Mr Venki Sundaram
Consultant Ophthalmic Surgeon
MD FRCOphth MRCOphth BMBCh BSc

Age-related macular degeneration

Age-related macular degeneration (AMD) is the most common cause of visual loss in people over 50 years of age.

Age-related macular degeneration

Dry AMD

This accounts for 80% of cases and is due to a build-up of waste products in the retina, and can slowly progress to cause loss of vision by loss of retinal photoreceptors (see Image 1). The most common reason for developing dry AMD is increasing age. Smokers have a 2-3 times risk of developing AMD and AMD is more common in patients who have 1st degree relatives with the disease.

Retinal photoreceptors

Image 1 – loss of retinal photoreceptors in advanced Dry AMD

Treatment

Although no treatments are currently available to treat Dry AMD, there are measures that can be taken to try and reduce its progression:

  • Stopping smoking
  • Eating a well-balanced diet, high in natural antioxidants and green leafy vegetables (e.g. spinach)
  • Nutritional supplements based on the AREDS and AREDS 2 trials have been shown to be effective in people with intermediate or advanced AMD

Numerous clinical trials are currently underway investigating the use of oral therapy or therapy administered to the eye to reduce the progression of Dry AMD.

Also, a Stem Cell therapy trial is in progress, investigating the safety of using stem cells to replace retinal photoreceptors that have been lost due to this condition

Wet AMD

This accounts for 20% of cases of AMD, but accounts for 80% of the severe visual loss through AMD. It is caused by an abnormal growth of blood vessels from beneath the retina, which can bleed or leak fluid, cause damage to the retina. Typical symptoms include a rapid decline in vision and distortion of images (see Images 2 and 3). If left untreated, a retinal scar can develop in the macula area (see Image 4), which can permanently affect central vision (see Image 5).

Visual acuity

Image 2 – reduced visual acuity due to Wet AMD

Distortion

Image 3 – distortion caused by Wet AMD

Mcular scarring

Image 4 – advanced macular scarring due to untreated Wet AMD

Central vision loss

Image 5 – central vision loss in untreated Wet AMD

Treatments

Fortunately, the treatment of Wet AMD has been transformed in recent years by the use of AntiVEGF injections such as Lucentis and Eylea (see Image 6). Many patients are now able to keep on driving, working, enjoying hobbies and living independent lives as a result of these therapies.

Numerous clinical trials have shown that these therapies can preserve vision in over 90% of cases and improve vision in over 30% of cases.

Evidence from clinical trials is continuing to emerge, providing information on the most effective ways to maintain the gains achieved through early treatment.

AntiVEGF injection

Image 6 – an illustration of an AntiVEGF injection (e.g. Lucentis or Eylea) being given into the eye