age related macular degeneration (amd)

Macular degeneration leads to a loss of central vision due to damage to the macula – a small part of the retina that lines the back of the eye. The layer of the retina responsible for nourishing the rod and cone cells in the macula and for carrying away waste products starts to function less effectively.

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Wet and Dry AMD

Wet AMD occurs when new and abnormal vessels begin to grow behind the retina toward the macula. These usually leak blood or fluid causing damage and rapid loss to central vision.         Dry AMD causes gradual macula degeneration to the macula usually over many years. ‘Dry’ does not relate to dry eyes. Rather the term is used to indicate that deterioration is not caused by leaking blood vessels as in ‘wet’ AMD. You can have both wet and dry AMD in both eyes or even dry in one eye and wet in the other. If macular degeneration occurs in one eye, it will possibly effect the other eye within five years.

The main risks related to AMD are:

• Age: this is the main risk factor since cell regeneration decreases with age, thus increasing the risk of AMD
• Diet and nutrition: free radicals (unstable oxygen molecules) can damage cells or prevent cell repair. Antioxidants are naturally occurring nutrients that help the body fight free radical damage so if you have a low intake of antioxidants you may be at an increased risk of developing AMD. Excessive alcohol and a diet high in fats decreases antioxidant levels thus increasing the chances of AMD. Individuals that are clinically obese may also be at risk of macular degeneration
• Smoking: Studies have shown that smoking reduces the protective effects of antioxidants in the eye and damages the eye structure. It’s been found that smokers are three times more likely to develop macular degeneration than non smokers.
• Sunlight: Macula cells are highly sensitive to blue light which occurs naturally in sunlight and cell damage occurs from excess blue light. Light coloured eyes are more prone to sunlight damage. Filters that block blue light and UV light will help to protect the eye.
• Genetics: Age related macular degeneration is not hereditary but it is believed that a family history of macular degeneration usually increases the chances of developing macular degeneration. When macular degeneration is found in a younger person a genetic link is usually found.
• Gender: Women aged over 75 are twice as likely to develop macular degeneration than men of the same age.
• High blood pressure: People with hypertension are one and a half times more likely to develop macular degeneration than people with normal blood pressure.

To protect your eyes from MD:

• Stop smoking
• Eat a diet rich in fruits and green leafy vegetables
• Consider supplementing with a balanced antioxidant
• Eat a diet low in saturated fat and rich in Omega 3 fatty acids (oily fish)
• Wear lenses that block blue and UV light
• Shade your eyes with a hat
• Keep your blood pressure down
• Limit your alcohol intake to the daily recommended units
• Have an eye exam at least once every two years

Rapid diagnosis of macular degeneration is critical. A three week delay for wet AMD is too long whilst assessment within three months is satisfactory for ‘dry’ AMD.

Treatments include:

• Hot laser: seals leaking blood vessels
• Photodynamic therapy: also seals leaking blood vessels – Visudyne is injected and used with cold laser treatment
• Anti VEGF drugs – new drugs that are injected into the eye and inhibit the growth of blood vessels and also reduce teh scarring effect of leaking vessels.

More detailed information can be found at the RNIB website.