. Some types of AMD need to be treated quickly, so it’s important to see your optometrist urgently if you notice any sudden change in your vision.
What is age-related macular degeneration?
AMD is a condition that affects the central part of your vision. It is caused by damage to the macular region of the eye, which is the part of the retina that provides detailed, central vision. It doesn’t normally affect your peripheral (side) vision, so while objects in the centre of your vision may become difficult to see, the vision to the side and edges should not be affected.
There are two main types of AMD – dry and wet. Dry AMD, sometimes referred to as wear and tear, is caused by a build-up of waste within the cells of the eye that react to light – these are called drusen. Drusen stop the cells from reacting properly to light. This form of AMD usually develops slowly.
Wet AMD happens when new blood vessels grow behind the macula. These blood vessels can begin to leak and this can damage the cells in the macular region and stop them from working. This process can start very suddenly.
Age is the main risk factor for developing AMD and the disease is more common in people over 65. Smoking significantly increases the risk of getting macular degeneration. Stopping smoking is the greatest change you can make to protect yourself from AMD. Ultraviolet light may also increase the risk of AMD, so, it’s a good idea to wear glasses that block or absorb UV light, especially in bright light. Getting enough exercise and eating a healthy diet, with lots of fruit and vegetables, can help to protect your eyesight. Kale, spinach and broccoli all contain nutrients that have been shown to help keep the eyes healthy. If you have a close relative with AMD, your risk of developing the condition is higher. You are also more at risk if you already have AMD in the other eye.
To begin with, dry AMD may have little effect on your vision. If the disease develops, your central vision may gradually become more blurred and it may become difficult to recognise faces and read things directly in front of you. Wet AMD will normally cause distorted vision, with straight lines and edges such as door frames becoming wavy and distorted. Some people also see a sudden blank spot in their central vision. Sometimes these changes can happen quickly, so it’s important to see your optometrist urgently if you notice any sudden change in your vision.
At the moment, there is no effective treatment for dry AMD, but it may be possible to see better with the help of special magnifiers and good lighting. Advice from the National Institute for Health and Care Excellence (NICE) states that patients with dry AMD should not normally be referred to the hospital eye service, but should continue to regularly see their optometrist to monitor the condition. If you have dry AMD, you should also take steps to monitor your own vision and can use an Amsler chart to do this. Download an Amsler chart.
Wet AMD can often be treated with injections into the eye, as long as it is diagnosed quickly. The injections work by stopping the growth of new blood vessels and can help to save your vision and reduce the risk of the disease getting any worse. If you notice any recent change in symptoms, you should contact your optometrist immediately. They will arrange for you to be seen by the hospital eye service.
Living with AMD
If your vision is affected due to AMD, your optometrist can advise you on steps you can take to help you in your daily life. This may include referring you to a clinic which can offer help in the form of magnifiers, or putting you in touch with local support groups. You may be advised to register your sight loss with your local authority.
If you have lost vision through AMD, you may experience visual hallucinations. This is known as Charles Bonnet Syndrome. Many patients find it reassuring to know that this is a common experience after losing vision, and although it can be quite upsetting, it is unlikely to be a sign of mental illness. If you experience visual hallucinations, you may want to discuss it with your eye care practitioner.
If you drive, you should discuss your eyesight with your optometrist.
Resources for your practice
If you're a practitioner, we recommend that you use this information, following a suitable examination, to reinforce advice given to the patient who has symptoms of AMD.