Macular Degeneration

Everyone can have slightly different symptoms, but usually the first thing you’ll notice is that it’s harder to see detail, such as small print. This may initially affect one eye or both.

You may find that your vision has a small, blurred area in the centre. Straight lines may look distorted or wavy, or like there’s a little bump in them. You may also find that you’re more sensitive to bright light.

AMD is not painful and does not affect the appearance of your eyes.

Dry AMD is the more common type of AMD and around 85% of cases. It results from the gradual deterioration of the macula as the retinal cells die off and are not renewed, it therefore develops very slowly and causes a gradual change in your central vision. Dry AMD usually takes a long time – sometimes years, to get to its final stage. At its worst, dry AMD causes a blank patch in the centre of your vision in both of your eyes. Many people with dry AMD do not totally lose their reading vision. If only one eye is affected you may not be aware of the change in your vision, and it may be detected unexpectedly during an eye test.

Wet AMD develops when the cells of the macula stop working correctly and your body starts growing new blood vessels to fix the problem. It therefore tends to present later; often where dry AMD already exists.

About 15% of AMD presents at wet AMD. Wet AMD can develop very quickly, causing serious changes to your central vision in a short period of time, over days or weeks. If you have dry AMD and you notice a sudden change in either of your eyes, you should let your optician or eye hospital know as soon as possible. This is because dry AMD can develop into wet AMD, and if this happens, sight-saving treatment may be possible.

You should have your eyes tested by an optician (also known as an optometrist) if you experience any of these in one or both eyes:

• You have difficulty reading small print despite wearing reading glasses.
• Straight lines start to look wavy or distorted. You can check this by looking at door and window frames, or tiles in your home.
• Your vision isn’t as clear as it used to be.

If your optician finds any changes to your macula or any cause for concern, they’ll send a letter to your GP or sometimes directly to the hospital.

Based on your optometrist’s letter, the hospital will judge how quickly you need to be seen by the ophthalmologist (the hospital eye doctor) and arrange an appointment for you.

Your optician may refer you to the hospital to see an ophthalmologist if they are concerned about your dry AMD diagnosis. If your optometrist suspects that you have wet AMD, then you’ll be referred very quickly to an ophthalmologist at the hospital.

Some people diagnosed with dry AMD may find that, with time, new blood vessels grow and they develop wet AMD. If you have dry AMD and you notice a sudden change in either of your eyes, you should let your optician or eye hospital know as soon as possible. This is because dry AMD can develop into wet AMD, and if this happens, sight-saving treatment may be possible.

You should seek an urgent (same day) appointment with an optician if:

• your vision gets suddenly worse.
• you have a dark “curtain” or shadow moving across your vision.
• your eye is red and painful.

These are not symptoms of AMD but can be signs of other eye problems that need to be treated immediately.

Go to A&E or call 111 straight away if you cannot get an urgent opticians’ appointment.

• Find an A&E department

Treatment depends on the type of AMD you have:

Dry AMD

Unfortunately, there is currently no way to treat dry AMD. Although research is going on to try and find out why the cells of the macula stop working, this has yet to lead to a proven treatment.

There is some evidence that high doses of vitamins C and E, the minerals zinc and copper and the micronutrients lutein and zeaxanthin when taken together may help slow down the progression of dry AMD, particularly if AMD has already caused vision changes in one eye. However, NHS England has advised doctors that there is insufficient evidence of effectiveness to allow prescription on the NHS and there is no evidence that taking high doses of these vitamins can prevent you from developing AMD in the first place. It is widely agreed that if you eat a healthy diet including at least five portions of fruit and vegetables a day, you should not need a supplement. Eating a healthy diet rich in oily fish, leafy green vegetables and fresh fruit is recommended. Orange and yellow fruits and vegetables such as sweetcorn and orange peppers are a good source of zeaxanthin. Broccoli, kale, leek, lettuce, peas, red pepper, and spinach are all good sources of lutein. Eggs contain both lutein and zeaxanthin, and many of these foods also contain vitamins C and E.

Wet AMD

The current treatments available on the NHS for wet AMD are a group of medications called anti-vascular endothelial growth factor (anti-VEGF) drugs. These medications are injected into the eyeball under local anaesthetic.

As new blood vessels form in your eye, your body produces a chemical which encourages further new blood vessel growth. Anti-VEGF drugs interfere with this chemical and stop the vessels from growing, minimising further damage to your sight.

Anti-VEGF injections will improve vision in about one in three people treated. However, treatment in most people will maintain vision and prevent the condition from becoming worse. About one person in every ten treated will not respond at all.

Lucentis® (medical name ranibizumab) was the first anti-VEGF to be licensed for wet AMD. In accordance with NICE AMD guidelines, all patients receive a standard ‘loading dose’ at the start of their treatment, normally three or more consecutive monthly injections.

There are two other licensed drugs available to treat wet AMD: Beovu® (brolucizumab) and Eylea® (aflibercept).

Older treatments for wet AMD are less effective than anti-VEGF injections and are only used in exceptional circumstances. These included laser treatment (which is difficult close to the macula, as it causes scarring and loss of vision) and photodynamic therapy. In photodynamic therapy, a medicine called verteporfin is injected into a vein and binds to the newly formed abnormal blood vessels in the macula, allowing them to be targeted with a type of laser.

Useful information about Macular Degeneration

• You can find out more about the research into the role of nutritional supplements in AMD.
• Read about living with AMD.
• The Macular Society helpline on 0300 3030 111.
• Understanding age-related macular degeneration – patient information leaflet by the Royal National Institute for the Blind (RNIB)
• What is AMD? – NHS UK
• About Macular Disease – Macular Society website
• Royal National Institute for the Blind (RNIB) website
• Macular Degeneration – Patient UK website
• Age-related macular degeneration – Moorfields Eye Hospital website

If you have been referred for a specialist opinion your details will be reviewed and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

How long will I wait?

If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.

• Waiting times
• Find services near you

Preparing for your appointment

RBIN Eye Tests Explained, Preparing For Your Appointment – for support and information on how to prepare for your appointment.