AMD Awareness Month September 2020

AMD (Age-related Macular Degeneration) is the No 1 cause of sight loss in Ireland for over 50s and more than 100,000 people suffer from it. Over 45% of Irish people over 70 years of age registered as legally blind are as a result of AMD.

Regular eye tests for those aged over 50 can identify the early signs of AMD, ensuring that the disease can be diagnosed as early as possible. Treatment at an early stage can prevent any further deterioration.

Research has shown that AMD tends to run in families and there seems to be an environmental trigger. Certain regions within the country have higher densities of sufferers.

With macular degeneration central vision becomes severely affected but sufferers will retain a certain level of peripheral vision.

What causes AMD?

AMD is the result of the ageing processes in the eye. The part of the retina (the tissue on the inside of the eye) responsible for seeing fine detail and colours and for making out facial features and shapes, is the macula. The macula is affected in age-related macular degeneration. This part of the eye suffers “wear and tear” over time and it is believed that a build-up of waste material at and around the macula is the reason for the reduction in vision that occurs in this condition.

What should you do to avoid AMD?

For treatment of AMD to be effective, it must be diagnosed as early as possible. Regular eye examinations are the key to early detection of retinal changes and other signs of disease. If you notice any change in the quality of your vision, have your eyes examined immediately. Regular examinations are particularly important for people over the age of 50 years and people whose families have a history of eye conditions

The latest research advises that diet can be useful in avoiding this problem and smoking has been indicated as a risk factor for developing the condition. Some people are advised to take oral vitamin supplements to reduce the risk of developing AMD, always consult your optometrist or ophthalmologist before taking any such supplements.

At OpticalRooms we recommend Europe’s #1 eye health nutritional supplement, Nutrof Total, for the following reasons:

• Once-a-day-formula- Convenient daily nutrition to support the eye.
• Resveratrol—Powerful antioxidant found in blueberries, dark chocolate and red wine.
• Lutein and Zeaxanthin- Essential carotenoids to enrich macular pigment in the eye.
• Pharmaceutical grade Omega-3 fish oils- Essential fatty acids known to be beneficial for eye health.
• Vitamins C & E plus Zinc and Copper- Excellent antioxidant and mineral combination to support eye health.
• Selenium- Key antioxidant and supports action of Vitamin E & Zinc.
• Vitamin D – Sunshine vitamin known to have anti–inflammatory and anti-angiogenic properties.

The following fruit and vegetables have also been reported to have some effect in reducing the risk of developing AMD:

• Yellow / Orange – corn, oranges, squash
• Green – kale, brocolli, cabbage

Symptoms: There are two types of AMD, Dry and Wet.

Dry AMD is the most common form of the condition and usually causes gradual changes in vision, often small changes over many years.

Wet AMD affects a much smaller percentage of sufferers and is usually of sudden onset with significant and obvious reduction in vision. In Wet AMD, abnormal blood vessels develop beneath the macula and begin to leak. This leakage of fluid results in straight lines looking wavy or distorted. In some cases of Wet AMD treatment is possible, but it is vital that referral to a retinal specialist occurs as soon as possible.

How is AMD detected and diagnosed?

People with AMD may notice that their vision has deteriorated. Many patients do not realise that they have a problem until their vision becomes significantly blurred. Optometrists perform a number of tests in an examination that enable them to detect the presence of AMD in the early stages.

At OpticalRooms we examine the macula with an instrument called an ophthalmoscope that allows examination of the interior of the eye. We place a drop in the eye to dilate the pupil to get a better view of the internal structures. Through the ophthalmoscope we will look for changes in the structure of the macula such as accumulations of waste material or new blood vessels.

Another test that may be used is a grid pattern known as an Amsler chart. Patients with AMD often report that sections of the grid appear to be distorted or missing..

Treatment options

As previously mentioned, we recommend Nutrod Total as a comprehensive once-a-day nutritional supplement to help maintain healthy eyes and normal vision. However, if the damage has already presented itself there are other treatment options now available.

Anti-Vegf Injections

One of the contributing factors for wet AMD is a protein called vascular endothelial growth factor (VEGF-A). VEGF-A causes new weak blood vessels to grow and leak within the eye, damaging central vision. Anti-VEGF therapies stop further damage to the eye and can even repair some of the damage that has occurred. Anti-VEGF therapy is injected into the eye. Multiple injections will be performed over a number of months. After that, your sight is monitored and further injections will be administered if required.

Photodynamic Therapy (PDT)

Photodynamic Therapy (PDT) uses a non-thermal (or cold) laser with an intravenous light-sensitive drug to seal and halt or slow the progression of abnormal retina blood vessels present in certain, specific types of AMD. This treatment does not produce a blind spot on the retina. The light is shone directly at the targeted tissue and the drug accumulates in these cells. It therefore reduces damage to normal surrounding tissue and allows the treatment to be given again as needed. It does not stop vision loss or improve vision in eyes already damaged by AMD.

Laser Surgery

Laser surgery is a procedure involving the application of a hot laser to seal and halt or slow the progression of abnormal blood vessels. In the 1990’s laser treatment was the only therapy available for AMD. Through the use of a high-energy light that turns to heat when it hits the parts of the retina to be treated, laser photocoagulation seals the choroidal neovascularisation (CNV) and stops the leaky blood vessel’s growth, preventing further vision deterioration. A scar forms as a result of the treatment, and this scar creates a permanent blind spot in the field of vision.

Only a small percentage of people with Wet AMD can be treated with laser surgery, as it depends on the location of the leaky blood vessels. The risk of new blood vessels developing after laser treatment is high. Repeated treatments may be necessary.

We would like to thank our Association and AMD.ie for their contribution to this article.

If you have any other concerns, or are worried that you could be suffering from AMD – contact us as soon as possible.

References

1. The Cost of Sight Loss Report NCBI 2011
2. Akuffo KO, Nolan J, Stack J, Moran R, Feeney J, Kenny RA, Peto T, Dooley C, O’Halloran AM, Cronin H, and Beatty S. Prevalence of age-related macular degeneration in the Republic of Ireland. British Journal of Ophthalmology. 2015.
3. Arnold et al. BMJ 2000;321:741-744 Clinical Evidence AMD.
4. Risk Factors for Macular Degeneration. American Macular Degeneration Foundation website.https://www.macular.org/risk-factors. Accessed October 2018.
5. https://nei.nih.gov/health/maculardegen/armd_facts