Macular degeneration | Treatment and how to live with it

What are the two types of macular degeneration

Macular degeneration, often referred to as age-related macular degeneration (AMD), is a progressive eye condition that affects the central part of the retina, called the macula.

This region is responsible for our central vision, allowing us to see fine details, recognise faces, and read. 

It can be very scary if you start to lose your vision but there are treatments available.

What is dry macular degeneration?

Accounting for about 90% of cases, dry macular degeneration is the more common form. It’s characterised by a gradual thinning of the macula as part of the natural ageing process.

Think of it as wear and tear on your retina over time. This form of the condition typically progresses slowly, and vision loss occurs gradually.

What is wet macular degeneration?

While less common (affecting only about 10% of macular degeneration patients), wet macular degeneration is more severe and can lead to rapid vision loss if left untreated.

Wet macular degeneration almost always starts as the dry form before progressing.

What causes it?

While the exact cause of macular degeneration isn’t fully understood, several risk factors have been identified:

1. Age

The risk increases significantly for those over 50.

2. Genetics

Family history plays a role, with certain genes linked to a higher risk.

3. Ethnicity

Caucasians are more likely to develop the condition than other ethnic groups.

4. Gender

Women are at slightly higher risk than men.

5. Smoking

Smoking significantly increases the risk and can speed up progression.

6. High blood pressure and high cholesterol

These conditions can affect blood vessels in the eye.

7. Sun exposure

Prolonged exposure to UV light may contribute to macular damage.

What are the symptoms?

Early detection of macular degeneration is crucial for managing the condition effectively, so regular eye checks are vital. The earlier you diagnose wet macular degeneration, the better the prognosis. However, macular degeneration may not present noticeable symptoms in its early stages. As it progresses, you might experience:

1. Blurred or fuzzy vision
2. Difficulty recognising faces
3. Straight lines appearing wavy or distorted
4. A dark or empty area in the centre of your vision
5. Difficulty adapting to low light levels
6. Decreased colour intensity

If you notice any sudden changes in your vision, such as a dark blob appearing in your central vision or any distortion (like straight lines appearing crooked or zigzagged), see an eye care professional immediately.

How does macular degeneration affect your life?

While macular degeneration doesn’t lead to complete blindness, it can significantly impact quality of life. The loss of central vision can make many daily activities challenging, such as reading, driving, or recognising faces. It’s important to note that peripheral vision is usually preserved, which helps maintain some level of independence.

What is the treatment for macular degeneration?

The treatment for macular degeneration depends on whether it’s the dry or wet form.

Dry Macular Degeneration

Currently, there is no approved treatment to reverse dry macular degeneration. However, research is ongoing, and there have been exciting developments, such as a new injection treatment that has shown promise in clinical trials in the United States.

Lifestyle modifications can help slow progression, including:

• Quitting smoking
• Maintaining a healthy diet rich in leafy greens and fish
• Regular exercise
• Protecting eyes from UV light with sunglasses
• Controlling blood pressure and cholesterol levels

Wet Macular Degeneration

For wet macular degeneration, treatment involves regular anti-VEGF injections to slow the progression of the degeneration. In a small number of cases, vision improves. But for most patients, the injections merely slow the degeneration, which is why it is so important to catch it early. Around 10% of patients don’t respond to treatment.

Anti-VEGF medication

However, there are several types of anti-VEGF medications available. Your eye specialist can discuss the options and help determine the best choice for you.

For patients who have recently experienced a stroke or heart attack, the priority needs to be healing the blood vessels around the heart and brain. As such, anti-VEGF injections are not suitable and you’ll need to wait for at least three months to begin treatment. Your consultant will discuss with the risks involved in such cases.

When does treatment start?

If you’re diagnosed with wet macular degeneration, you’ll likely be referred to a hospital eye clinic through a fast-track system. Treatment typically starts as soon as possible, sometimes even on the day of diagnosis.

For anti-VEGF injections, the procedure is very quick, usually taking only a few minutes, and is usually done as an outpatient treatment allowing you to go home the same day.

After the injection, it’s important to follow your doctor’s instructions carefully and to keep the eye clean. You should avoid rubbing your eye or exposing it to tap water, refrain from any activity that might introduce dirt into your eye for a few days (e.g. gardening or dusty work), and make sure to report any signs of infection immediately (e.g. increasing pain or redness). While eye infection is very rare (about 1 in 4000-5000 injections), it can be very serious and lead to a loss of eyesight.

Side effects are generally mild and may include temporary discomfort or a feeling of something in the eye with some mild irritation or itching, which can usually be treated with over-the-counter pain medication.

Living with Macular Degeneration

While macular degeneration can be challenging, there are many ways to maintain quality of life and independence:

1. Low vision aids: Magnifiers, special lighting, and electronic reading devices can help with daily tasks.
2. Home modifications: Simple changes like improved lighting and contrast can make navigation easier.
3. Support services: Many areas have low-vision clinics and eye care liaison officers who can provide valuable assistance and advice. And there are also local groups and organisations like the Macular Society to provide support.
4. Regular check-ups: Keep your glasses prescription up to date and attend regular eye examinations.
5. Stay active and engaged: Continuing with hobbies and social activities is important for mental well-being.
6. Consider registration: Depending on the severity, you may be eligible to register as sight impaired, which can provide access to various support services.

Looking to the Future

Research into macular degeneration is ongoing, with promising developments on the horizon. From new longer-lasting treatments to experimental approaches like stem cell therapy, the future holds hope for improved management and potentially even reversal of this condition.

Saanan Umeed is a Medical Retina Consultant at Midland Eye. Midland Eye was founded by four ophthalmic surgeons who wanted to provide patients with a comprehensive, specialist service for the diagnosis and treatment of all eye conditions. The team are leaders in their field and offer a consultant-only service to all patients requiring eye care or surgery.