Retinal Degeneration
This is a condition in which the macula – the central part of the retina – begins to deteriorate. In most cases, it develops with the increase of age, this is why it is mostly known as age-related macular degeneration (AMD). Deformities do not affect peripheral vision typically.
There are a number of risk factors that will contribute to the likelihood of Macular Degeneration occurring in a person. These include:
History of family members with AMD
Research has shown the smoking doubles the possibility of AMD occurring.
Caucasians are more likely to develop this condition as compared to Asians.
High blood pressure is linked to higher incidence of AMD.
Deposits of AMD are lipid-laden particles called drusen, and tend to occur in people with high lipid levels.
Vitamin C, E, Lutein, Zeaxanthin, zinc and nuts have all been shown to reduce risk of AMD.
Macular degeneration is a progressive disease. Prompt medical intervention is recommended to prevent further progression and to maintain good vision. In the early stages, typically Dry AMD, patients can be asymptomatic. This is because the lipid-filled deposits called drusen, do not cause any visual disturbance. Drusen are usually small in size – about the width of a hair – and do not cause symptoms until much larger.
In the intermediate stage; larger drusen may be present in one or both eyes. Larger drusen may cause symptoms of metamorphopsia (distorted vision) if they are present at the fovea or central macula.
In late stages, typically Wet AMD, symptoms will be apparent as damage the macula causes noticeable vision loss. Without treatment or control measures, your eyesight may deteriorate to the point that you may even fall within the “legal blindness” category. This is when your eyesight is so impaired that it has to be defined by law to either make you eligible for certain benefits or limit certain activities like driving a car.
The risk of developing Macular Degeneration increases as we grow older. Statistically, 1 in 3 adults will suffer from macular degeneration before the age of 75.
Detecting AMD in the early to intermediate stages can be difficult as patients often do not experience noticeable symptoms. At this stage, it is usually detected via a dilated eye examination conducted by an experienced eye specialist.
Eye exams take many forms, below are some of the eye exams we use in Singapore to check for signs and symptoms of Age-Related Macular Degeneration (AMD).
Eye drops are first used to dilate the patient’s pupils. This allows a better view of the retina (the part of the eye where light rays are captured to give you sight). Following which, a specialized magnification lens is used to take a look inside the eye, checking for deformities and other unusual signs. Any signs of Age-Related Macular Degeneration will be investigated in deeper detail.
An eye examination with the Snellen Visual Acuity Chart is performed with refraction to determine the patient’s best-corrected visual acuity in both eyes.
This test is great for testing for distortions in your vision. Patients can use one eye to look at the Amsler Grid (which is basically a grid with straight lines and a dot at the centre), if lines appear to be wavy or in some cases, missing, it might be a sign of Age-Related Macular Degeneration
Light waves are used to create very high-resolution images of the inside of the eye with this test. This provides a very detailed, microscopic image of the central macula. With such high-resolution imaging, signs of Age-related Macular Degeneration such as drusen and choroidal neovascularisation can be detected.
In this type of AMD, abnormal blood vessels begin to grow beneath the macula. These new blood vessels may leak fluid and blood into the retina, leading to distorted vision. Generally, this condition causes straight lines to appear wavy, and central vision loss may occur. As the disease progresses, the continued growth of abnormal blood vessels can damage the retina, potentially leading to blind spots. If left untreated, persistent bleeding will eventually cause scar tissue to form in the affected area of the retina, resulting in permanent central vision loss.
Dry macular degeneration (dry AMD) is characterized by the presence of yellow deposits in the macula, known as drusen. When these deposits are minimal, they typically do not impact vision. However, as they increase in size and quantity, vision problems may develop, particularly when reading. If dry AMD progresses, the light-sensitive layer of the macula gradually thins, leading to the deterioration of macular tissue. At this stage, patients may experience vision loss in the form of blind spots or even a complete loss of central vision. Although severe vision impairment is more common in wet AMD, approximately 90% of AMD cases are of the dry form. Nevertheless, dry AMD can progress to wet AMD, making early intervention crucial. Once diagnosed, it is essential to take proactive measures to prevent further damage to the retina and reduce the risk of permanent vision loss.
The approach to AMD treatment depends on whether the condition is dry or wet AMD. While there is currently no cure, early and appropriate macular degeneration treatment in Singapore can help slow progression, preserve vision, and reduce the risk of permanent central vision loss.
Wet AMD treatment focuses on controlling abnormal blood vessel growth and leakage beneath the macula, which can otherwise lead to rapid vision deterioration.
The primary treatment is intravitreal anti-VEGF injections, which block signals that stimulate the growth of these abnormal vessels. Commonly used medications include Avastin, Lucentis, Eylea, and Vabysmo. These injections are performed in a controlled clinical setting and are typically given over a series of sessions, with frequency tailored to the patient’s condition.
In selected cases, photodynamic therapy (PDT) or laser treatment may be used alongside injections to further reduce leakage and stabilise the retina.
For dry AMD treatment, management is centred on slowing disease progression and maintaining visual function.
This typically includes:
Some patients may also be suitable for newer options like photobiomodulation light therapy, which aims to support retinal cell health.
As AMD is a chronic and progressive condition, treatment is tailored to each individual based on disease stage, symptoms, and lifestyle needs. Ongoing follow-up is essential to monitor response to treatment and adjust the management plan accordingly.
Early diagnosis and timely intervention remain key to achieving better long-term visual outcomes and maintaining quality of life.
Here are the steps you can take to fend off or manage the disease.
The first step is to schedule regular eye exams. Routine visits to an eye specialist are essential to ensure your vision and eye health remain in optimal condition. Your doctor will determine how often you should have check-ups based on your specific needs. Between appointments, you can monitor your vision at home using the Amsler grid—a simple test consisting of a grid with a small central dot. When viewed with each eye separately, straight lines should appear uniform. If lines appear wavy or sections are missing, it may indicate macular disease. Complimentary Amsler grids are available at our clinic.
The second step is to maintain a well-balanced diet, make smart nutritional choices and healthy lifestyle. Consuming foods rich in vitamins, minerals, and omega-3 fatty acids can help support eye health and reduce the need for additional supplements. However, if your diet lacks essential nutrients, taking high-quality supplements—such as those contained in the AREDS2 formula—is highly recommended to help protect your vision. Prioritizing proper nutrition and healthy lifestyle can play a crucial role in slowing the progression of macular degeneration and maintaining overall eye health. Our clinic is able to provide the AREDS2 supplement to you.
The third step is to quit smoking. While it may be challenging, breaking a harmful habit is always beneficial. Smoking has been scientifically proven to damage your overall health, including your eyes. By giving it up, you’re not only protecting your own well-being but also creating a healthier environment for your family and friends.
The fourth step to preventing age-related macular degeneration is to supplement with 10mg of lutein and 2 mg of zeaxanthin (2 tablets a day). These retinal carotenoids are critical to improve the retinal cell function and can delay the onset of macular degeneration.
Building these good habits can reduce the risk of AMD occurring, ensuring continued good health for your eyes and greatly improved quality of life for you.
Age-related macular degeneration does not typically cause complete blindness. However, it can affect central vision, which may impact reading, driving, and detailed visual tasks. Early assessment and management can help preserve remaining vision.
Treatment for AMD aims to stabilise the condition and prevent further deterioration. In some cases, vision may improve, but the main goal is usually to preserve existing vision rather than fully restore it.
Without appropriate management, AMD may progress and lead to further central vision loss. Regular monitoring helps ensure that changes are detected early and treated when necessary.
Some types of age-related macular degeneration require ongoing management, which may include regular monitoring and repeat treatments over time. Your doctor will assess your condition and recommend a treatment plan tailored to your needs.
