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  • Macular degeneration (also called age-related macular degeneration or AMD) is the leading cause of blindness and severe vision loss in Australia. The name actually refers to a group of degenerative diseases of the retina – in particular the macula, which is responsible for central and fine-detail vision. Because this is a painless condition and peripheral vision is not affected, many people are not aware that they have AMD until the disease is in the advanced stages. Once advanced, AMD can be classified into wet and dry forms. Most people have the dry form of AMD.

    People aged over 50 years or those with a family history of macular degeneration face the greatest risk. This debilitating eye disease causes people to lose the ability to distinguish faces, read, drive and see fine detail. Some people may no longer be able to work. Early detection and treatment offers the best hope of minimising significant damage.

    • Blurred vision
    • Shadows or missing areas of vision
    • Distorted vision
    • Straight lines appear wavy
    • Difficulty discerning colours
    • Poor adaption to dark conditions (from brighter environments)
    • Numbers and letters appear jumbled
  • How common is macular degeneration?

    One in seven Australians over the age of fifty has macular degeneration, so it’s probably much more common than you realise.

    Are some people more at risk than others?

    While anyone can develop macular degeneration, available data suggests that you have a higher risk if you smoke or have a family history of macular degeneration.

    It’s extremely important that you get your eyes checked regularly, particularly if you are in a high-risk group.

    How do I know if I have macular degeneration?

    Regular eye checks after the age of 50 are important. If you have difficulty reading, distinguishing faces, or start to see dark or empty patches in your central vision, get your eyes checked immediately.

    There are also simple home tests that can indicate if you have any visual changes worth investigating.

    Why don't prescription glasses help?

    Prescription glasses can bend light to help it focus on the retina, but they can't correct any damage in the retina itself.

    Does macular degeneration affect children?

    The forms of macular degeneration that affect younger people are very rare and usually caused by a specific gene defect. The most common form is Stargardt's Disease, which may develop from 10 years of age (although vision loss may not occur until in your twenties or thirties).

    Knowing your family history in relation to eye diseases is extremely helpful.

    What is the difference between wet and dry macular degeneration?

    The advanced stage of macular degeneration can be divided into two types:

    1. Dry macular degeneration (also called atrophic) is the most common type. Here the macular tissue thins (atrophies) and eventually stops functioning properly. Vision loss is insidious and gradual.

    2. Wet macular degeneration (also called neovascular or exudative) affects about 10% of people with advanced AMD. Abnormal blood vessels grow beneath the macula and can leak fluid or bleed, causing the macula to swell. Vision loss is sudden and more noticeable than with dry AMD.

Diagnosing macular degeneration

Regular eye examinations

Everyone should have their eyes checked on a regular basis by an optometrist, regardless of whether you require glasses to see. Your optometrist will check your vision and also look for signs of any other eye disease. This is particularly important for conditions such as macular degeneration, where there may not be any noticeable visual abnormalities until late in the disease course. If there are any abnormal signs or you are in a high-risk group (e.g. you smoke, have diabetes or a family history), your optometrist may recommend further tests to examine the retina and can refer you to a retinal specialist.

If you have difficulty reading, distinguishing faces, or start to see dark or empty patches in your central vision, have your eyes checked immediately.

Home screening

You can perform some simple screening tests for macular degeneration at home. For those over the age of 50, look at a straight edge (e.g. of a door or window) one eye at a time to see if there are any ‘bumps’ or missing parts to the line. If there are, have your eyes checked immediately.

An Amsler Grid may be recommended for people at high risk of developing macular degeneration. Named after Swiss ophthalmologist Marc Amsler, this grid contains a series of horizontal and vertical lines with a dot in the middle. If the lines appear wavy or any are missing, have your eyes checked immediately.

Fluorescein angiography

This test (sometimes called retinal photography or eye angiography) uses a fluorescent dye to show any blockages or leaks in the blood vessels supplying the retina. The dye is usually injected into a vein in your arm and flows through the blood system to the retinal blood vessels. Your ophthalmologist will use a special camera to take photographs. Please note that your vision will be blurred for up to 12 hours after the test, as your pupil will be dilated using eye drops.

Optical coherence tomography (OCT)

Optical coherence tomography (OCT) is a non-invasive test that captures detailed images of the retina. The scan allows the ophthalmologist to identify areas of retinal thinning, thickening, or swelling caused by fluid build-up and leaky blood vessels. Your pupils will be dilated for this test and the procedure takes less than 10 minutes. The scans are performed without the need for direct contact with your eyes.

Treating wet macular degeneration

There is no cure for wet macular degeneration, although some treatments can slow or stop progression of the disease and vision can be maintained (or even improved) for many people.

The benefits of early treatment are:

  • Less damage to the macula caused by the abnormal blood vessels
  • Less oedema (swelling caused by excess fluid) in the macula, which would otherwise distort its shape and position
  • Prevention of scar tissue and the abnormal membrane that can form under the retina and damage macular tissue
  • Reduced chance of losing central vision

Eye injections

For wet macular degeneration, early detection is vital because eye (intravitreal) injections can be used to stop abnormal blood vessels leaking and dry up the abnormal macular fluid (oedema). Repeated injections and regular monitoring can prevent further vision loss in 95% of sufferers. Vision is significantly improved in up to 40% of those treated.

Anti-VEGF eye injections

Vascular Endothelial Growth Factor (VEGF) is a protein secreted by oxygen-deprived cells. Low levels of VEGF are normal; however when there are high levels of this protein, abnormal blood vessels will grow. Anti-VEGF drugs (e.g. Lucentis, Avastin and Macugen) block the protein and the corresponding abnormal blood vessel growth – they are given as eye injections. These drugs are used in the treatment of macular degeneration and diabetic retinopathy.

Anaesthetic drops are used to numb the eye, and the injection is given via a tiny needle from the side – you won’t be able to see the needle coming towards your eye. You may feel slight pressure, but there won’t be any pain.

Photodynamic therapy (PDT)

Photodynamic therapy is used for a small number of patients who have a specific type of AMD. A special dye, known as a photosensitiser, is injected into an arm vein and flows through the blood system to the retinal blood vessels at the back of the eye. A cold laser is then used to activate the dye, with the resultant photochemical effect shrinking and sealing abnormal blood vessels. Many people will need to be treated about every 3–4 months.

Eye injections may be used in conjunction with photodynamic therapy.

Treating dry macular degeneration

Unfortunately, there is no approved treatment for patients with the dry form.

Research studies investigating disease progression and potential therapies, some of which involve Vision Eye Institute specialists, are currently ongoing.

Preventing macular degeneration

Quit smoking

Smokers are three times more likely to develop macular degeneration (in addition to a number of other serious health-related issues), so now is the time to quit.

Eat fish, green and gold

Research has shown eating foods rich in carotenoids are particularly beneficial. These include dark green leafy vegetables (e.g. spinach and kale) and coloured vegetables (particularly gold-coloured ones, e.g. corn, yellow capsicum, sweet potato). Foods rich in vitamin C, omega-3 fatty acids (e.g. oily fish such as salmon) and zinc are also good for eye health.

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