What is macular degeneration?
What is it look like if you have macular degeneration?
The central vision is blurry or sometimes missing but the peripheral or away from central vision is usually clear
What is the treatment for macular degeneration?
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What does the optometrist and eye surgeon see?
There are changes to the central part of the back of the eye, the macula called drusen, sometimes pigmentation and sometimes patches where the retina has worn out.
What is age related macular degeneration?
This is a condition where the part of the eye that enables us to see in detail, wears out and stops working. It is the commonest cause of blindness in the population over the age of 50 in the western world.
What are the types of disease?
The commonest type is dry AMD which is where the cells in the macula wear out and stop functioning in older age group patients. This happens due to a combination of factors, such as inherited genes, old age and lifestyle factors such as smoking.
Wet AMD is a much more aggressive form of macular degeneration where the eye starts to produce networks of abnormal blood vessels under the retina which leak fluid into the retina causing distortion and ultimately scar tissue can develop in the macula which destroys the central vision.
What are the symptoms of AMD?
Blurring of central vision, distortion of vision (straight lines looking wavy or wobbly), gaps in vision and reduced colour vision.
What are the treatments for AMD?
Dry AMD does progress slowly and until recently there has been no treatment for this condition, however I am pleased to be the only Ophthalmologist, in the United Kingdom able to offer access to the only treatment shown to provide an effective management for dry AMD, backed by scientific evidence.
Wet AMD can be treated with a course of injections into the eye which effectively stops the progress of the disease and can enable the vision to improve. These injections are given with minimal discomfort. No needles are seen by the patient prior to the injection being administered.
There are currently 3 medicines which can be given for this purpose, Avastin, Eylea and Lucentis. The latter 2 are licensed medications for the treatment of this condition. These medicines are accessed in the NHS in patients who have vision that has reduced significantly or have no scarring at the macula. Avastin is an unlicensed medicine which is as effective as the Lucentis but can be given outside the NHS environment but is much more cost effective for those funding treatment, because they do not meet the criteria for eligibility for NHS treatment.
How are injections given into the eye?
Local anaesthetic drops are used to numb the surface of the eye, a small device is placed on the eye, which keeps the eyelids apart, stabilises the eye and enables the injection to be delivered through the coats of the eye with little or no discomfort, with the patient only able to see the face of the injector.
Case Studies
Mr PS is 73 and has wet AMD in left eye causing distortion and blurring.
The Problem:
- He can’t recognise faces with that eye now. The other eye is a lazy eye since childhood.
- Mr PS vision is still above the NICE threshold for treatment despite his symptoms so does not qualify for treatment on the NHS
- Mr PS needs to drive to look after his wife whom he cares for
The Solution:
Mr PS had 3 injections of Avastin, which stabilised the vision and improved the distortion and blurring in the centre. After 3 injections his vision was back to normal. He remains under close review and may need further injections in future but he’s delighted that his vision has been stabilised.
Mr FC is 75 and has noticed distortion and blurring of vision in both eyes suddenly.
The Problem:
- He travels around the world and is struggling currently to travel due to his vision.
- Mr FC has wet AMD in both eyes which has caused a significant reduction in vision
- Mr FC needs to be able to travel for periods of 6-8 weeks at a time
The Solution:
Mr FC had injections of Eylea into both eyes, initially monthly but then 2 monthly, this has stabilised his vision and improved his vision significantly. He has regular 2 monthly injections which keep his vision stable and enable him to continue travelling without worrying about his vision.