As we age, our vision naturally changes, but for some, these changes go beyond needing reading glasses or better lighting. With age-related macular degeneration (AMD), for instance, everyday tasks become difficult.
In this article, we’ll explore everything you need to know about AMD, its impact on your quality of life and how to treat it.
What is Age-Related Macular Degeneration?
AMD affects the macula, the central part of the retina that produces sharp vision. The eye disease does not cause complete blindness, but it affects your quality of life by blurring or distorting central vision, making it hard to read, recognise faces, or perform other daily activities that require clear sight.
AMD mainly affects people over 50, with symptoms not appearing until significant vision loss has occurred. Hence, regular eye check-ups are imperative for early detection and management.
Types of Age-Related Macular Degeneration
AMD occurs in two primary forms: dry AMD and wet AMD. While both types affect the macula, they differ in their progression, severity, and treatment approach.
Dry AMD (Non-neovascular AMD)
Dry AMD makes up about 90% of Singapore’s AMD cases. It is characterised by small yellow deposits accumulating under the macula, causing it to thin and lose function over time. Dry AMD progresses slowly, gradually losing central vision.
In the early stages, people may not notice significant symptoms, but as the disease progresses, vision can become increasingly blurry or distorted.
Wet AMD (Neovascular AMD)
Wet AMD is less prevalent but more severe. It is characterised by abnormal blood vessels growing beneath the macula, leaking fluid or blood and causing rapid vision loss. This type of AMD progresses quickly and can lead to significant central vision impairment in a short period if left untreated.
The symptoms of wet AMD often appear suddenly and include visual distortions, blind spots, and rapid blurring of central vision. Immediate medical attention is necessary to prevent further vision deterioration.
Symptoms of Age-Related Macular Degeneration
AMD does not typically cause pain, and symptoms may develop gradually, especially in the case of dry AMD. Common signs of the condition include:
- Blurred or distorted central vision
- Difficulty recognising faces
- Dark or empty spots in central vision
- Reduced brightness or intensity of colors
- Straight lines appearing wavy or bent (a symptom of wet AMD)
If you experience any of these symptoms, schedule an eye examination as soon as possible. Early intervention can help preserve vision.
Causes and Risk Factors of Age-related Macular Degeneration
- Age – AMD is mostly found in people over 50.
- Genetics – A family history of AMD increases the likelihood of developing the disease.
- Smoking – Tobacco use raises the risk of AMD as it can damage the eye’s blood vessels.
- Obesity – Being overweight can contribute to the risk of AMD progression.
- High Blood Pressure – Damage from hypertension affects eye vessel health.
- Diet – A diet lacking in nutrients like antioxidants and omega-3 fatty acids can increase risk.
- Prolonged Sun Exposure – UV damage may play a role in AMD development over time.
How is Age-Related Macular Degeneration Diagnosed?
AMD is diagnosed through a detailed eye exam that includes:
- Visual Acuity Test – Measures your sight at different distances.
- Dilated Eye Exam – An examination of the macula for signs of AMD.
- Amsler Grid Test – Identifies distortions in vision, a key symptom of AMD. Missing squares or wavy lines on the Amsler self-monitoring test indicate changes at the macula due to leakage of fluid and blood into the sub-retinal and intra-retinal layers
- Optical Coherence Tomography (OCT) – Produces detailed cross-sectional images of the retina to detect abnormalities.
- Fluorescein Angiography – Uses a dye (fluorescein) to highlight abnormal blood vessel flow and growth in wet AMD.
- Colour Fundus Photography – ultra high resolution and colour photography shows the extent of AMD in plan view.
Regular eye exams, especially for individuals at higher risk, are advisable for early detection and effective management.
Treatment Options for Age-Related Macular Degeneration
AMD is irreversible, but treatments can lessen its progression and, in some cases, improve vision. Treatment approaches vary depending on whether the condition is dry or wet AMD.
Anti-VEGF Injections for Wet AMD
Anti-vascular endothelial growth factor (anti-VEGF) injections are the most effective treatment for wet AMD. These injections help prevent abnormal blood vessel growth and leakage, slowing vision loss and, in some cases, improving vision. Anti-VEDF medications include Vabysmo, Lucentis, Eylea 2mg, Eyela 8mg and Avastin. Treatment typically requires regular injections to maintain results.
Photodynamic Therapy
Photodynamic therapy (PDT) is a treatment approach for wet AMD. A light-sensitive drug is injected into the bloodstream, which is then activated with laser light to target and destroy abnormal blood vessels. PDT is often used in combination with anti-VEGF injections for better outcomes. Anti-VEGF forms the base of treatment, and PDT refines it in selected cases but not all cases of wet AMD.
We use PDT for polyps where the subretinal fluid does not resolve with anti-VEGFs. A subset of AMD (PCV,Polypoidal Vasculopathy) has polyps.
Polypoidal choroidal vasculopathy (PCV) is a subtype of wet age-related macular degeneration (AMD). It’s characterized by the growth of abnormal blood vessels in the retina that can leak fluid or blood, potentially causing vision loss. PCV is distinct from other subtypes of wet AMD, such as choroidal neovascularization (CNV), and may have different clinical features, natural history, and treatment responses
What else can PDT treat? We also can use half-fluence PDT for subfoveal CSR leaks where the SRF does not spontaneously resolve after 6 months or so. But CSR (central serous retinopathy) is a different disease from AMD.
This is to clarify usefulness of PDT in both CSR and AMD.
Nutritional Supplements recommended for AMD
For individuals with AMD, nutritional supplements can work against disease progression. The AREDS 2 formula contains a specific combination of defined doses of Lutein, Zeaxanthin, Zinc, Copper, Vitamin C and Vitamin E, which can slow the progression of severe vision loss in some patients. This is borne out of a pivotal randomised controlled trial (AREDS 2).
Laser Surgery for Wet AMD
For some patients, laser surgery may be recommended to treat wet AMD by sealing abnormal blood vessels and preventing further leakage, reducing damage to the retina. The procedure may slow disease progression in specific cases where anti-VEGF injections are not sufficient or suitable.
How Age-Related Macular Degeneration Affects Quality of Life
AMD can have a profound impact on daily life, making it challenging to do tasks that require sharp vision. Many people experience frustration, anxiety, and even depression as their vision deteriorates.
Adjusting to vision loss often requires lifestyle changes, assistive devices, and support from family and healthcare providers. For individuals with severe AMD, low-vision aids such as magnifying glasses, brighter lighting, and adaptive technology can help maintain independence. Rehabilitation programs are also available to help patients develop new strategies to navigate their environment.
While AMD presents significant challenges, with the right support and adaptive tools, many of them continue to lead fulfilling, independent lives.
Get Treatment for AMD at Angel Eye & Cataract Centre
The early detection of AMD is crucial for preserving vision. Since symptoms may not appear until the disease has significantly progressed, routine eye exams are essential, especially for individuals over 50 or those with risk factors. Detecting AMD early allows for timely intervention, slowing progression and reducing the risk of severe vision loss.
If you or a loved one is experiencing vision changes, Angel Eye & Cataract Centre offers comprehensive eye examinations and treatment for AMD. We are dedicated to preserving your vision and helping you maintain your quality of life.
Schedule an appointment with us and start protecting your eye health.
