Eye Info

Treatments for Age-Related Macular Degeneration (AMD)

Summary: AMD is the most common cause of poor sight amoung people over 60.

What is the macula?

At the back of the eye is a layer of light sensitive tissue called the retina. The macula is found at the centre of the retina where the incoming rays of light are focused. The macula is very important and responsible for: what we see straight in front of us, the vision needed for detailed activities such as reading and writing and our ability to see colour.

What is age-related macular degeneration (AMD)?

Sometimes the delicate cells of the macula become damaged and stop working. We do not know why this is, although it tends to happen as people get older and is referred to as age-related macular degeneration. AMD is the most common cause of poor sight among people over 60 but never leads to complete sight loss as peripheral or side vision will remain undamaged. There are two different types of AMD:

Dry AMD: Around 90 per cent of people diagnosed with AMD have the dry type. It occurs when the cells of the macular become old and start to waste away meaning that these cells can no longer function properly. Dry AMD is also called non-exudative AMD.

Wet AMD: this is less common (10 per cent of cases) and occurs when tiny new blood vessels grow between the retina and the back of the eye. These blood vessels leak and bleed as they grow causing scarring of the macula. Wet AMD is also known as exudative or disciform degeneration.

What treatment is available for AMD?

Dry AMD

Although there is currently no treatment available for dry AMD, you can be helped to see better with a variety of optical aids which make use of the parts of the retina that are not affected. These range from brighter reading lights and magnifying glasses to more sophisticated equipment. Ask your doctor to refer you to a low vision clinic.

Wet AMD

People with wet AMD can also be helped to see better with optical aids and equipment. There is also some treatment available for wet AMD, however it is not suitable for use in all cases.

Laser treatment

Wet AMD can sometimes be treated by laser, a device that gives an intense beam of light. This is usually done as an outpatient and although it may cause some discomfort, it is not painful. A special contact lens is put onto the eye to help focus the laser onto the macula and the heat from the laser beam then destroys the leaky blood vessels. The benefit of this treatment is that it can prevent further degeneration of the macula. However, the laser treatment can damage healthy macula cells meaning that you might lose a little sight to save a lot. Laser treatment is only useful in about 10 per cent of people with wet AMD and this always where people have reported their symptoms early.

Photodynamic therapy

A new treatment for wet AMD has recently been announced called photodynamic therapy (PDT). With PDT a light-sensitive dye is injected into the bloodstream and is transported to the retina at the back of the eye. This chemical highlights the blood vessels that are growing abnormally. A low energy or 'cold' laser beam is then shone onto the macula. This makes the chemical react and destroy the leaking blood vessels without damaging the healthy tissue around the affected area in the back of the eye. More than one treatment is usually required.

PDT has been the subject of clinical trials and has been approved for use within the European Community. It is routinely available in the USA, Canada and most European countries. In the UK the treatment is offered at a number of centres and is currently the subject of an appraisal by the National Institute for Clinical Excellence.

It is estimated that between 5,000 and 7,000 people in the UK each year could benefit from PDT. However, it is important to note that wet AMD can progress rapidly. For PDT to be as effective as possible, individuals with early wet AMD need to be fast-tracked through the referral and waiting list processes in order to receive treatment before further loss of vision occurs.

PDT is unsuitable for long-established wet AMD and cannot restore sight that has already been damaged by macular degeneration. PDT cannot be used to treat dry AMD.

Other treatments

New treatments for 'wet' macular degeneration are being developed all the time. A group of treatments called anti VEGF therapies are likely to be the next available in the UK. There are a number of different treatments being tested but all of them involve an injection into the eye that stops the development of the new leaky blood vessels. This has to be repeated about every six weeks for as long as your doctor thinks is necessary. Like PDT this type of treatment is limited to people whose 'wet AMD' affects the middle of the macula and its main aim is to stop 'wet AMD' from getting worse. However, in some cases it has been shown to restore some of the vision already lost and it can help with a wider range of people than PDT.

At the moment these anti VEGF treatments are not available on the NHS. However local Primary Care Trusts can decide on a case-by-case basis whether or not to provide this treatment through the NHS. The treatment may also be available privately. To find out if anti VEGF treatment would help your eye condition and if it is available in your area, please speak to your eye specialist. More treatments for 'wet' AMD are likely to become available in the near future adding to the treatment choices available.

Where can I get more advice?

If you need advice on treatment options for your type of AMD, it is best to speak to your ophthalmologist at the hospital.

Further information

For further information, advice and support please contact:

RNIB Helpline:
Telephone 0845 766 99 99 (calls charged at local rates)
Email helpline@rnib.org.uk

The Macular disease also provides information and support for people dealing with macular degeneration and related retinal diseases they can be contacted at.

The Macular Disease Society
PO Box 1870
Andover
Hampshire
SP10 9AD
Helpline

Telephone 0845 241 2041
email info@maculardisease.org

RNIB is part of an organisation called AMD Alliance International whose role is to promote awareness of age-related macular degeneration – the leading cause of blindness in the western world. If you'd like more information please go to the AMD Alliance website at http://www.amdalliance.org/

1995-2007 RNIB, Registered charity number 226227

Content author: helpline@rnib.org.uk

Last updated: 20/10/2008 15:51

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