Age-related macular degeneration (AMD) affects a tiny part of the retina at the back of your eye, called the macula. AMD causes changes to the macula, which leads to problems with your central, detailed vision. AMD doesn’t cause pain and doesn’t lead to the total loss of sight.

AMD affects the vision you use when you’re looking straight at something, for example when you’re reading, looking at photos or watching television. Your central vision can become distorted or blurry, and over time, a dark or missing area may appear in the centre of your vision.

What are the symptoms and when should I seek help?

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. 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.

You should have your eyes tested by an optometrist (also known as an optician) 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.

Your optometrist can measure any changes in your vision and look at the back of your eye. They may see 'drusen’ when they examine your retina. Drusen are small deposits under the retina, which they can see as yellow dots. Drusen can be present as a normal part of ageing and are not always a sign that someone has AMD. Your optometrist might say you have early AMD if you have a few medium sized drusen in one or both your eyes.

If your optometrist 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 (also known as a hospital eye doctor) and arrange an appointment for you.

What are the different types of AMD?

AMD can be further classified as ‘early’, ‘intermediate’ and ‘late’. In early and intermediate AMD, there may be no vision loss and there may be no symptoms. Early and intermediate AMD are often picked up in a routine eye examination by the optometrist due to the presence of drusen at the macular area.

There are two main types of late or advanced AMD, “dry” AMD and “wet” AMD. They are called “dry” and “wet” because of what happens inside your eye and what the ophthalmologist sees when examining the inside of your eye, not because of how your eye feels or whether you have a watery or dry eye.

Dry AMD

This is also known as geographic atrophy, where there is central vision loss because all the cells at the macula have degenerated so much that they no longer work. It

It is the more common type of AMD. Dry AMD develops very slowly and causes a gradual change in your central vision. It usually takes a long time – sometimes years, to get to its final stage. At its worst, dry AMD causes a dark or missing area in the centre of your vision in both of your eyes. It doesn’t affect your peripheral vision, so it never leads to total blindness. Some people with this stage of AMD may go on to develop the wet form of AMD.

Wet AMD

About 10 to 15 per cent of people who develop late AMD have wet AMD, often having had dry AMD to begin with. You develop wet AMD when the cells of the macula stop working correctly and your body starts growing new blood vessels to fix the problem. As these blood vessels grow in the wrong place, they cause swelling and bleeding underneath the macula – this is why it’s called “wet” AMD. This new blood vessel growth is medically known as neovascularisation. It causes more damage to your macula and eventually leads to scarring. Both the new blood vessels and the scarring can damage your central vision.

Wet AMD can develop very quickly, causing serious changes to your central vision in a short period of time, over days or weeks.

Treatment is available for wet AMD, which stops the new blood vessels from growing and damaging your macula. This treatment usually needs to be given quickly before the new blood vessels do too much damage to your macula. If the blood vessels are left to grow, the scarring and the sight loss they cause is usually permanent. Wet AMD doesn’t affect your peripheral vision, so it doesn’t lead to total blindness.

What is the treatment for AMD?

Early or intermediate AMD has no treatment. There’s some evidence that high doses of vitamin A, C, E, the minerals zinc and copper and the micronutrient lutein when taken together may help slow down the progression of intermediate AMD, particularly if wet AMD has already caused vision changes in one eye. However, there is no evidence that taking high doses of these vitamins can prevent you from developing AMD in the first place.

There are several vitamin products available which have been designed for people with dry AMD and you can usually buy these over the counter or from your pharmacist. A balanced diet with plenty of fresh fruit and vegetables is good for your general health and may also help your eye health.

You can find more information about antioxidant vitamins for AMD on our website or by calling our Helpline for a factsheet.

Treating Late AMD

Unfortunately, at the moment there is no way to treat late 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.

Treating Wet AMD

The treatment available on the NHS for wet AMD is a group of medications called anti-vascular endothelial growth factor (anti-VEGF) drugs. 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. Click the link below for more information on anti-vascular endothelial growth factor (anti-VEGF) drugs.

What help is available?

Both types of AMD can cause severe problems with your central vision. However, most people with AMD have some vision and there are a lot of things you can do to make the most of your remaining vision. This may mean making things bigger, using brighter lighting, or using colour to make things easier to see.

Coping

It’s completely natural to be upset when you’ve been diagnosed with AMD and it’s normal to find yourself worrying about the future and how you will manage with a change in your vision.

It can sometimes be helpful to talk about these feelings with someone outside of your circle of friends or family. At RNIB, we can help with our telephone Helpline and our Sight Loss Counselling team. Your GP or social worker may also find a counsellor for you if you feel this might help.

Your eye clinic may also have a sight loss adviser (also known as an Eye Care Liaison Officer or ECLO), who can be on hand to provide you with further practical and emotional support about your eye condition.

The Macular Society has local groups which meet throughout the country and also offer a telephone counselling service. Sometimes, it can help to talk about your feelings or share your experience with people who may have had similar experiences.