Macular Degeneration

Age-related macular degeneration (AMD) is an eye disease that may get worse over time. It’s the leading cause of severe, permanent vision loss in people over age 60. It happens when the small central portion of your retina, called the macula, wears down.

Macular Degeneration in the central vision mainly affects reading:

Macular degeneration which affects mainly the central part of the sight. Age-related macular degeneration (AMD) is an eye disease that may get worse over time. It’s the leading cause of severe, permanent central vision loss in people over age 60.

It happens when the small central portion of your retina, called the macula, wears down. The retina is the light-sensing nerve tissue at the back of your eye.

Because the disease happens as you get older, it’s often called age-related macular degeneration. It can cause severe vision problems due to the central loss of clarity of vision. The central part of your sight is the area that sees all the detail. The peripheral part of your vision only sees motion and is useful for night time vision. You can not see detail with the peripheral part, for detail you need the central part of the sight to be healthy and functioning well.

Another form of macular degeneration, called Stargardt disease or juvenile macular degeneration, affects children and young adults.

retinal image with dry macular changes and drusen at the macula
retinal image with dry macular changes and drusen at the macula

What causes it?

As you get older, the circulation in your eyes can become poor and lead to a build-up of waste products in the macular region of the retina.
The result of this build-up is that your eyes will not work as well as they once did. A lack of exercise and fitness increases your macular degeneration risk at any age, even when older, so stay active to lower your risk of macular change. Heart disease and strokes are related to macular degeneration as both are related to the reduction of metabolism of the body and thus the  macula too.

Poor lifestyle contributes to early macular changes, and you need to ensure you age gracefully and slowly.

Risk factors for macular degeneration:

Are macular supplements worth while ?

We are all keen to make our vision last as long as possible, Carotenoids are one of the supplements definately worth while taking.

A macular supplement can be helpful too, such as Macushield. This can only be helpful if you have dry macular changes. see this link from the RNIB.

Macushield is available from Pharmacists and Optometrists, you can also order it on line. There is good evidence macular supplements are worth taking, especially if they contain AREDS2 compounds.

There is also a supplement available which contains Omega fatty acids called ‘Eyetas‘ this looks promising but does not appear to be available in the UK. 

Natrural supplements can also be taken to provide antioxidants such as Goji berries.

A new light therapy called Valeda for macular degeneration is also available in London. The equipment is made by Lumithera.

What is the macular region of the retina?

The retina is at the back of the eye. The macula is the central part of the retina, which picks up the fine detail. The macula is where the majority of the cones are in your retina. Cones are the cells that give your sight detail and color. without functioning cones your sight would be monochrome = black and white.

New treatments for Dry Macular degeneration:

An antidepressant best known as Prozac could offer the first treatment for the leading cause of blindness among people over 50, new research from the University of Virginia School of Medicine suggests.

UVA’s Bradley D. Gelfand, PhD, and collaborators have found early evidence that the drug fluoxetine (Prozac) may be effective against atrophic (or “dry”) age-related macular degeneration, a condition that affects nearly 200 million people worldwide. The drug has shown promise in the scientists’ lab tests and animal models, and the researchers bolstered by their results by examining two huge insurance databases encompassing more than 100 million Americans. That analysis concluded that patients taking fluoxetine were less likely to develop atrophic macular degeneration (AMD).

Further reseach is being done with stem cells to reverse macular degeneration by Life Sciences Independent Research.

New research from Trinity College Dublin is concentrating on gene therapy for dry macular degeneration which affects up to 10% of adults over 65.

Published research by Neuroscience suggests that drugs to lower cholesterol, control diabetes, and dampen down inflammation may help to lessen the risk of developing age related macular degeneration (AMD).

Furthermore, researchers created a groundbreaking “cell atlas” of the human eye that could revolutionize treatments for blinding diseases like glaucoma and macular degeneration. The atlas identifies nearly 160 unique cell types across different eye structures, and pinpoints which genes each cell type expresses.

The study by neurobiologist Joshua Sanes paves the way for highly targeted gene therapies by showing exactly where disease-associated genes are activated. Beyond clinical applications, the atlas offers evolutionary insights into the complexity of human vision.

How does macular degeneration affect sight?

Things you see may be blurred, especially in the centre. This might make it difficult to read bus numbers or recognise people’s faces.
• Straight lines may look curved, this is most likely in wet macular change, or have gaps and missing parts which is more likely in dry macular change.
• You may notice blank areas when looking at the TV or reading.
Is this the start of blindness? The macula is the part of the eye that sees detail, so fine vision will be affected. However, the periphery of your vision will be unaffected. There is an Orcam myreader available that fits on your spectacles, which can be used to read prices and text out aloud.

You can receive further on line and telephone helpf from the macular society, click here.

Is there a cure?

For most people who get this condition, the answer is no. However it can be slowed down with the use of macular supplements in some cases, e.g. age related dry macular degeneration.
However, some people have dry macular degeneration that has changed to wet, in which case they have leaking or swollen blood vessels at the macula. Wet macular degeneration can only be treated at an eye clinic in a hospital. Recent reseach indicates not all wet macular degeneration needs to be treated with Anti VEGF injections long term. This research was done at the Johns Hopkins Wilmer Eye Institute in the USA.

Is there prevention?

It is vital to diagnose wet exudative macular changes as soon as possible. This is usually first noticed by the patient due to a sudden reduction in reading vision and distortion. Distortion in you vision can be noticed by looking at straight lines using text or window frames accross the road. A more standardised way of checking your vision is with the use of an Amsler chart. If you are going to use an Amsler chart to check your central vision you must do this on a regular basis, once a week. This is to get you used to the vision in each eye and make you aware of any changes sooner rather than later. If distortion or missing patches are noticed you need to book in asap for an examination of your sight.

At that stage you may well benefit from OCT to help with the diagnosis of wet vs dry macular changes. Referral to an eye clinic for wet macular changes needs to be made quickly and you need to be assessed further withing weeks of the initial visit. If you only check your sight using an Amsler chart, once every month or two you may be too late to recieve effective treatement for wet macular changes.

We recommend you put an amsler chart up say on the inside of the cupboard door where you find your cup of tea in the morning. That way you can quickly and reliably test your vision, it takes a few seconds per eye.

Below is an OCT scan of wet exudative macular change, this can initially be noticed with regular use of an amsler chart and confirmed with an OCT scan:

macular oct scan showing wet degeneration
macular oct scan showing wet degeneration

Can I be helped to see better?

First of all you need to ensure that the lighting and contrast of the reading material is sufficient. Then book an appointment with a competent Optometrist for a full eye examination and advise on further screening for macular change. Your spectacle prescription needs to be up to date with a spectacle lens suitable for your tasks and vision issues. Your Optometrist can also refer you to a Low Vision Clinic at a hospital or local community colinic, bot of which offers a choice of magnifying aids.

Vitelliform Macular Degeneration:

Vitelliform Macular Degeneration is a milder form of macular change. There is no treatment for the condition, however the vision is not usually severely affected. Below is an Optos image of VMD = Best macular degeneration.

vitelliform macular degeneration

When To See Simon Kleyn Optician - Optometrist

Make an appointment for an eye test / examination if you notice any changes in your vision. If you develop sudden vision changes, such as double vision or flashes of light, sudden eye pain, or sudden headache, call us straight away. 

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