Keeping sight of age-related macular degeneration
We all reach an age where our sight stops being perfect. I was going to be the exception - 20:20 vision into my eighties - until a couple of years ago when a practical joker stole every book in my home and replaced them all with smaller print copies. Regular visits to the optician can prevent many problems, but it can't stop us getting older.
The light detecting layer at the back of the eye is called the retina, and this is lined with cells called rods and cones. Rods are mostly at the edges of our visual fields, and are good for peripheral vision and night vision, as they're more sensitive in picking up light. We use our cones to see colour and sharp detail when we look straight on. These are most densely packed in the macula - the central part of the retina. As the name suggests, in age-related macular degeneration, or AMD, the cells of the macula wear out.
Although AMD is the commonest cause of eyesight problems in the over-50s, it doesn't affect your peripheral vision, so it doesn't cause blindness. Even if your eyesight is affected, there are lots of ways can maintain your quality of life.
AMD is painless and symptoms usually come on slowly, progressing over many years. They include needing brighter light to read; blurring of sharp focus with your glasses on; problems recognising faces; straight lines appearing wavy; and a 'blind spot' in the middle of your vision that gradually gets bigger.
Wet or dry?
About 90% of people with AMD have 'dry' AMD, in which the cells of the macula just wear out. While it can't be treated, it doesn't tend to be as severe as wet AMD and comes on slowly, often over many years
In wet AMD, new blood vessels form on the macula. These are fragile and leaky, and can damage the cells and cause scarring. It can cause severe loss of vision within months, but it is treatable.
What's the treatment?
If you're diagnosed with wet AMD, you may be eligible for a treatment called anti-VEGF. Medicine is injected straight into the eye in a course every few weeks, using a very fine needle. The treatment sounds scary but it is done using local anaesthetic drops and takes only a few seconds. This treatment is new but very exciting - while it doesn't help everyone, up to two in five people treated see a significant improvement in their eyesight. Existing treatments for wet AMD include ranibizumab (Lucentis®) and more recently aflibercept (Eylea®), bevacizumab (Avastin®) isn't formally licensed for treatment but is sometimes used.
What if my eyesight is badly affected?
The world is full of adaptations if you know where to look. Large print books, big-numbered phones and magnifying glasses make things bigger; adjustable lights that shine on whatever you're doing make them brighter; contrasting backgrounds make them bolder.
The RNIB has great ideas as well as products to buy. Visit them at www.rnib.org.uk or contact their helpline on 0303 123 9999. Alternatively visit macularsociety.org for advice and support. Many hospitals now run low-vision clinics, which specialise in adaptations to help you cope. They or your GP can also tell you about benefits you might get if you're registered visually impaired.
How can I protect myself against AMD?
While you can't reverse AMD, there are lots of ways you can help yourself.
- Eat a healthy diet with lots of fruit and veg. Some vitamins may help ward off or delay progression of AMD.
- Don't smoke - it can damage your eyes as well as your lungs
- Avoid bright sunlight by wearing sunglasses with high level UVA and UVB protection
- Get your eyes checked at least every two years, even if you haven't noticed any change in your vision. Many other eye problems ( including glaucoma) become more common with age, and early treatment could save your sight
- Always see a doctor or optician quickly if you notice a sudden drop in vision; loss of vision; distortion of your vision; flashing lights or a rapid increase in 'floaters'.
With thanks to 'My Weekly' magazine where this article was originally published.