Aged Macular Degeneration

What is Age-Related Macular Degeneration (ARMD)?

ARMD is a leading cause of severe vision loss in people aged 50 or older.

ARMD is a disease of the macula. The macula is a small area of the retina at the back of the eye and is responsible for sharp central vision, allowing people to read and see fine details. In AMD the macula is damaged.  In early ARMD patients may not notice any problems. As ARMD worsens, visual symptoms such as blurred central vision and distortion of vision may occur.
As ARMD progresses further, central vision can become severely affected making reading impossible.

Who is at risk of ARMD?
Age is the biggest risk factor for ARMD. Most ARMD cases occur after age 50 although ARMD can sometimes occur at younger ages.

Additional risk factors for ARMD include:
Smoking - Research shows that smoking increases the risk of ARMD
Family History & Genetics - People with a family history of ARMD are at higher risk

What can you do to reduce your risk of developing ARMD?

Avoid smoking
Exercise regularly
Maintain normal blood pressure and cholesterol levels
Eat a healthy diet rich in green, leafy vegetables, nuts & fish

Types of AMD

The two types of ARMD are Dry ARMD & Wet ARMD

Dry ARMD (Non-Neovascular)
This is the most common type of ARMD. Early in dry ARMD, vision is often normal and the diagnosis is made by the presence of drusen seen by an ophthalmologist.  As the disease progresses, gradual vision loss can occur and when severe, dry ARMD can cause severe central vision loss.

Wet ARMD (Neovascular = New Vessels)
This is the less common (but more aggressive) form of ARMD.  If untreated, wet ARMD often leads to severe vision loss. Wet ARMD occurs when abnormal blood vessels break through the retina and leak fluid or blood.  This leakage can lead to rapid and irreversible damage to the macula.

Symptoms of ARMD
Symptoms experienced can be different for all people with ARMD. Often people hardly notice ARMD in its early stages. Typically, symptoms will present themselves as: 
Blurred, jumping or missing words/letters on a page
Dark or empty areas appear in your central vision
Straight lines appear distorted or wavy

How is ARMD diagnosed?
Many people do not realize that they have a macular problem until symptoms become problematic. Your eye doctor can use a range of useful diagnostic tools that help detect the early stages of ARMD before you experience any obvious changes.

Amsler Grid
This is a simple vision test that involves a small piece of graph paper testing one eye at a time. It identifies changes in your central vision that may cause the lines in the grid to disappear or appear wavy; this is a sign of ARMD.

Optical Coherence Tomography
OCT is an imaging system allowing your eye doctor to achieve high-resolution, clearly detailed images of retinal tissues and structures. It helps your eye doctor evaluate the health of the macula in great detail. Our powerful OCT 5000 can detect drusen, the earliest signs of ARMD. Besides detecting drusen, our OCT utilizes the new AngioPlex algorithm to show abnormal blood vessels hiding underneath the fluid leaking into the macula.

Fluorescein Angiography 
This procedure will give your eye doctor more information to determine whether you have the beginning of wet ARMD.  A small amount of yellow fluorescent dye (Fluorescein) is injected into a vein in your hand or arm where it enters the bloodstream and travels towards the eye. Once at the eye, it highlights the blood vessels in the retina so they can be photographed. Your eye doctor will continue to take pictures as the fluorescein circulates throughout the vessels to pinpoint specific areas of new vessel growth and leakage.
Dilated Eye Exam
Your ophthalmologist will place drops in your eyes to enlarge the pupils. This provides a bigger window for your eye doctor to look through and comprehensively examine the back of your eye using a special magnifying lens.

How is ARMD Treated?

A well-balanced diet is important for macular health.  It is important to have a diet rich in green leafy vegetables and fish.

Nutritional Supplements
Nutritional supplements are the common form of treatment for dry ARMD.  They consist of antioxidant vitamin supplements that may reduce the progression of dry ARMD. A large scientific study found that people at risk for developing advanced stages of ARMD lowered their risk of progression when treated with a high-dose of:

- Beta Carotene (15 mg)
- Copper (2 mg)
- Vitamin C (500 mg)
- Vitamin E (400 IU)
- Zinc (80 mg)

Anti-VEGF Injections (Lucentis & Eylea)
Anti-VEGF injections are used to treat wet ARMD.  They were introduced into practice in the mid-2000’s and their use has revolutionised the treatment of wet ARMD
 around the world.  

The medicine is injected into the eye to stop new blood vessel growth and leakage in the retina. In wet ARMD there is an abnormally high level of vascular endothelial growth factor (VEGF) protein secreted by the abnormal new vessels and this promotes further growth of abnormal blood vessels. Anti-VEGF injections block this new growth by targeting, and blocking, the VEGF protein. 

The goal of treatment is to dry out the fluid between the retinal layers at the macula thereby leading to stabilisation and improvement of vision.