Age-related macular degeneration
Specialists who treat this condition:
Mr Nicholas Beare
Prof Ian Pearce
Age-related macular degeneration (AMD)
Age-related macular degeneration (AMD) is a painless eye condition that generally leads to the gradual loss of central vision but can sometimes cause a rapid reduction in vision. Previously, there were limited treatment options available but over the past decade there has been great advances in available treatments particularly for the more severe forms of AMD.
The retinal consultants at Liverpool Eye Clinic have been at the forefront of development, research and delivery of the most successful forms of AMD treatment over the recent decade.
The risk of AMD increases with age and up to one third of adults can become affected. There are two main types of AMD, called 'dry AMD' and 'wet AMD' :
Dry AMD
Dry AMD develops when the cells of the macula become damaged as a result of a build-up of waste products called drusen. It is the most common type of AMD, accounting for around nine out of 10 cases. The loss of vision is gradual, occurring over many years. However, an estimated one in 10 people with dry AMD will then go on to develop wet AMD.
Wet AMD
Wet AMD develops when abnormal blood vessels form underneath the macula and damage its cells (doctors sometimes refer to wet AMD as neovascular AMD).
Wet AMD is serious and without treatment, vision can deteriorate within days.
FAQs
What are the symptoms ?
The main symptom of macular degeneration is blurring of your central vision. In particular, it results in:
distortion of central vision – images, writing or faces can become distorted in the centre (this is most commonly associated with wet AMD)
loss of visual acuity – visual acuity is the ability to detect fine detail, for example when you read or drive
loss of contrast sensitivity – contrast sensitivity is the ability to see less well-defined objects, such as faces, clearly against the background
What do I do if I develop new symptoms?
If you notice that your vision is getting gradually worse, you should see your GP or optometrist. If appropriate they can refer you on to the Liverpool Eye Clinic for further investigation, diagnosis and management.
If your vision suddenly gets worse, particularly if images are distorted or you notice blind spots in your field of vision, medical advice should be sought immediately.
The Liverpool Eye Clinic can provide one stop clinics for the diagnosis, investigation and management of AMD.
How can I reduce my risk ?
It is not always possible to prevent macular degeneration as it is not clear exactly what triggers the processes that cause the condition.
Your risk of developing the condition is also closely linked to things such as your age and whether you have a family history of the condition.
However, you may be able to reduce your risk of developing AMD, or help prevent it getting worse, by:
stopping or reducing smoking
eating a healthy diet high with plenty of fruit and leafy green vegetables
wearing UV-absorbing glasses when outside for long periods
How is AMD treated ?
Although there is no current cure for either type of AMD there are several established treatments available to halt the progression of the disease and provide some improvement to vision.
The retinal consultants at the Liverpool Eye Clinic are amongst the UKs leading experts in AMD and can provide you with the most appropriate up to date information with regards to the management of your AMD condition and can provide regular monitoring to identify the earliest stages of the disease.
With dry AMD, treatment is mostly based on helping a person make the most of their remaining vision, reducing the risk of developing wet AMD and recognizing the early signs of conversion to wet AMD.
Management of Dry AMD
With dry AMD, the deterioration of vision can be very slow. You will not go completely blind as a result of the condition and your peripheral (outer) vision should not be affected.
Help is available to make tasks such as reading and writing easier. Getting practical help may improve your quality of life and make it easier for you to carry out daily activities.
You may be referred to a low vision clinic. These clinics can provide useful advice and practical support to help minimise the effect dry AMD has on your life. For example, things that may make it easier for you to carry out close, detailed work include:
magnifying lenses
large print books
intensive (very bright) reading lights
There are also a number of devices that can help you adjust to low vision, such as screen-reading software on your computer so you can ‘read’ emails, documents and browse the internet.
Management of Wet AMD
The most significant advances in treatment have been in Wet AMD where intraocular injections of drugs such as Lucentis and Eylea have revolutionized the care of patients. Laser photodynamic therapy, radiotherapy and surgery is available for selected cases. Early diagnosis and treatment of wet AMD is essential in reducing the risk of severe loss of vision.
VEGF stands for 'vascular endothelial growth factor'. It is one of the chemicals responsible for the growth of new blood vessels that form in the eye as a result of wet AMD. Anti-VEGF medicines work by blocking this chemical and stopping it from producing the blood vessels. Lucentis and Eylea are the most commonly used anti-VEGF treatments used in the UK.
The anti-VEGF medication has to be injected into your eye using a very fine needle. You will be given local anaesthetic eye drops so the procedure does not hurt. Most people tolerate this very well with minimal discomfort.
Anti-VEGF medication is primarily used to stop wet AMD from getting worse. However, in some cases it has also been shown to shrink the blood vessels in the eye and restore some of the sight lost as a result of macular degeneration.
The experienced retinal consultants at the Liverpool Eye Clinic can tell you if you are suitable for anti-VEGF treatment with Lucentis or Eylea.
Lucentis (ranibizumab)
Studies show that Lucentis can help slow loss of visual acuity in over 90% of people, and may even increase visual acuity in around a third of people.
You will be given one injection of ranibizumab into your affected eye once a month, for three months. After this time, you will be monitored during a 'maintenance phase'.
If your vision deteriorates and is thought to be due to further leakage of fluid during this maintenance phase, you may be given another injection of ranibizumab. This monitoring will continue, and you will have injections as necessary, with at least one month in between injections.
If your condition does not show signs of improvement after treatment with Lucentis, or continues to get worse, alternative treatments will be considered.
Common side effects of ranibizumab include:
minor bleeding from your eye
minor discomfort in your eye
inflammation or irritation of the eye
feeling like there is something in your eye
increased pressure within your eye
Eylea (aflibercept)
Eylea is a further type of anti-VEGF medication for wet AMD and studies have shown that it is at least as effective as ranibizumab in treating people with the condition.
At first, you will be given one injection of aflibercept into your affected eye once a month, for three months. Injections will then be given once every two months. After a year of treatment, the intervals between injections can be extended depending on how well the medication is working.
On average, treatment with Eylea tends to involve fewer injections and monitoring visits than treatment with Lucentis.
Common side effects of aflibercept are similar to Lucentis, including:
minor bleeding in your eye
minor discomfort in your eye
inflammation or irritation of the eye
feeling like there is something in your eye
increased pressure within your eye
Verteporfin photodynamic therapy (PDT)
PDT was developed in the 1990s and pioneered in Liverpool. It is only available in a limited number of sites in the UK (including the Liverpool Eye Clinic) and is only suitable for selected cases of wet AMD. It involves having a light-sensitive medicine called verteporfin injected into a vein in your arm. The injection lasts around 10 minutes. The verteporfin attaches itself to the abnormal blood vessels in your macula (the part of your eye responsible for central vision).
A low-powered laser is then shone into your damaged eye, over a circular area just larger than the affected area in your eye. This usually takes around one minute.
The light from the laser is absorbed by the verteporfin and activates it. The activated verteporfin destroys the abnormal vessels in your macula while reducing harm to other delicate tissues in your eye.
Destroying the blood vessels stops them leaking blood or fluid, preventing damage and therefore stopping the macular degeneration from getting worse.
You may need this treatment every few months to ensure any new blood vessels that start growing are kept under control.
Radiotherapy
Radiotherapy has been used in the past for treating wet AMD with varying results. Recently, radiotherapy has been investigated to see whether its use in combination with anti-VEGF injections may be of benefit in reducing the number of injections needed. Although early results of some studies are encouraging, the longer term benefits are still unknown.
The retinal consultants at the Liverpool Eye Clinic have more than 15 years experience in the delivery of radiotherapy for AMD and can advise you as to its suitability for you.
Surgery
Surgery is suitable for a limited number of wet AMD cases with recent bleeds underneath the macula or into the cavity of the eye. In recent years new surgical techniques have been developed to treat wet AMD including macular rotation and telescopic intraocular lens implantation. Both these techniques have shown spectacular results in isolated cases but are only suitable for selected cases of AMD. The retinal consultants at the Liverpool Eye Clinic will be able to advise suitability for these techniques and the more experimental techniques being explored of stem cell transplantation, retinal pigment epithelial transplantation and retinal microchip implantation.
What services we offer
Management of Wet AMD
The retinal consultant at the Liverpool Eye Clinic can offer one stop clinics for the diagnosis, investigation and management of AMD.
Facilities available include the latest ETDRS vision charts, colour photography, fluorescein angiography and Optical Coherence Tomography (OCT) in our imaging suite and full facilities for intravitreal anti-VEGF injections, laser PDT and surgery in our dedicated facility.
The retinal consultants at Liverpool Eye Clinic are amongst the most experienced and respected of all UK retinal specialists and have been at the forefront of development, research and delivery of the most successful forms of AMD treatment over the recent decade. They are regularly invited to advise at national and international level on the management of AMD and other retinal disorders and can advise patients on all the latest forms of treatment available. Individual profiles of our retinal consultants (Messrs Beare, Briggs, Harding and Pearce) are available on the Liverpool Eye Clinic website.
Monitoring of AMD
The retinal consultants at the Liverpool Eye Clinic can advise on all aspects of AMD care and can provide regular advice and monitoring of both dry and wet AMD. The fully equipped imaging suite at the Liverpool Eye Clinic at One Penny Lane can provide rapid analysis to identify the earliest stages of AMD.
For an annual fee, regular monitoring and imaging can be arranged utilizing the latest macular imaging equipment to identify and manage both dry and wet AMD.