Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is an eye condition associated with ageing that over time, destroys sharp, central vision.

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If you have been experiencing dark patches in your central vision or if there is visual distortion with straight lines appearing wavy or crooked lately, beware — these could be signs of age-related macular degeneration (AMD). Find out more about macular degeneration symptoms and treatments.

What is Age-related Macular Degeneration?

Age-related macular degeneration (AMD) is an eye condition associated with ageing that gradually destroys sharp, central vision. AMD is the most common cause of blindness in many developed countries. In Singapore, it ranks among the top four causes of blindness. It typically affects those above 50 years of age.

AMD affects the macula of the eye, which is the part of the eye that allows you to see fine details. The macula is located in the centre of the retina, the light-sensitive tissue at the back of the eye.

When AMD occurs, day-to-day activities such as reading, driving and even recognising faces may be affected.

There are two forms of AMD: wet and dry.

What is Wet AMD?

In the wet form of AMD, abnormal blood vessels grow under the macula and leak blood and fluid. This causes retinal cells to die and creates blind spots in central vision. An early symptom of wet AMD is that straight lines appear wavy. If you notice this condition or other changes to your vision, consult your eye-care professional immediately.

What is Dry AMD?

Dry AMD occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye. This form of AMD is more common than the wet form. One of the most common early symptoms of dry AMD is drusen, which are yellow deposits under the retina. Dry AMD is painless and usually affects people over the age of 60.

Causes and Risk Factors

Age is the greatest risk factor for AMD. The condition may occur during middle age, but studies show that people over the age of 50 are at greater risk than other age groups. Other risk factors include smoking, obesity, hypertension and a history of AMD in family members.

By leading a healthy lifestyle, you can reduce your risk of developing AMD:
Eat a healthy diet high in green leafy vegetables and fish
Do not smoke
Treatment

When severe scarring at the macula has already occurred, vision is unlikely to recover. Therefore early detection of AMD means a greater likelihood of improving vision or slowing the deterioration, depending on the form of the condition.


Age-related Macular Degeneration Treatment

Wet AMD can be treated with laser surgery, photodynamic therapy and injections into the eye.

Laser Surgery 

This procedure uses a laser to destroy the abnormal blood vessels. A high-energy beam of light is aimed directly onto the blood vessels and destroys them. However, laser treatment may also destroy some surrounding healthy tissue, causing visual problems.

The risk of new blood vessels developing after laser treatment is high. Therefore, repeated treatments may be necessary. In some cases, vision may further deteriorate despite repeated treatments.

Photodynamic Therapy

This procedure is relatively painless and takes about 20 minutes. It can be performed in a doctor's office.

A drug called verteporfin is injected into your arm, sending the drug to all the blood vessels in the body, including the new blood vessels under the macula. A light is then shone into your eye for about 90 seconds. The light activates the drug, which in turn destroys the new blood vessels and leads to a slower rate of vision decline. Unlike laser surgery, this drug does not destroy surrounding healthy tissue. As the drug is activated by light, it is important that you avoid exposing your skin or eyes to direct sunlight or bright indoor light for two days after treatment.

Photodynamic therapy slows the rate of vision loss but does not stop vision loss or restore vision in eyes already damaged by advanced AMD. Because treatment results can be variable and may be temporary in some eyes, you may need repeat treatments.

Injections 

Wet AMD can now be treated with new drugs that are injected inside or around the eye so as to reverse the development of abnormal new vessels and control inflammation. The type of medications used include:
Anti-angiogenesis drugs
Steroids

This form of treatment can help slow down vision loss from AMD and in some cases improve vision; however multiple injections are likely to be required.

Currently, there is no known effective treatment for dry AMD although research is promising. In its early and intermediate stages, dry AMD does not result in vision loss. Treatment is therefore focused on delaying and possibly preventing intermediate AMD from progressing to the advanced stage, in which total vision loss occurs.

Living with AMD

In most cases, it is not possible to reverse the damage caused by AMD. However, there are ways to cope with and make use of the remaining sight such as:
Reading books with larger print
Ensuring sufficient lighting for activities
Not driving at night or in heavy traffic
Removing obstacles in the home such as rugs or other tripping hazards

If you develop blurring of central vision, you should have your eyes checked by an eye-care professional as soon as possible. Tests may be required to diagnose and assess your condition. Your eye-care professional will be the best person to explain the problem and the treatment options.



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