Vision Scotland

Macular degeneration

Macular degeneration is a common eye disorder among people over 50.  Blurred or reduced central vision is caused if the macula (part of the retina) thins.
Vision Scotland Glaucoma

Macular degeneration

Macular degeneration is a common eye disorder among people over 50.  Blurred or reduced central vision is caused if the macula (part of the retina) thins.

What is Macular degeneration?

Macular degeneration (MD) is a condition which affects the macula, a small area at the centre of the retina. The macula is responsible for what we see straight in front of us, allowing us to see fine detail for activities such as reading and writing, as well as our ability to see colour. The condition is most common in people over 65. Vision can be severely affected if the cells of the macula are damaged and stop working. Symptoms include blurred vision or distortion, with straight lines appearing wavy and objects appearing to be an unusual size or shape. In more advanced cases, sufferers develop a blank patch or dark spot in the centre of their sight which makes reading, writing and recognising some objects difficult.
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Age related MD is relatively common.

People rarely lose all their vision from age-related macular degeneration and it doesn’t always affect both eyes. The peripheral areas of the visual field remain unaffected so to a degree, this allows patients to adapt to the condition.

The sufferer may have poor central vision but even in advanced stages of the disease you will still be able to use peripheral vision to compensate by looking to the side of the visual field rather than making use of the direct line of sight.

Treatment for AMD should be sought as soon as a problem is recognised as this will reduce the risk of further deterioration of sight.

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Mr Ross discusses cataract surgery
Cat, Optometrist at Vision Scotland

Dry macular degeneration

Dry macular degeneration tends to develop gradually and causes no pain. While no one knows exactly what causes the condition, it has been linked to heredity and environmental factors, like diet and smoking. In some cases, dry macular degeneration can progress into wet macular degeneration. Unfortunately, there is still no treatment for dry macular degeneration although we would recommend regular check ups to monitor progress.

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Wet macular degeneration

Wet macular degeneration is caused by the growth of abnormal blood vessels within the retina, leading to a build-up of fluid, bleeding and scarring. Wet AMD can cause serious visual loss in a much shorter space of time than dry AMD, sometimes within a few months.

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Friendly optometrist talking to patient
Diagnostic testing for RLE surgery at Vision Scotland

Why does it happen?

The cause of the condition isn’t known but there are some commonly identified risk factors. Smoking, high blood pressure, obesity and genetic factors all play a part in AMD both in its presentation and development.

The physiological cause of the disease differs between wet and dry AMD.

Dry AMD is caused by a build up of a fatty substance on the back of an eye. Onset of the condition is slow as the fatty residue increases. There is usually no treatment available for dry AMD, however, visual aids are available to manage the impact of dry AMD on life such as magnifying glasses, bold print books and special lighting.

Wet AMD is caused by the growth of abnormal blood vessels on the back of the eye. Onset is much quicker, a matter of days or weeks. In Wet AMD, treatment is possible to reduce the worsening of vision.

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How is it diagnosed?

If you suddenly develop blurred vision or distortion in your vision you could be suffering from MD.

Mr Sanjay Mantray, Consultant Ophthalmologist at Vision Scotland
Mr Jonathan Ross looking down a microscope during cataract surgery

How is it treated?

Unfortunately there are no cures for dry macular degeneration but treatments are available for Wet AMD sufferers. Treatments are used to slow the progression and protect you from severe visual impairment.

Macular degeneration surgery

The surgery itself usually takes around 10 minutes and is pretty painless – although you might experience moments of mild discomfort. Please ensure you don’t eat or drink anything for 2-3 hours before your surgery.

Step 1

On the day of treatment, you’ll be given local anaesthetic eye drops before the injection, and the area around your eye will be cleaned with an antiseptic.

Step 2

Once the anaesthetic has taken affect, your consultant will inject the drug through the wall of the eye. The injection takes a few minutes and you’ll usually be able to go home about an hour later.

Step 3

You may need regular repeat injections for the treatment to be successful – please ask your consultant for further advice.​

Post treatment

Injection for wet AMD is a relatively new treatment. Like all medical procedures, there are risks as well as benefits. Although a rise in pressure within the eye is expected immediately after the injection, occasionally an incision is required to release fluid from the eye if the pressure is too great.

Eye drops

In rare cases the inside of the eye can become infected. This can be serious and can lead to permanent loss of vision – antibiotic eye drops are used to reduce the risk of infection. Also in rare cases, the retina can become detached, which may require surgery. The chance of complications depends on the exact type of injection you’re having and other factors, such as your general health.

Information

Your consultant will advise you on any risks that apply to you, as well as answer any questions you may have. Our expert eye surgeons have carried out over 10,000 eye operations each and put patient care at the heart of their work. Contact us for more information on treatment for macular degeneration.

Eye Injections

Anti-angiogenic injections are given directly into the eyes to stop vision getting worse. The most common and effective treatment for wet macular degeneration is known as anti-VEGF (vascular endothelial growth factor) theory. This is an injection of a drug into the eye that controls the build-up of fluid under the retina. In normal patients, VEGF is a healthy molecule which promotes the growth of blood vessels.

However, when the VEGF works less effectively, new blood vessels in the choroid layer (behind the retina) are weaker and so leak into the retinal layers.

The injections prevent new blood vessels from forming and blocks leaking that occurs from already formed abnormal blood vessels. Injections are effective on 90% of people and causes an improvement in vision for 30% of people.

At Vision Scotland, anaesthetic drops are administered before the eye is injected. These drops number the eye so treatment is painless and without discomfort. There are a few side effects associated with these injections such as bleeding, irritation and redness. Injections are usually given every few months for as long as they are helping.

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Vitamins

The National Eye Institute of Health has carried out a large study (Age-related eye disease study) that suggests that daily supplements of vitamin C, E, beta-carotene, zinc and copper can reduce the risk of vision loss from AMD.

Photodynamic therapy

Photodynamic therapy involves a light being shined at the back of the eye to destroy abnormal blood vessels that cause wet AMD. It may be recommended alongside eye injections. Photodynamic therapy can be repeated every few months and side effects can include temporary vision problems, eye and skin sensitivity and sensitivity to light for a few days or weeks.

Without treatment, vision will gradually get worse. The type of AMD one has (wet AMD or dry AMD) affects the speed of onset of the condition. With wet AMD, deterioration can occur relatively quickly, whereas the changes are usually more gradual in dry AMD.

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Eye close up post surgery

Reduce the risk

To help reduce the risk of age related macular degeneration we recommend you:

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