Do you have or know someone who has age-related macular degeneration?

Also known as AMD, this condition is the third most common cause of blindness and poor vision in our country for older individuals, specifically those past the age of 60.

This makes it vital to recognise the early symptoms of age-related macular degeneration, as this is key to treating and managing the condition. Today, we’ll help with that by taking you through all you need to know about the ailment.

What is Age-Related Macular Degeneration (AMD)?

Let’s start with the core problem, which is macular degeneration.

When we speak of macular degeneration, we refer to a condition that causes a gradual loss of central vision while mostly leaving peripheral vision untouched. This is contrary to glaucoma, which tends to affect the peripheral vision first.

This vision loss is due to a part of the eye called the macula being damaged. This is the central region of the retina, and the area that allows us to see images sharply.

When damage to the macula occurs in someone older (as is common), we call it age-related macular degeneration.

So, how does age-related macular degeneration affect vision? Generally, it just worsens the central part of what we can see, and as such, it rarely leads to complete blindness.

The two forms of Age-related Macular Degeneration

There are two types of AMD: wet and dry. Dry AMD is the more common form of age-related macular degeneration, found in 85-90% of cases.

For this, the degeneration of the macula happens gradually. As the cells age and start to break down, damage accrues. Waste deposits from the dead cells also start to build up in your eye, furthering the damage.

The more serious variant of AMD is called Wet AMD. This can cause a rapid or sudden drop in vision, and is usually a result of blood vessels appearing under the retina abnormally.

Blood and fluids can leak out of these blood vessels, which ends up damaging and scarring the retinal cells. Over time, this can lead to severe scarring and loss in vision.

Fortunately, only 10% of dry AMD cases will progress to this more severe form.

Early symptoms of Age-Related Macular Degeneration

So, how can you tell if you have AMD? As it happens, a lot of people actually don’t see age-related macular degeneration symptoms early on.

However, there are some things to try and look out for, to be safe. For instance, the earliest symptom of age-related macular degeneration is a change in your vision.

This change can be acute or gradual. It may even present with something as odd as images suddenly being distorted, e.g. a straight beam appearing to have a wave in it.

Another possibility would be sudden visual obstruction of your central vision. These can range from blurry spots to patches of visual blurring or loss.

Some people also report lowered sensitivity to contrast or difficulty telling similar colours apart.
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What eye exams are used to check for AMD?

Generally, a doctor will need to perform a a dilated eye exam to properly examine your retina and macula. This exam may involve several common tests performed by eye doctors to confirm the diagnosis. These include:

• Amsler grid screening - This is a simple test  test where your eye doctor will ask you to look at several straight lines forming a grid of squares. Any distortion in these lines or even missing lines or squares may indicate AMD.

• Optical coherence tomography, or OCT - This involves passing a non-irradiating laser beam through your eye to get detailed images of the various layers of your macula. This allows the doctor to assess whether the AMD is wet or dry. This test is fast, non-invasive, and painless, and is a mainstay for diagnosing and monitoring AMD.

• Angiography - This test is sometimes done when more detailed features of the macula or the degeneration need to be seen. It involves injecting a dye through your blood stream to look at the circulation through the blood vessels in the eye. 

The photos help doctors check for vessels that may be broken or abnormal. As such, this isn’t typically used to check for the dry form of AMD, which doesn’t involve abnormal blood vessel formation.

Who is at risk for AMD?

While there is no perfectly reliable way to predict who shall get age-related macular degeneration, there are some correlations. The following all seem to heighten the possibility of getting an age-related macular degeneration diagnosis:

• Positive family history
• Smoking
• Obesity and raised Body Mass Index
• Presence of other cardiovascular risk factors 

Age-related macular degeneration is among the more common concerns for our population. For example, a 1997 study found that 1 out of every 4 Singaporean residents aged 60 and above has the condition. 

This emphasizes the value of regular eye screenings, especially for anyone at least 50 years old and bearing a family history of the condition.

Prevention and treatment for Age-Related Macular Degeneration

Fortunately for us, medical and surgical advances have opened up new treatment options for the condition. Below are some of the available options.

‍ 1. Intravitreal anti-VEGF injections

The most common way to treat wet AMD currently is via intravitreal injections of anti-vascular endothelial growth factors.

Intravitreal injections involve injecting a needle into the back cavity (also known as the vitreous cavity) of the eye. 

Meanwhile, anti-vascular endo-thelial growth factors, or anti-VEGFs, are antibodies or proteins that help to treat the bleeding or leakage of fluid in the eye, which is the hallmark of wet AMD.

Common anti-VEGF agents used currently include the following:

• Lucentis (Ranibizumab)
• Eylea (Aflibercept)
• Vabysmo (Faricimab)

2. Laser therapy

It’s also worth noting that some cases of AMD may benefit from laser therapy. The lasers used include argon lasers or photodynamic therapy.

Only your eye doctor can determine whether or not your case is a viable candidate for this treatment, however, as not all AMD is amenable or needed to be treated with laser therapy.

3. Lifestyle interventions (to prevent or potentially slow disease progression)

All of the procedures we’ve detailed are designed to stop the disease from getting worse instead of completely curing it. But at the end of the day, prevention is better than cure. And certain lifestyle habits can hopefully prevent this condition from reaching the advanced stages.

Healthy diets rich in anti-oxidantes as well as omega 3 and 6 fatty acids can improve eye health. These include foods such as fish, green leafy vegetables and nuts, just to name some examples. A large multicenter study (AREDS) has also shown that taking certain supplements may decrease the risk of progression for certain types of AMD. 

Aside from that, we should try to avoid things known to increase the risk of AMD development. Smoking is the main modifiable risk factor, and should be avoided or stopped. Also, maintaining a healthy lifestyle will not only help your eye health but also your general well-being. 

Get screened for AMD today

AMD is a condition that affects a good share of Singaporeans over 60, but as you can see, there are ways to try to avoid it as well as treat it if it does present.

Again, however, it’s vital to note that as with glaucoma, AMD is not completely reversible. To be exact, it’s not possible to restore vision that has already been lost.

This simply underscores the need for regular eye screenings – so that you can take steps to halt the advance of macular degeneration before it does more irreparable damage.

If you want to get screened for AMD and similar eye problems today, reach out to us at the Shinagawa Eye Centre. We can perform all of the assessments you need to better care for your vision.

Call us to enquire or book an appointment for treatment now.