Patient information: Age-related macular degeneration


What is the macula? The retina lines the inside of the back of the eye.  It functions a bit like the film in the back of a camera, in that it absorbs light to form an image of the outside world.  The most important part of the retina is the macula - this is the part of the retina that the light is focussed on.  It gives the central vision that is important for fine visual tasks such as reading and driving.
Macula
What is age-related macular degeneration (AMD)? This is commonly divided into two types: wet AMD and dry AMD. Wet AMD occurs when new blood vessels grow into the macula and then leak fluid and blood. Dry AMD occurs when the substance of the macula degenerates (atrophies).  There are early forms of AMD that have no new vessels or atrophy of the macula.  However, with time they do sometimes progress to more advanced types of AMD.  

What are the symptoms of AMD?   Mild AMD may have no symptoms at all, whereas advanced AMD can have a severe impact on vision.  People with AMD seldom go completely blind, but loss of central vision may make fine visual tasks like reading and driving more difficult, or sometimes impossible.   Rapid changes in vision, particularly blurred or distorted vision, should prompt patients to visit an eye doctor urgently, as this may mean they have wet AMD and this is best treated promptly.

How is AMD treated? There is unfortunately little that can be done to treat dry AMD in the way of drugs or surgery, although modified glasses and optical devices can help, and surgical trials are underway to establish if intraocular telescopes may be useful for some patients.  Social support and practical aids around the house are also a great help for some people.  There are by contrast many exciting new medical treatments for wet AMD including new types of laser, and drugs that are injected into the eye.  The new drugs include Avastin, Lucentis, and Macugen. NHS funded Lucentis is now available to many patients with wet AMD, if they meet the NICE criteria for treatment. This will depend on their vision, how long the disease has been present, and how much damage there is from AMD. There are other types of laser treatment available on the NHS, some that involve the combination of laser and an injection given into a vein in the arm (photodynamic therapy or PDT).  These are only available in the NHS in a few specialised treatment centres such as King's College Hospital.  Specific nutritional supplements (vitamins and mineral tablets) may also be suitable for some patients and can be purchased over the counter from pharmacies, however talk to an eye doctor about which supplements are best suited to your condition as some are inappropriate, or potentially harmful.  

New treatments for AMD?  There are many new treatment for AMD under evaluation. For more information on the the MERLOT study of epimacular brachytherapy, and other new treatments click here


Any further questions? There is a wealth of information available on the internet, but it is of variable quality.  One of the best information sheets is available free from the Royal College of Ophthalmologists (click here to view). This also provides a list of useful contact numbers.

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