Vision Loss – could it be Macular Degeneration?
Age-related macular degeneration (AMD) is a painless eye condition that causes you to lose central vision, usually in both eyes. Central vision is what you see when you focus straight ahead. There are 2 types of AMD – dry AMD and wet AMD.
The main symptom of macular degeneration is blurring of your central vision. This means:
- you lose visual acuity – the ability to see fine detail, so reading and driving become difficult
- you lose contrast sensitivity – the ability to distinguish between objects such as faces against a background
- images, writing or faces can become distorted in the centre – most commonly associated with wet AMD
Your peripheral vision (side vision) isn’t affected. Glasses won’t be able to correct your blurred central vision. Both eyes tend to eventually be affected by AMD, although you may only notice problems in one eye to begin with.
If you have dry AMD, it may take 5 to 10 years before your loss of vision significantly affects your daily life. Sometimes your healthy eye will compensate for any blurring or vision loss if only one of your eyes is affected. This means it will take longer before your symptoms become noticeable.
You may have dry AMD if:
- you need brighter light than normal when reading
- text appears blurry
- colours appear less vibrant
- you have difficulty recognising people’s faces
- your vision seems hazy or less well defined
If you’re experiencing any of these symptoms, you should make an appointment with your GP or local optometrist (a healthcare professional trained to recognise signs of eye problems).
In most cases, wet AMD develops in people who’ve already had dry AMD. If you have wet AMD, any blurring in your central vision will suddenly worsen.
You may also experience other symptoms, such as:
- visual distortions – for example, straight lines may appear wavy or crooked
- blind spots – these usually appear in the middle of your visual field and become larger the longer they’re left untreated
- hallucinations – seeing shapes, people or animals that aren’t really there
Book an emergency appointment with an optometrist if you experience sudden changes in your vision, such as those described above. Wet AMD needs to be treated as soon as possible to stop your vision getting worse.
Why it happens
Dry AMD develops when the cells of the macula become damaged by a build-up of deposits called drusen. The macula is the spot at the centre of your retina (the nerve tissue that lines the back of your eye). The macula is where incoming rays of light are focused. It helps you see things directly in front of you and is used for close, detailed activities, such as reading and writing. It’s the most common and least serious type of AMD, accounting for around 9 out of 10 cases. Vision loss is gradual, occurring over many years. However, an estimated 1 in 10 people with dry AMD go on to develop wet AMD.
Wet AMD – sometimes called neovascular AMD – develops when abnormal blood vessels form underneath the macula and damage its cells. It’s thought these blood vessels form as an attempt by the body to clear away the drusen from the retina. Unfortunately, the blood vessels form in the wrong place and cause more harm than good. They can leak blood and fluid into the eye, which can cause scarring and damage to your macula. Wet AMD is more serious than dry AMD. Without treatment, vision can deteriorate within days.
The exact cause of macular degeneration isn’t known, but the condition develops as the eye ages.
Who has an increased risk?
It’s unclear what triggers the processes that lead to AMD, but a number of things increase your risk of developing it. These are described below.
The older a person gets, the more likely they are to develop at least some degree of AMD. Most cases start developing in people aged 50 or over and rise sharply with age. It’s estimated 1 in every 10 people over 65 has some signs of AMD.
AMD has been known to run in families. If your parents, brothers or sisters develop AMD, it’s thought your risk of also developing the condition is increased. This suggests certain genes you inherit from your parents may increase your risk of getting AMD. However, it’s not clear which genes are involved and how they’re passed through families.
A person who smokes is up to four times more likely to develop AMD than someone who’s never smoked. The longer you’ve been smoking, the greater your risk of getting AMD. You’re at even greater risk if you smoke and have a family history of AMD.
Studies have found rates of AMD are highest in white and Chinese people, and lower in black people. This could be the result of genetics.
In some cases, early age-related macular degeneration (AMD) may be detected during a routine eye test before it starts to cause symptoms. If you’re experiencing symptoms of macular degeneration, such as blurred central vision, visit your GP or make an appointment with an optometrist. If your GP or optometrist thinks that you have wet AMD, you’ll be referred to an ophthalmologist. Your appointment will usually be at a hospital eye department. If you need to travel by car to the hospital, ask someone else to drive you back as the eye drops given to you may make your vision blurry.
The ophthalmologist will examine your eyes. You’ll be given eye drops to enlarge your pupils. The ophthalmologist will use a magnifying device with a light attached to look at the back of your eyes, where your retina and macula are. They’ll check for any abnormalities around your retina. The ophthalmologist will then carry out a series of tests to confirm a diagnosis of macular degeneration.
Treating macular degeneration
There’s currently no cure for either type of AMD. With dry AMD, treatment aims to help a person make the most of their remaining vision – for example, you may wish to try:
- magnifying lenses
- large-print books
- very bright reading lights
- screen-reading software on your computer so you can “read” emails and documents, and browse the internet
Diet and nutrition
There is evidence a diet high in vitamins A (beta-carotene), C and E – as well as substances called lutein and zeaxanthin – may slow the progression of dry AMD, and possibly even reduce your risk of getting wet AMD. Foods high in vitamins A, C and E include:
- leafy green vegetables
Leafy green vegetables are also a good source of lutein, as are peas, mangoes and sweetcorn. There’s no definitive proof eating these foods will be effective for everyone with dry AMD, but this type of healthy diet has other important health benefits, too.
The current recommended supplements for AMD include a combination of antioxidants, carotenoids, and omega-3 fatty acids. It is recommended especially for people who are not eating enough greens and fish.
Recommended daily intake
Lutein, 6-10 mg
Vitamin C, 500 mg
Vitamin E, 200 – 400 IU
Vitamin D3, 1000 – 2000 IU
Zeaxanthin, 2 mg
Zinc, 20 – 80 mg (with copper 2mg)
Omega-3 fatty acids, 1000 mg (fish oil) if not eating fish
Dietary supplements (eg Macushield and Macusave, Ocuvite Lutein Forte) are also available in case you are not getting enough from diet alone. Consultant opthalmologists will often prescribe these supplements that used to be allowed on the medical card but are now only available to purchase over the counter. These products contain the ingredients that are shown to slow the progression of dry AMD. Clinical trials have shown that boosting the diet with 10mg Meso-Zeaxanthin, 10mg Lutein and 2mg Zeaxanthin – led to significant improvements in the protection of the delicate macula as well as improved vision. There is also a growing body of evidence to suggest that supplementing the macular pigment in this way with all three macular carotenoids may also help to slow or possibly even prevent, age-related macular degeneration (AMD). The main difference between these products is price. Grants Pharmacy have a special opening offer price on Macusave, €12.50 for a box of 30, or €29.95 for a box of 90.
Reducing your risk
It’s not always possible to prevent macular degeneration because it’s not clear exactly what triggers the processes that cause the condition. Your risk of developing AMD is closely linked to 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 smoking if you smoke
- taking supplements recommended
- eating a healthy, balanced diet that includes plenty of fruit and vegetables
- moderating your consumption of alcohol
- trying to achieve or maintain a healthy weight
- wearing UV-absorbing glasses when outside for long periods
Visit us in Grants Pharmacy to identify the best products recommended for you or to chat about AMD. Grant’s pharmacy is open 6 days a week for any queries on the above or any other worry you may have. Leonie, Janet or any Pharmacist in Grants Pharmacy can tell you more about the supplements in this article. Pop in and experience a fast, friendly and informed service. Grant’s Pharmacy is located in Wexford town, in Enniscorthy town, in Arklow town – all beside Pettitts and in Gorey town opposite the GPO. Find us on Facebook.