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Macular degeneration

What is macular degeneration?

Macular degeneration, also known as age-related macular degeneration (AMD) is a condition that affects the macula, the central part of your retina responsible for sharp central vision. It leads to loss of central vision, making it difficult to read, drive, or recognize faces.

 

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What are the different types of macular degeneration (AMD)?

There are two main types of AMD:

  • Dry AMD: This is the more common form, characterized by gradual thinning and deterioration of the macula over time. It may progress slowly and cause vision changes gradually.

  • Wet AMD: This is a less common but more severe form where abnormal blood vessels grow under the macula, leaking fluid and blood

 

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What are the symptoms of macular degeneration (AMD)?

  • Straight lines or text appearing wavy or crooked  

  • Blurred or distorted central vision

  • Difficulty reading or recognizing faces

 


Who is at risk for macular degeneration (AMD)?

  • The 2 main risk factors are 

    • Getting wiser (or older), especially in those over 60 years of age 

    • Current smokers 

  • Other risk factors include: those with a family history of macular degeneration, an unhealthy diet lacking a variety of fruits and vegetables

 

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How is macular degeneration (AMD) diagnosed?

An ophthalmologist or an optometrist can diagnose AMD through a comprehensive eye exam, including:

  • Vision testing

  • Dilated eye exam 

  • A special eye scan called Optical coherence tomography (OCT)

Is there a cure for wet macular degeneration (wet AMD)?

There is currently no cure for wet AMD. However, there are treatments available to slow progression of the disease. This involves injecting a drug into the eye which contains anti-vascular endothelial growth factor (Anti-VEGF). This drug “dries up” the wet macula by causing the abnormal vessels to stop growing and shrink. 

It is very important that treatment for wet macular degeneration is NOT delayed! If a patient delays seeking help, the leaking blood and fluid can result in scarring and irreversible damage to his/her eyesight. Read below for a more in-depth explanation of eye injections and what to expect. 

Scans of an eye with wet macular degeneration - Before and After treatment
- blue arrows point to the areas of excess fluid and swelling
- notice the stark difference in thickness after treatment, whether the bottom photo demonstrates a much more normal (and thinner) retina

Eye scan demonstrating the improvement in wet macular degeneration with treatment

Is there a cure for dry macular degeneration (dry AMD)?

There is no cure for dry AMD. There is however, a newly approved eye injection in the USA that is being used to slow progression of dry AMD. It hasn’t been approved for use in Australia as yet, but eventually will be (I suspect within a year or so). 

 

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What about eye supplements? Will these help my macular degeneration? 

Eye supplements may be helpful for macular degeneration but it depends on your specific case. 

This was based on a large study of over 4000 individuals in the USA, which demonstrated that a particular formula of vitamins and minerals did help to slow disease progression. It is important to note that these supplements DO NOT TREAT macular degeneration. Additionally, if you already have a healthy diet that includes a good variety of fruits and vegetables (i.e. eat the colours of the rainbow), you are likely to be consuming these vitamins and minerals. 

 

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What supplement brand should I buy?   

Firstly, I do not have any financial interests in these brands or supplements. Second, there is no best brand out there. Listed below are a few available ones in Australia

  • PreserVision (AREDS2 formula)

  • Blackmores MacuVision Plus

Both are easily accessible either from your local chemist or from online retailers.

What can I do to prevent macular degeneration (AMD)? 

  • Maintain a healthy diet: Eat plenty of fruits, vegetables (eat the “colours of the rainbow”) 

  • Don't smoke: Smoking is a major risk factor for AMD.

  • Protect your eyes from UV rays: Wear sunglasses that block UVA and UVB rays when outdoors

  • Schedule regular eye exams with your optometrist 

Tell me more about the eye injections. 

In order to dry up the macula, a medication class called anti-VEGF, needs to be injected into the eye. Currently, three different drugs have been shown to be effective – aflibercept (Eylea), ranibizumab (Lucentis) and faricimab (Vabysmo). These medications work by inactivating molecules that cause abnormal growth of blood vessels in your eye.  

 

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Can I have an of the procedure? 

Injecting medicine into the eyeball sounds scary, but rest assured it is a short, painless procedure and over before you know it. This is usually done in my procedure room, with the steps as follows

  • You are asked to lie down on the treatment bed where local anaesthetic drops are instilled into your eye to numb it 

  • This is followed by a local anaesthetic injection (which is painless), to numb it further 

  • Once the eye is completely numb, your eye is then sterilised with antiseptic 

  • I get my patients to look down towards their nose, and within 2 seconds the injection is done, with most patients not even realising it’s over! 

  • The eye is then washed with some sterile saline solution 

  • No pad or eye shield is required after 

 

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What happens after the injection? 

  • You can go home directly after, but it is important to have someone drive you home 

  • Patients are advised to obsessive about keeping the eye clean for the next 2 days. This means 

    • Avoiding any dusty or dirty places where there is potential for debris to get into the eye

    • Avoid any non-sterile water getting into the eye for 2 days. Showering is fine but do not get any water into the eye.

    • Avoid rubbing your eye   

    • No swimming for 1 week  

How often will I need injections? Is one injection enough?  

  • Unfortunately, wet macular degeneration requires ongoing injections to maintain or to improve your eyesight. 

  • The frequency of injections will vary depending on how well your eye responds to the injections. If your eye responds favourably, we will be able to increase the intervals between injections gradually – from every 4 weeks initially up to every 3-4 months (that means only 4 injections per year) 

  • An ideal injection schedule looks like this

A typical regimen of eye injections for the treatment of wet macular degeneration

  • If there is worsening of the macular degeneration, the frequency of intervals will need to be reduced (this is all tailored to your eye and will be discussed in more detail with you)

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Are there any risks with eye injections? 

As with any procedure, eye injections despite being straightforward, are not risk-free. This is why I spend time discussing the pros and cons of treatment vs no treatment with my patients. 

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Common but minor side-effects include feelings of irritation or grittiness of the eye, red eyes or some superficial bleeding on the surface of the eye. These are all transient and go away after a few days to weeks. Over-the-counter lubricating drops can help with these symptoms. 

The worst-case scenario is getting an infection in the eye after an injection (termed endophthalmitis). This is an extremely rare occurrence, with past data showing that the chance of this happening is about 1 in 2000-3000. Although rare, an infection in the eye can be devastating and potentially cause blindness, hence my constant nagging to patients to be obsessive about hand hygiene and eye cleanliness after each injection!   

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Please click here to read a more in-depth discussion about risks of surgery/procedures.

There are other uncommon risks associated with injections that I will discuss with you in detail + give you an information sheet to take home.  

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