Age-related macular degeneration

of 7 Age-related macular degeneration Introduction This leaflet sets out to answer some of the questions most commonly asked by patients. We hope you will find it helpful. Where is the macula? The eye is shaped like a ball. The pupil, close to the front, is the opening which allows light to enter the eye. Just behind the pupil is the lens which focuses the light on the retina at the back of the eye. The retina is a delicate tissue which converts the light into images and sends them to the brain along the optic nerve. The macula is a small area at the very centre of the retina and is responsible for seeing fine detail and colours. What is age-related macular degeneration (AMD)? AMD is a condition which occurs later in life and is an increasingly common disorder affecting people over the age of 60. In AMD, disturbances occur in the macular area causing problems with the centre of the vision. There is no specific medical treatment for most cases but new symptoms of distortion or sudden deterioration of vision need to be assessed immediately as treatment can sometimes be of benefit. Types of AMD Dry AMD With age the delicate cells at the back of the eye become less efficient at doing their job and waste products Reference No. GHPI0691_07_13 Department Ophthalmology Review due August 2016

of 7 (drusen) accumulate. Cells in the macula may slowly wear out causing loss of sight in the central part of the field of vision. The peripheral (or side) vision is not affected, 90% of cases of macular degeneration are of this type. In the early stages there are often no difficulties with the eyesight but changes can be seen at the back of the eye when examined. The central vision declines slowly over many years. In advanced cases it may be difficult to recognise faces. A grey or black patch may be seen in the centre of the vision and reading might not be possible unless a very strong magnifier is used. Peripheral vision always remains, so that the affected person can see to move around. Wet AMD Distortion of vision is an important warning sign of early wet AMD. Objects appear misshapen and straight lines appear bent. In this form of AMD, tiny blood vessels develop under the macula and these leak fluid or bleed. These blood vessels may develop quickly and result in more rapid deterioration of vision. Look out for new symptoms of distortion or sudden deterioration of vision and see an optician or eye doctor straight away if this occurs. The Amsler grid included on page four may be used to check distortion of vision. Using your reading glasses, if you wear them, hold the chart at a comfortable distance away. Cover one eye Focus on the dot in the centre of the chart Are any of the lines wavy, blurred or distorted? Are there any missing areas or dark areas in the grid? Can you see all corners and sides of the grid? All lines should be straight, all intersections should form right angles, and all the squares should be the same size Don t forget to test both eyes (each eye separately)

of 7 Amsler Grid An example of distortion Any irregularity should be reported to your optician or eye doctor immediately. The Amsler Grid is helpful in revealing signs of wet AMD, although it is not a substitution for regular eye tests.

of 7 Will I go blind? AMD is not painful, and almost never leads to total blindness. Only the central (reading) vision is affected and the surrounding vision remains normal. Useful side vision that allows you to see to get around is retained in both forms of AMD. Will it help my sight if I use my eyes less? You cannot wear your eyes out. Going closer to the TV or print to see more clearly is not bad for your eyes. Losing the vision in one eye does not cause extra strain on the other. Is there anything that will help me see better? To make the most of your peripheral vision learn to move your eyes until the image of the thing you wish to see is focused on the most useful area of the retina. For most people with AMD, the best position to help you see better is to fix your sight slightly above or to the side of the object you want to see. Will a new pair of glasses help me see more clearly? Stronger lenses will not repair the damage that has occurred at the back of the eye. Magnifying devices known as low vision aids enable most patients to continue to perform normal everyday tasks such as reading newsprint or price tickets. Magnifying devices range from very simple, hand held magnifiers to telescopic spectacles or more complex electronic devices. All Low Vision Aids require adaptation and determination from the user. When you read, have the light from a window behind and to the side of you. Direct the light from an angle poise lamp onto the page. Try changing your light bulbs to stronger ones. If your vision is poor in sunlight, try using a broad rimmed hat, visor or sunglasses: the best lens tint is reddish-brown. Can I continue to drive with macular degeneration? The law requires you to inform the Licensing Authority (and insurance company) of any change in health or sight likely to affect the safety of your driving. You must be able to read a number plate fixed to a motor vehicle in good daylight and with spectacles if worn.

of 7 You must also have an adequate field of vision. (see appendix at the back of this leaflet for specific legal requirements).to drive when unable to meet both these requirements is a criminal act and will invalidate insurance. Your inability to meet these requirements means that you must notify the Licensing Authority. You should not drive until you have had confirmation that your vision meets the required standards. A report may be requested from your ophthalmologist or optometrist. Standards are more stringent for vocational drivers. Treatments Prevention There is evidence that avoiding smoking and eating a healthy balanced diet with plenty of fresh fruit and dark green, orange and yellow vegetables can help to prevent AMD. Eating a diet low in saturated fats and red meat, and increasing the proportion of healthy fats such as those in oily fish, may also help to prevent AMD. People who smoke have a much higher risk of developing AMD. Dry AMD There is no specific treatment for dry AMD but magnifying aids and bright focused lights for reading can be helpful. An assessment can be made for various magnifying aids at the Low Vision Aid clinic at Gloucestershire Royal Hospital or Cheltenham General Hospital. Wet AMD Injections Wet AMD is treated with drugs that are injected into the eye (anti- VEGF therapy). Abnormally high levels of a specific growth factor occur in eyes with Wet AMD and promote the growth of abnormal new blood vessels. This drug treatment blocks the effects of the growth factor. The NHS in this area funds Lucentis injections. Are there any other treatments? Photodynamic therapy (PDT) can prevent or delay loss of vision in some patients with a particular form of wet AMD. Argon laser treatment can also be used in particular forms of AMD. This is usually in addition to Lucentis treatment.

of 7 Avastin is similar to Lucentis and some doctors believe it works as well. It is much cheaper than Lucentis and this has been a consideration for people who have had to fund their own treatment. However, Avastin treatment is currently unlicensed for use in the eye and is not approved by the National Institute of Clinical Excellence (NICE) and therefore is not widely used in the NHS. What happens now? Your optician will refer you to see an eye specialist at the hospital for assessment of your condition. The vision will be tested in both eyes using an eye chart and you will be given eye drops which enlarge your pupils. The eye drops will allow the eye specialist to look at the macular area at the back of the eye. The drops take about 30 minutes to work and may blur your vision for several hours. Many patients with AMD do not meet the visual requirements for driving and it is certainly preferable that you do not drive to or from your appointment. The eye specialist will give you information about the type of AMD you have and whether there is any treatment available. The specialist will arrange any treatment that is appropriate and a visit to the low vision aid clinic if necessary. Contact information If you have any questions about your condition not covered in this leaflet please speak to one of the medical or nursing staff at: Eye Clinic, Cheltenham General Hospital Tel: 0300 422 3200 Eye Clinic, Gloucestershire Royal Hospital Tel: 0300 422 8358 Eye triage Tel: 0300 422 3578

of 7 Further information Royal National Institute of the Blind Telephone: 0303 123 9999 Website: www.rnib.org.uk Macular Society Telephone: 0300 3030 111 Website: www.macularsocitey.org Driver and Vehicle Licensing Agency (DLVA) Telephone 0300 790 6801 Website: www.dvla.gov.uk Appendix You must be able to read a number plate fixed to a motor vehicle in good daylight and with spectacles if worn at the following distances. At a distance of 20 metres containing letters and figures 79 millimetres high and 50 millimetres wide (i.e. post 1.9.2001 font). or At a distance of 20.5 metres where the characters are 79 millimetres high and 57 millimetres wide (i.e. pre 1.9.2001 font). You must also have an adequate field of vision. Driving and Vehicle Licensing Agency (DVLA). At a glance Guide to the current medical standards of fitness to drive. (Chapter 6). www.dft.gov.uk/dvla/medical/~/media/p Accessed 12/1/2011