Age-Related Macular Degeneration

The macula is a small area in the retina that is responsible for the finest vision. In age-related macular degeneration, the ability to see fine details is lost. This only affects central vision. Macular degeneration cannot cause complete blindness. Patients with macular degeneration continue to use their peripheral vision. There are two types of age-related macular degeneration.

Dry Macular Degeneration

It is the most common form of age related macular degeneration. It affects 80% of the people with macular degeneration. It is characterised by tiny yellow deposits on the macula called drusen. Drusen are deposits of extracellular material under the retina. The presence of drusen is common in people over 40years of age. When the drusen are more numerous it is called Dry macular degeneration. It causes gradual blurring of the central vision.

Wet Macular Degeneration

Wet Macular Degeneration develops when abnormal blood vessels grow into the macula. These abnormal blood vessels tend to bleed under the macula. As a result, patients develop distorted vision. Bleeding and scaring can lead to permanent loss of central vision.

Diagnosis

During your appointment for assessment of the macular function the distance vision will be tested first. Then the Amsler chart vision will be assessed. Following that the anterior segment of the eye will be examined on the slit lamp and the intraocular pressure will be measured. Then dilating drops will be applied and you will be asked to wait in the waiting area. Following adequate dilation the OCT examination will be performed as well as dilated fundoscopy examination.

Management

Dry Age-related Macular Degeneration

At present there is no treatment for dry macular degeneration. However, there are many way in which the lifestyle can be improved to reduce progression of the disease. These include:

• Healthy diet with fresh green leafy vegetables, fruits and fish
• Keeping clear from smoking
• Protecting the eyes from the UV light by wearing sunglasses
• Amlser monitoring of the vision
• Vitamin supplements (AREDS 2 supplementation) please consult the ophthalmologist for their suitability for you
• Good blood pressure and cholesterol control

There are many studies underway for the management of Dry Age Related Macular Degeneration. The Valeda light delivery system is one of them. Please enquire at the clinic for your suitability.

Wet Age-related Macular Degeneration

We provide intravitreal anti-VEGF injections at the clinic to control the bleeding from abnormal blood vessels and reduce the scaring at the macula. Vascular endothelial growth factor (VEGF) is a substance produced by the body to regulate the growth of blood vessels. In wet macular degeneration, an excess of VEGF leads to the formation of new, unhealthy blood vessels. Various drugs are available to block VEGF and help control the subretinal and antraretinal fluid in AMD. Everything should be injected into the eye through the white part of the eye with small needles. The entry points are self-sealing and do not require stitches. Injections are given on a regular basis and stop the abnormal blood vessels from growing, leaking and bleeding under the retina.

Often, three initial monthly injections are given, followed by longer intervals between injections. Unfortunately, only a few patients with age-related macular degeneration escape with infrequent injections or by stopping injections altogether. Fortunately, injections are not as uncomfortable as one might imagine, and even rare patients who need monthly injections in both eyes tolerate it very well.

Our clinic offers all possible medication options to offer you the best result for your case.

• Macugen
• Avastin (bevacizumab)
• Lucentis (ranibizumab)
• Eylea (afibercept)
• Beovue (Brolucizumab)

Nutrition in Age-related Macular Degeneration

Research shows that patients who eat a lot of spinach and vegetables are less likely to develop macular degeneration. Spinach, vegetables and other green leafy vegetables are good sources of lutein and zeaxanthin, two important macular pigments. These nutrients are also found in yellow corn, broccoli, oranges, avocados and egg yolks.

Some people with macular degeneration are deprived of the mineral zinc, which can be found in meat, fish, beans, pasta, oats and shellfish. We recommend diet that incudes the above food.

Studies show that patients with high levels of omega-3 fatty acids in their diet are less likely to develop macular degeneration. Omega-3 fatty acids can also prevent retinal damage. Fish, fish oils, nuts and some vegetable oils are good sources of omega-3 fatty acids.

Useful Resources

• Age-related macular degeneration - Royal College of Ophthalmologists
• What Is Macular Degeneration? - American Academy of Ophthalmology
• Age-related macular degeneration (AMD) - RNIB

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