Understanding Age-Related Macular Degeneration (AMD & PCV)
Age-related macular degeneration (AMD) is among the top 3 most common causes of blindness worldwide. It affects people above the age of 50 years, targeting central vision, and causing severe and potentially permanent vision loss. As it primarily affects the macula (central fixation point of the eye), peripheral vision remains largely intact.
Symptoms
Risk Factors
Non-modifiable risk factors are risk factors one cannot control, like age, family history, and genes. Having severe AMD in one eye increases the risk of developing it in the other eye.
As gene therapy research accelerates, there is hope that genetic therapy for AMD could become easily available one day.
Types of AMD: Wet AMD & PCV
Extensive bleeding at the macula in wet AMD.
Treatment Options for AMD
Dry AMD Treatment:
- Lifestyle Modifications: Stop smoking, maintain a healthy weight, and monitor your central vision regularly if you have risk factors.
- Dietary Changes: Take a balanced diet with sufficient antioxidants, vitamins, and minerals.
- Vitamin Supplementation: Some individuals with dry AMD may benefit from specially formulated vitamin preparations, such as the AREDS2 supplements, which have been shown to reduce the risk of dry AMD developing into wet AMD.
- Intravitreal injection therapy: although new drugs are now available for the treatment of individuals with certain grades of disease, these are not easily accessible at this stage.
Wet AMD Treatment:
- Intravitreal Injection Therapy: The gold standard treatment for wet AMD involves injecting anti-VEGF medications directly into the eye. These medications block the growth of abnormal blood vessels, reduce fluid leakage, and prevent further vision loss. Multiple injections may be required over time, depending on the severity of the condition.Many antiVEGF medications are now available. Lucentis (ranibizumab), Eylea (aflibercept), and the newest medication Vabysmo (faricimab) are all very effective provided treatment is started early.
- Laser Therapy: In some cases, laser therapy may be used in conjunction with intravitreal injections to target and seal abnormal blood vessels, further stabilizing vision and preventing disease progression.
FAQs about AMD
The “Amsler grid” is a useful way of monitoring central vision at home so that you can pick up changes in your vision and seek treatment early. Individuals with any form of AMD should monitor their central vision regularly.
How do you use the “Amsler chart”?
- Use the chart in a well-lit area.
- Wear your glasses if necessary, so that your view of the chart is as clear as possible when viewing at a reading distance (30-40cm). (Glasses should not be worn if it is a progressive, as it may cause false distortion on the chart.)
- Look at the chart using 1 eye at a time.
- Fixate on the central black dot. You should be able to see the rest of the chart while fixating on the black dot.
- You should see your eye doctor quickly if:
- There are distorted lines, blind spots or abnormal shadows blocking your view of the chart.
- Your view of the chart is blurred.
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Studies have shown that individuals with certain stages of AMD can reduce their risk of deterioration by taking a specially prepared vitamin supplement. This preparation contains very specific combinations of nutrients which are at much higher doses than normally found in general health supplements. Therefore, a thorough eye examination should be done to confirm suitability before starting on this supplement.
Currently, wet AMD cannot be cured. However, intravitreal injection therapy using anti-VEGF drugs is extremely effective. This treatment can now stabilize and even recover lost vision if treatment is started early and before there is irreversible damage.
Intravitreal injection
Making changes to the home environment can make a big difference.
These may include:
- Installing adequate white lighting in important living spaces like the kitchen, reading room, etc. Motion-controlled lights that turn on upon entering a room will prevent accidents from poor lighting.
- Stick colored marking tape on the edge of steps to prevent falls.
- Use modified clocks, watches, and reading material with large print to make reading easier. Magnifiers and visual aids may be useful. Otherwise, talking clocks and audio books are also available. Ask your eye doctor about the range of devices available and where to get hold of them.
- If one hopes to drive, one will need to be formally assessed by an eye doctor to confirm if driving safety guidelines are met.