Age-related macular degeneration

What is age-related macular degeneration?

Macular degeneration, also known as age-related macular degeneration (AMD), causes loss of central vision as a result of damage to the macula. The macula is a highly concentrated area of light-sensitive cells in the retina at the back of the eye, vital for seeing detail when looking straight at something. 

Damage to the macula can’t be reversed. AMD is the most common cause of permanent and severe sight loss in the UK, affecting around 600,000 people. This number is expected to more than double by 2050.

What are the different types of age-related macular degeneration?

There are two types of age-related macular degeneration: ‘dry’ AMD and ‘wet’ AMD. They are called dry and wet AMD because of what happens inside the eye and what the eye doctor sees when examining the inside of the eye.

Dry and wet AMD have some similarities. They usually affect both eyes, but sometimes one eye is affected before the other. Both types of AMD affect the central vision but neither will lead to complete blindness.

What causes macular degeneration?

Macular degeneration happens when cells within the macula, a tiny area within the retina at the back of the eye, become damaged and scarred. These cells are photoreceptor cells, which means they’re sensitive to light and play a vital role in our ability to see details and colour. 

Although the exact causes of AMD are unclear, some of the factors that are thought to increase the risk of developing the condition include:

• Age – AMD is mostly diagnosed in people over 65, but it can affect people from the age of 50.
• Gender – more women develop AMD than men (this is probably because women tend to live longer)
• Family history of AMD – the condition can sometimes run in families, and a number of faulty genes that increase the risk of AMD have been discovered. But AMD is not always inherited.
• Smoking – smoking greatly increases the risk of developing AMD.
• Lifestyle – some studies have linked high blood pressure, being overweight and lack of exercise as possible risk factors. Some studies have also suggested diet and exposure to high levels of sunlight may also influence the risk of developing AMD – but the extent of these potential links isn’t fully established.

Some studies have also suggested a person’s diet and exposure to high levels of sunlight, may also be factors that can influence the risk of developing AMD – but the extent of these potential links isn’t fully established.

What are the signs and symptoms of age-related macular degeneration?

Symptoms usually start with changes in your vision, which can develop very slowly or rapidly (either way, it’s vital to get symptoms checked immediately). One or both eyes can be affected, although most people who are diagnosed with AMD will eventually have macular damage in both eyes.

These changes can vary between people, but often include:

• Difficulty seeing details – This is often one of the first changes you notice. You may be struggling to read small print, see clearly while driving or see what’s happening on the TV screen.
• Reduced central vision – You may find that your vision is becoming blurry or smudged in the central area. This may develop into a blank or dark spot at the later stages of AMD.
• Distorted lines – Straight lines may appear wavy or crooked in the middle. While reading, the lines in the middle of the page may become very blurred and distorted.
• Reduced colour perception – It's harder to see colour, or colours aren’t as vibrant as they used to be.
• Sensitivity to light – You may feel more sensitive to bright light or may have more difficulty seeing in low lighting.
• Hallucinations – Some people who have lost a lot of vision because of AMD may see things, such as shapes, colours or figures, that are not really there. This is called Charles Bonnet syndrome.

Age-related macular degeneration doesn’t cause pain or affect the appearance of the eye.

Is macular degeneration serious?

While macular degeneration doesn’t cause complete blindness, losing your central vision means you can’t see things when you’re looking straight at them, so it can have a huge impact on day-to-day life. It can affect your ability to carry out everyday activities such as reading, driving or seeing faces.

While AMD  the loss of central vision  Once the damage has happened, it’s irreversible. This is why we're funding vital research into AMD.

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How is age-related macular degeneration diagnosed?

AMD is usually diagnosed following routine eye tests. Alongside testing your vision and asking about any changes you’ve noticed, an optometrist will look at the back of the eye using a special light and magnifying glass to check for signs of damage.

If your symptoms are severe or progressing or significant damage is detected, you'll be referred to a specialist (ophthalmologist) for further tests. These may include:

• Optical coherence tomography (OCT) – a type of scan of the retina that can detect changes to the macula more reliably and earlier than other imaging tests. By looking at the OCT scans, the eye doctor will be able to see very detailed pictures of the inside of the eye, which helps diagnose and monitor the condition.
• Fluorescein angiography – this involves injecting a special yellow dye into the arm which then travels to the blood vessels in the eye, enabling the specialist to examine them more closely. This shows whether there are any abnormal new blood vessels growing under the retina.

If you have age-related macular degeneration, getting a diagnosis as early as possible is vital, as damage to the macula can’t be reversed. This is especially important for wet AMD, which requires an urgent referral to a specialist.

What are the treatments for age-related macular degeneration?

Unfortunately, there are currently no treatments available for dry AMD. Regular check-ups and tests can help monitor changes.

 Treatments are available for wet AMD that can help to stop further sight loss, such as anti-VEGF medications, but they can’t ‘undo’ damage that’s already occurred, so starting treatment as early as possible can make a big difference.

What can help age-related macular degeneration?

There’s some evidence that diet or supplements may help slow down the progression of macular damage.  Taking high doses of vitamins A, C and E, the mineral zinc, copper and the micronutrients lutein and zeaxanthin in combination could potentially help slow the progression of dry AMD.

Specially formulated supplements are available to buy over the counter at pharmacists, but further investigation into the potential benefits of nutrition is needed. They are not currently available on prescription. It’s best to speak to your GP, optician or eye doctor who may be able to give you personalised advice.

A balanced diet with plenty of fresh fruit and vegetables is good for general health and may benefit eye health.

Regular eye check-ups and tests are also helpful to monitor changes.

What research is there into age-related macular degeneration?

Fight for Sight’s goal is for a new treatment to be developed within the next ten years – to help save hundreds of thousands of people from losing their sight. 

Macular degeneration is the most common cause of severe sight loss in the UK, and figures are on the rise. Although some treatments are available for wet macular degeneration, there are no treatments currently available for dry macular degeneration and the condition continues to have a huge impact.

We are investing in 22 research projects to help find new and more effective treatments. For example, Professor Heping Xu is leading research at Queen's University Belfast. He is using a range of techniques to investigate what’s happening within the molecules (components that make up cells) when scarring of the retina occurs during macular degeneration. Understanding this better could lead to developing new targeted treatments.

Fight for Sight has also partnered with the Macular Society, Blind Veterans and Scottish War Blinded to form Action Against Age-Related Macular Degeneration. By funding further research together, our goal is to understand more about the condition and make tackling the leading cause of severe sight loss a reality.

In the first episode of our eye research podcast, Professor Pete Coffey, based at the Institute of Ophthalmology talks to Fight for Sight about the devastating impact of age-related macular degeneration and hopes for a potential new treatment.

Fight for Sight's Research Strategy has pledged to spend over 20 million on pioneering eye research over the next five years.

If you're personally affected by age-related macular degeneration and are interested in fundraising to help us fund cutting-edge research in this area find out how to get involved.