Well, this really depends on the stage of macular degeneration.
There are two stages: dry and wet.
In the very early stages of dry AMD, you may not notice anything at all, but
you may be finding it difficult to read close up, particularly small print, and you will go see your optician.
When you see your optician, the optician will tell you have dry AMD and this may cause you some alarm.
However, do not be too concerned, as you have not any symptoms at this point and may not for many years.
However, later in the disease, you may change from dry AMD to wet AMD,
and when this happens, you get a distortion in your vision.
When you look at straight lines, for example, if you look at the side of a table or a window
or perhaps straight lines on a grid like this, called an Amsler grid,
which sometimes the opticians give you to look at.
And you will get distortion of those straight lines – they may appear curved or wiggly.
In the later stages, if you develop a bleed within the eye,
then your vision may dramatically change and you may see a black spot in the centre of your vision.
And I will show you a picture of that here.
However, this is at very advanced stages and it's unlikely that you will get to this stage.
This is the question I often get asked by my patients because they're very concerned
and they don't really understand the difference between the two.
So Dry AMD is often asymptomatic, and you will be found to have this by your optician.
With time, what happens when you're reading,
you'll notice that you cannot see so well without very bright lights or unless you have very large print.
This may not mean that you have dry AMD but can be an early sign.
It could just be that you have problems with age as you cannot read close up,
and this is very common after the age of 40.
When you see your optician, he will take some photographs of the back of the eye
and he may well show you these pictures of the dry AMD.
What we see at the optician's and with the slit lamp is we see these small discreet yellow dots.
We call these drusen.There are two types: they are discreet, dry drusen, and you have kind of soft drusen.
And the soft drusen are the ones that will turn into wet AMD.
We classify dry AMD into early (stage one), slightly more advanced (stage two), and then stage three and stage 4.
Stage 3 and stage 4 are the conditions in which we are more worried.
If you're stage 1 or stage 2, you probably may not develop symptoms for many years.
So, you can ask your ophthalmologist which stage you're on and this may help with treatment.
The last stages of dry AMD we call atrophy, which is when the tissues slightly thin in the eye and then
you develop kind of missing patches in your eyes.
However, this can be overcome with increasing the print size that you use.
Wet AMD is completely different to dry AMD and only ten percent
of patients will develop the wet AMD – thank goodness!
But with a wet AMD, this is a change in the development of the drusen. They start to soak up water
and as they do this, they break through a part of the retina called Bruch's membrane.
Bruch's membrane forms a barrier between the retina layers and the blood vessels underneath.
If you can imagine the blood vessels in the retina like a bag of blood, this blood is very important and
it provides nutrition to the rest of the eye.
When you develop breaks in Bruch's membrane, then the blood vessels start to burst through
and they will start to grow inside the retina, and this is why you get the distortions.
They push aside the photoreceptors in the eye, which carry the images to your brain
and they start to cause distortion as you can imagine.
How I always explain it to my patients is if you can imagine a pizza. So, the pizza is basically a tomato base
and then you have the cheese on top, and the tomato is supposed to stay under the cheese.
But what happens is the cheese starts to stretch and the tomato
comes up and goes on top of the retina and causes the black splotches and the distortion.
So, what we need to do is to stop that tomato sauce coming up onto your retina.
And we do have treatments for that. So, with a wet AMD, it is completely different to dry,
and you may realise that the changes happen because you get the distortion.
The major risk factor for macular degeneration (age-related) is probably family history.
So, if you have a family history – some family member – and that would be your mother,
your grandmother, your father or even a brother or sister, that would be the major risk factor.
We're looking at those genes for this condition at the moment, although, there's many, many genes.
The next risk factor, which is very important, which can be modified, is smoking.
So, we know this from the studies carried out in
the United States called that the AREDS trial (A-R-E-D-S) that smoking is a major risk factor.
So, if you smoke, it's a very good idea to stop and you can also tell your family members,
your children to stop smoking as this will lead to wet macular degeneration.
Obviously, stopping smoking is not easy. The other risk factors are probably dietary.
How do we know this? Well, we've looked at studies coming from Japan, Denmark and Italy.
And particularly in Japan there was no evidence of wet AMD until quite recently, in the last
25 years – probably because of their diet, because they have a very varied diet and they
were not eating processed foods. Again, there's a very interesting study in Italy that shows
in areas which are using mainly organic farming and no access to processed foods, the incidence
of wet AMD was unheard of until the last 20 years. Major studies in Denmark with nurses
have shown if you increase your fruit and vegetables and you don't eat processed foods,
again, your risk of AMD is greatly reduced, which is why we often give dietary advice
to our patients.
Well, it depends of course on the form of AMD. There's dry and wet.
The dry AMD, many doctors will say to you there's no treatment, but that's not entirely true.
We do give dietary advice and we advise you to stop smoking
and you can get some help from your GP with stopping smoking.
This is obviously important, because you have two eyes and one eye may not be affected.
So, although you may say to yourself “one eye has been affected, what's the point?”, there is a point to stopping smoking.
With the dietary advice, you can either take supplements,
which we will give you specific advice on which supplements to take.
And you've got to be very careful if you smoke which supplement you take as it can be an increased risk of
other diseases if you take those supplements and you've been a smoker.
There are fantastic treatments for wet AMD. These have been in use since 2004.
The injections that we are given sound very frightening, but in actual fact, once you have your first injection,
you're usually relieved as it's nowhere near as bad as you think it will be
and really does last just for a few seconds.
We treat the patients with a series of injections.
Unfortunately, it's not just one injection. You usually have one injection a month for
three months and then you'll have a further six to seven injections. And then after that
we start every two months and then we start increasing the interval between the injections,
until we get to an interval of about three months.
Many of my patients have had over 30 to 40 injections and are still doing extremely well.
And they have lost their anxiety they have regarding the treatment.
So when you come for the treatment, what will happen is
you will be consented for the treatment and told the risks.
The risks for the injection are extremely small: they are one in a thousand nationally for an infection
and one in 3,000 for any other cause, such as retinal detachment.
Many patients worry about the side effects of the treatment.
The treatment is actually what's called Anti-VEGF injection (anti-vascular endothelial growth factor).
This growth factor is produced in our body naturally. However, in age-related macular degeneration
this growth factor is increased in the retina, which is causing the blood vessels to grow.
The Anti-VEGF stops this in its tracks.
However, the treatment injection only lasts between one to two months,
which is why you need to keep on having the injections.
There are plans in the future to have injections which last a lot longer.
So some patients ask me, could there be any side effects in the body with these injections?
There is some association between these injections and, for example, cardiovascular disease and
stroke and I will talk to you about this on your consultation.