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Age Related Macular Degeneration

Age Related Macular Degeneration (ARMD) is a common condition that affects the central part of the retina (the macula lutea) as people get older.

Human Retina

Human Retina

ARMD is commonly divided into two types, dry and wet. Dry is a very slowly developing wear and tear of the retina at the back of the eye. Most people have the dry form (90%), and in the vast majority of cases this has little effect on eyesight. By the age of 70, 1 in 3 people have some signs of ageing at the back of the eye. Very occasionally in the dry form the macula can wear out (atrophy). This can slowly affect central vision.

Some people develop the wet form where new blood vessels grow under the centre of the retina. This can make central vision worse over a matter of weeks. All people with the wet form initially had the dry form.

Normal Vision

Normal Vision

The same picture seen by a patient with Age Related Macular Degeneration

The same picture seen by a patient with Age Related Macular Degeneration

The abnormal blood vessels at the back of the eye are classified into 2 main groups by their appearance on a special photograph of the back of the eye called a fluorescein angiogram. These are called classic and occult.

How can wet ARMD be treated?

1. Argon Retinal Laser

The earliest treatment for wet ARMD was Argon Retinal Laser. This destroys the blood vessels but also destroys the overlying retina leaving a blind spot (scotoma).

This means that only blood vessels away from the centre can be treated. Even when the laser is successful, there is a high chance the blood vessels will come back (more than 50% over 2 years). Most blood vessels occur under the centre so laser is not appropriate for the majority of cases.

2. Photodynamic Therapy

The next treatment that became available was photodynamic therapy (PDT). This works best for the treatment of classic blood vessels. This involves having an injection of a light sensitizing dye called verteporfin (trade name visudyne) into a vein. This dye travels round the body and sticks to the abnormal blood vessels at the back of the eye. A cold laser of a specific wavelength of light is then shone at the abnormal blood vessels 15 minutes after the beginning of the injection. This activates the drug and makes it release noxious chemicals called free radicals. These chemicals damage the blood vessels. The treatment is a course of assessments and possible treatments every three months for 2 to 3 years. The treatment reduces the chance of losing a lot of vision, but on average eyesight still gets worse.

3. Anti Vascular Endothelial Growth Factor (VEGF)

The most modern treatment for wet ARMD is Anti VEGF injections. There are 2 main drugs used, Avastin and Lucentis. These both involve a 2 year course of injections into the vitreous of the eye.

How can I prevent ARMD?

Smoking has been shown to increase the risk of developing ARMD. In some cases multivitamins can reduce the risk, but a diet rich in vegetables and fruit is also important. Red, green and yellow fruits are good for the eye, as are green vegetables, particularly spinach and kale top.

How can dry ARMD be treated?

Currently there are no effective treatments for dry ARMD. The risk of it getting worse can be reduced by multivitamins, if appropriate. In some circumstances, an implantable telescope such as the Implantable Miniature Telescope or the IOL VIP system can improve vision.

Useful Links

The Macular Disease Society

Telephone: 0845 241 2041

The Royal National Institute of Blind People (RNIB)

Telephone: 0845 766 9999