Age-Related Macular Degeneration Treatment

What is Macular 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). I would like to mention that the deformity does not affect peripheral vision typically.

Symptoms of Macular Degeneration include:

Blurry or dark areas around the centre of vision

Decreased resolution of vision, which affects one’s ability to drive, read the fine print, etc.

Changed colour perception

There are a number of risk factors that will contribute to the likelihood of Macular Degeneration occurring in a person. These include:

  • Genetic Predisposition (history of family members with AMD);
  • Smoking History – Research has shown the smoking doubles the possibility of AMD occurring.
  • Race – Caucasians are more likely to develop this condition as compared to Asians.
  • Hypertension;
  • high cholesterol/poor nutrition

Macular degeneration is a progressive disease. Medical advice and intervention is recommended to stop it from getting worse. In the early stages, symptoms are typically not felt. To diagnose AMD at this stage, I typically look for the presence of drusen of medium size – about the width of a hair.

At intermediate stages, larger drusen might be present in the patient’s eye/eyes. The retina might also be subject to changes in pigmentation. Symptoms may be experienced with some individuals, as vision loss due to the changes in the eye set in. Most, however, do not realise this is happening!

Late stages, 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.

How do you detect AMD?

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).

  • Dilated Eye Exam

Eye drops are first used to dilate the pupils for the patient. This allows me to get a better view of the retina (the part of the eye where light rays are captured to give you sight). I’ll then use a specially made magnification lens to take a look inside the eye, checking for deformities and other unusual signs. Any signs of Age-Related Macular Degeneration appearing will be noted down and investigated in deeper detail.

  • Visual Acuity Test

Simple eye test with a chart, measuring how well your eyes see at certain distances.

  • Amsler Grid

This test is great for testing for distortions in your vision. I’ll get my patients 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

  • Optical Coherence Tomography

Light waves are used to create very high-resolution images of the inside of the eye with this test. This gives me a very detailed report and vital information on what is happening in the areas captured.

When I do this test, I’ll first use eye drops to dilate the patient’s pupils. Once the head and eyes are in position, the chin is rested securely on the chin rest. A light beam is then fired into the patient’s eye. The patient is required to hold still for a few seconds while the images are captured by the machine. This process is painless and well tolerated by most patients.

With such high-resolution imaging, my intention is to look for several telltale signs of Age-Related Macular Degeneration such as drusen or other abnormal deposits in the retina. Though some amounts of fine drusen are totally normal as we grow older, larger pieces may indicate that the patient has developed or is developing Age-Related Macular Degeneration.

Types of Age-Related Macular Degeneration (AMD)

Wet form

With this type of AMD, abnormal blood vessels start to grow underneath the macula. The growth of these new blood vessels may leakage of fluid and blood into the retina, which leads to distorting of vision.

Broadly speaking, here is how it looks like: straight lines will appear as wavy, central vision loss might occur. As the condition continues to progress, growth of these new blood vessels may cause damage to the retina, resulting in possible vision loss in the form of blind spots. If the condition of these abnormal blood vessels is left untreated, the bleeding will sooner or later cause a scar to form in the affected area of the retina, which will result in permanent central vision loss.

Dry form

Known as dry macular degeneration (dry AMD), yellow deposits can be observed in the macula. These deposits are called drusen. When their number is insignificant, vision is not likely to be affected; however, if they grow in size and quantity, this can cause vision problems. These problems will be most noticeable when reading. Now, if dry AMD progresses, the light-sensitive layer in the macula thins out, which leads to macular tissue death. At this point, the patient might experience vision loss in the form of blind spots or even lose central vision. Patients suffering from the wet form are usually the ones that experience a major area of vision loss. Luckily, about 90% of people get dry AMD. Yet, it is important to note that the dry AMD may easily develop into wet AMD. So, once you are diagnosed with this condition, you ought to take measures as soon as possible to prevent and manage any possible damage to the retina and permanent loss of vision.

Macular Degeneration Treatment

Currently, there is no treatment for the macular degeneration but the symptoms can be reduced and slowed down in a number of ways. Schedule regular checkups with your eye doctor! This will help spot the symptoms early can greatly aid eye care, treatment and management of the condition. Below, I’ll explain a more about treatment options for each form of macular degeneration.

What works for wet macular degeneration:

  • Photodynamic therapy (laser therapy) – This is a treatment that is performed in the outpatient department with the help of light-activated drugs, called photosensitising or photosensitiser agents. Photodynamic therapy works like this — The inactive form of said medication is put into a syringe and administered into a vein in the arm. It then migrates to the abnormal blood vessels in the macula where it builds up. Next up, special cold laser light of low intensity is shone at the retina, as a result of which the drug is activated on the new blood vessels in the region. What is good about this treatment is that the retinal cells are not damaged. The treatment generally works to reduce leakage.
  • Intravitreal Injections – This treatment delivers anti-vascular drugs directly into the blood vessels in the eye by a quick and painless procedure. The abnormal blood vessels are then suppressed. The suppression of these abnormal blood vessels will then lead to alleviated symptoms of the disease.

    What works for dry macular degeneration:

    •  So far the treatment for the dry form of Age-Related Macular Degeneration is best prevented by refraining from smoking, improving nutrition and lutein/zeaxanthin supplements.
    • Additionally, an occupational therapist or a rehabilitation specialist might partner up to help you adapt to it. Talk to your doctor for more details.
    • Another way to significantly improve your eyesight is to have a telescopic lens implanted in one or both eyes. It comes packed with lenses that improve close-up and distant vision alike. The only drawback is its field of view is quite narrow, which means its use is restricted to an urban environment.

    Prevention of Age-Related Macular Degeneration

    Here are the steps you can take to fend off or manage the disease.

    The first one is to remember to schedule routine eye exams. It is important to visit an eye doctor every now and then to make sure one of the most important organs in your body is in good health. Depending on your condition, the specialist will tell you how often you should have check-ups. In between those, you can self-assess your vision at home with the Amsler grid. The test is literally a piece of the grid with a small dot in the centre and you have to look at it with each eye separately. If everything is fine with your site, you will see straight lines. If a macular disease is present, some of the lines may be missing or you might see wavy lines. You can purchase a package on the Internet.

    The second step is to manage your personal nutrition well and choose your food intake wisely. The richer in vitamins, minerals and omega-3 fatty acids present in the food you eat, the less often you will have to reach for the bottle of nutritional supplements. However, if your eating habits or diet is not capable of providing your body with everything it needs, then pill supplements are highly recommended.

    And the third step is to ditch cigarettes. It may be easier said than done, but breaking a bad habit is always great. Smoking is proven to do harm to your body overall, including your eyes. By quitting, you’ll be doing your own body a favour. From a lifestyle perspective, your family and friends will benefit from this change as well.

    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.

    Why Asia Retina Eye Surgery Centre?

    At Asia Retina, treatment of Macular Degeneration is customised to each and every individual. Our options include eye injections scheduled at a treat-and-extend regime; laser, if necessary; and surgery is reserved for cases of massive retinal bleeding that needs urgent evacuation. To better understand the disease and for help with identifying which macular degeneration treatment best fits your condition, we encourage you to book an appointment.

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