Patient Information - Age Related Macular Degeneration

This page aims to give you some information about the condition of Age Related Macular Degeneration or AMD for short. It is one of the commonest causes of poor vision amongst retired people with almost 50% of those over 75yrs having a degree of AMD.

The Retina

The retina is situated at the back of the eye and acts like the film in a camera. It is the part of the eye that converts light into electrical impulses which are then passed along the optic nerve to the brain and form the image you see.

The Macular Area

This area of the retina is responsible for most of our central vision. Unfortunately this is the part of the retina which Macular Degeneration affects. It does not affect the retina outside this area, which means that your peripheral vision will never be affected by this condition. It is only the central vision which is affected causing difficulty in reading but NOT total blindness.

Types of Macular Degeneration

DRY type - is a gradual thinning of the central retina which usually takes many years to develop

Advanced Geographic macular atrophy in "dry" type ARMD

WET or Disciform type - here the body tries to heal the ageing retina by making new blood vessels grow into the retina. Unfortunately, these are very fragile and often bleed. This can lead to a sudden deterioration of vision. The vision may become distorted and straight lines, like window panes, may appear bent.

	Fluorescein angiogram of "wet" AMD	Disciform Scar

Is there any treatment?

Most people have the dry form for which there is no specific treatment other than dietary supplements - see below. Although the condition may slowly progress, it will never make you go completely blind, as it does not usually affect the peripheral vision. Some people have the wet form of macular degeneration. Treatment is now possible in most forms of wet disease due to the introduction of anti growth factor injections such as Lucentis and in the future possibly radiation treatment to the macula. Over the last two Lucentis has become the first line treatment in most cases with good results. These drugs are still relatively new but NHS funding is now place and most of the major private health companies also recognize and fund Lucentis treatment. Please see separate leaflet on Lucentis treatment for further information. Other treatment options include Photodynamic Therapy using Visudyne, possibly combined with intravitreal Triamcinolone steroid injections."

Can Glasses help?

You should ensure that you have an up to date pair of glasses. Full frame reading glasses are better than Bifocals of Varifocals. If you are having difficulty reading, please ask to be referred to the Low Vision Aid Clinic for advise on magnifying aids. Remember extra lighting can help with reading.

Can I do anything to prevent it happening?

Good advice for everyone young and old is to wear a pair of UV blocking sun glasses together with a brimmed hat when outside in the sun.

Stop Smoking

If you are a smoker, research has shown that smokers have a higher instance of Age Related Macular Degeneration and I would encourage you to stop smoking to help decrease your overall risk as well as avoiding other medical problems.

What about dietary supplements?

Results from the AREDS study, published in the Archives of Ophthalmology (2001) show that taking supplements containing high levels of antioxidants and zinc, significantly reduced the risk of advanced age-related macular degeneration (AMD).

People at high risk for developing advanced stages of AMD lowered their risk by about 25 percent when treated with a high-dose combination of vitamin C, vitamin E, beta-carotene and zinc.

The supplements benefitted patients with both the wet and dry forms of AMD. Supplements did not provide benefit for those with either early AMD or no AMD. Previous studies have suggested that people who have diets rich in green, leafy vegetables have a lower risk for developing AMD. However, the high levels of dietary supplements that were evaluated in this study are difficult to achieve from diet alone.

Five year follow up of patients who are taking the high dose preparations has shown no significant side effects other than a mild increase of non specific genito-urinary tract problems which is of questionable significance. Other researchers feel that high levels of Lutein and Zeoxanthine may also be of benefit in reducing the risk of progression of ARMD and there are several animal studies to support this. I would therefore recommend that you use a combination tablet containing not only the high dose multivitamins and antioxidants as used in the AREDS trial but additional Lutein supplements as well.

The best combination I have found to provide all of these ingredients is the preparation known as "VitEyes". These tablets will provide the appropriate levels of supplements when used twice a day and are obtainable in three month supplies from my offices via Jacquie, my personal assistant, on 01189 553457

Smokers

In smokers a slightly different formulation is recommended which my secretary will be happy to discuss with you.

General Advice

Television
Sit closer to the TV to help you see, this will do no harm.

Driving
You must be able to read a number plate confidently at 20.5 meters (67 feet) to satisfy the DVLA standards. If you cannot then your insurance is invalid and unfortunately you cannot drive.

Partial Sighted and Blind Registration
For those whose vision is badly affected registration brings many benefits. The support team will visit you in your own home and assess whether you need any additional help or appliances. They can arrange the talking book and other support services which you may find very helpful.

Useful Addresses