Age-Related Macular Degeneration ( AMD )

Eye Specialist

What is Age-Related Macular Degeneration ( AMD )

Age-Related Macular Degeneration is one of the major reasons which causes loss of eyesight among the older population of the country.

Age-Related Macular Degeneration can happen in 2 ways:

  • 1. One with progress slowly due to which the vision loss does not occur for a long period of time
  • 2. Another one which progresses very swiftly and can lead to permanent damage to the sight loss

AMD may affect one or both eyes, Even though Age-Related Macular Degeneration is most connected with ageing it is also recently being connected with genetics.

Types of Age-Related Macular Degeneration?

Macular Degeneration is of two types which are as follows:

1. Dry Macular Degeneration (non-neovascular):

Non-Neovascular Macular Degeneration are found in 90% of the patients who face AMD. It is considered as the early form of the disease and can be caused due to the following reasons:

  • a) Ageing
  • b) Thinning of macular tissues
  • c) Pigment deposition in the macula or
  • d) Can also happen due to the combination of Thinning of macula tissues and deposition of pigment in the macula.

How to identify Dry Macular Degeneration?

Dry Macular Degeneration can be identified when drusen i.e yellowish spots begin to deposit and accumulate in and around the macula. It is said that these spots are debris or the deposits from the deteriorating tissue

How Serious can Dry Macular Degeneration be?

Dry Macular degeneration is not as severe as Wet Macular Degeneration but can lead to a loss of central vision loss.


2. Wet Macular Degeneration (neovascular):

Neovascular macula Degeneration as mentioned above is a cause of not treating the Dry Macula Degeneration and consist of 10% of the total patients who face AMD. It is a chronic eye disease which causes blurred vision and blind spot in your vision.Wet macular degeneration leads to the growth of new blood vessels beneath the retina and also leakage of blood and fluid.The leakages further lead to a damage ( Permanent in nature ) to the light-sensitive cells of the retina, which leads to the death of the cells creating the blind spot where the cells die off.

Choroidal neovascularization ( CNV ), the process which causes Wet Age-Related Macular Degeneration and abnormal growth of blood vessels is a body's misguided way to create a new network of blood vessels to supply more nutrition and oxygen to the retina of the eye which unfortunately leads to creation of scars which sometimes leads to loss of eyesight.

Further Wet Macular Degeneration is divided into two types:

A) Occult: Occult is a process termed when the growth of new blood vessels beneath the retina is not that noticeable and the leakage in the occult CNV is less evident. This type of Wet Macular Degeneration most often produces less severe vision loss.

B) Classic: This type of Wet Macular Degeneration is severe and can easily be diagnosed with the scarring and the growth of blood vessels are very evident and observation of delineated outlines beneath the retina.


How to Diagnose Age-Related Macular Degeneration?

Diagnosis of AMD can be done with the following test:

A) Amsler Self Test : One can do a self-test with the help of the Amsler Grid and check if the lines look distorted or wavy or if the areas of the visual fields are missing.

B) Optical Coherence Tomography Macula : This is a common way of diagnosing the AMD in an imaging way with the help of infrared light waves which are used to make cross-section photographs of the choroid layer and retina. Optical Coherence Tomography helps in providing very useful information about the drusen, retinal structure, new blood vessels and haemorrhaging. In this process, the patient is provided with a dialiation drops which are put in the eyes and then is asked to sit in the front of the camera with the chin placed on the chin rest and then gets a complete report after completing the imagining process which takes 15 to 20 minutes.

C) Fundus Flourescin Angiography : In this process, Fluorescein, a yellow dye in nature is injected into the arms of the patient. The patient is then asked to sit in front of the camera which then shows the blood flow and the possible places where leakages have taken place in the retina or choroid. This process takes approx 20 to 30 minutes and required. Saliva and are sometimes dark orange after the process which is the result of body metabolizing the dye.


Treatment for Age-Related Macular Degeneration?

Treatment for Macular Degeneration depends upon the severity of the disease which can be stated as follows:

A) Early Age-Related Macular Degeneration : Currently, there is no treatment available for the early stage of AMD. Many people show no symptoms of loss of vision. An ophthalmologist may recommend you to undergo an eye examination at least once in a year which will help the doctor to know if the problem is advancing.

The doctor may ask the patient to change the lifestyle to prevent its advancement.

B) Intermediate or Late Age-Related Macular Degeneration : In a case, if doctor derived the stage of AMD in this category, he may recommend the patient to have some intake of vitamins listed below to slow the process of AMD. The following are the list of Vitamins which can be taken on doctors recommendation to slow the process of AMD:

  • 500 milligrams (mg) of vitamin C
  • 400 international units of vitamin E
  • 80 mg zinc as zinc oxide
  • 2 mg copper as cupric oxide
  • 10 mg lutein and 2 mg zeaxanthin

C) Advanced Age-Related Macular Degeneration : Wet Macular Degeneration also typically results in Vision Loss. The doctor may recommend various therapies to further stop the vision loss. However, it is not possible to cure the vision loss as the damage done by the disease is irreversible and cannot be termed as a permanent treatment. The following are the therapies which can be done to reduce the advancement of the disease:

  • Anti-Vascular Endothelial Growth Factor (VEGF) Injection : This treatment is one of the 3 options where Anti-vascular endothelial growth factor is secreted into the eyes to prevent the spread of VEGF due to the Neovascular AMD. This treatment may require multiple injections to be taken on a gap of a certain duration.
  • Photodynamic therapy : This technique is done by exposing laser to certain areas of the retina where there is abnormal growth of blood vessels. Firstly a doctor injects a drug called verteporfin through the vein of the patient's arms. The Drug then travels to the blood vessels of the body and then is absorbed by the new and growing blood vessels. The doctor then shines the laser into the abnormal blood vessels of the eye which is causing the AMD which activates the drug which leads to slowing the growth of AMD and Slowing the loss of vision.
  • Laser Surgery : This Surgery involves aiming of an intensely hot laser beam at the abnormal blood vessels in the eyes to destroy them. it is not similar to the laser which is used in the photodynamic therapy.