Age-related macular degeneration

Belinda was diagnosed with age-related macular degeneration in 2010. Read her full story. She said:

Find out how the macular degeneration research we fund will have a huge impact for people like Belinda who are living with the condition.

What is age-related macular degeneration?

Macular degeneration, also known as age-related macular degeneration (AMD), causes loss of central vision as a result of damage to the macula – a small but highly concentrated area of light-sensitive cells found within the retina at the back of the eye. These cells are vital for seeing fine details when looking straight at something, both close up and far away. While AMD doesn’t cause complete blindness, the loss of central vision can affect a person’s ability to carry out everyday activities such as reading, driving or seeing faces.

Damage to the macula can’t be reversed. It’s the most common cause of permanent and severe sight loss in the UK, affecting around 600,000 people – this number is expected to more than double by 2050.

There are two types of age-related macular degeneration – ‘dry’ and ‘wet’ AMD. Dry AMD tends to develop more slowly over time, while the wet form of the condition can cause rapid severe sight loss.

If detected early enough, treatment can help prevent wet AMD from getting worse, but there’s currently no treatment available for dry AMD. For both types, once the damage has happened, it’s irreversible. This is why funding vital research into AMD plays a big part in our mission to create a future everyone can see.

Fight for Sight’s goal is for a new treatment to be developed within the next ten years.

Different types of age-related macular degeneration

There are two types of age-related macular degeneration: ‘dry’ AMD and ‘wet’ AMD. They are called dry and wet AMD because of what happens inside the eye and what the eye doctor sees when examining the inside of the eye.

Dry and wet AMD have some similarities. They will usually affect both eyes, but sometimes one eye is affected before the other. Both types of AMD affect the central vision but neither will lead to complete blindness. But there are also some differences between the two types of AMD that set them apart from each other.

Dry age-related macular degeneration

Dry AMD is the most common form of age-related macular degeneration. Around 8 out of 10 people with AMD have this type of the condition. It is caused by a build-up of waste and thinning of the retina at the macula, which causes it to function less effectively.

Dry AMD usually develops very slowly, causing a gradual change to a person’s central vision over several years. Some people with dry AMD will go on to develop wet AMD. There are currently no effective treatments that can help slow down or prevent dry AMD from progressing to late-stage disease.

Wet age-related macular degeneration

Wet AMD is less common but is a more rapidly progressive type of AMD. Many people with wet AMD will have initially had dry AMD. The condition can develop very quickly, causing rapid changes to a person’s central vision over days or weeks.

Wet AMD is caused by the growth of abnormal new blood vessels in the retina (the light-sensitive tissue at the back of the eye). These unhealthy vessels may leak blood or fluids (which is why it’s called ‘wet’ AMD), leading to scarring of the macula and loss of central vision. Left untreated, the damage and sight loss caused by the growth of these blood vessels is usually permanent.

What causes age-related macular degeneration?

Macular degeneration happens when cells within the macula, a tiny area within the retina at the back of the eye, have become damaged and scarred. These cells are photoreceptor cells, which means they’re sensitive to light and play a vital role in our ability to see details and colour. Macular degeneration only affects central vision, so peripheral vision (the outer edges) isn’t lost. But losing central vision means you can’t see things when you’re looking straight at them, so it can have a huge impact on day-to-day life.

What are the risk factors associated with AMD?

Although the exact causes of AMD are unclear, some of the factors that are thought to increase the risk of developing the condition include:

• Age – AMD is mostly diagnosed in people aged 65 and over, but it can also affect younger people from 50 years old onward.
• Gender – more women develop AMD than men (but it’s believed this is probably because women tend to live longer)
• Family history of AMD – while the condition can sometimes run in families and a number of faulty genes that increase the risk of AMD have been discovered, AMD is not always inherited.
• Smoking – smoking greatly increases the risk of developing AMD.
• Lifestyle – some studies have linked high blood pressure, being overweight and lack of exercise as possible risk factors for AMD.

Some studies have also suggested a person’s diet and exposure to high levels of sunlight, may also be factors that can influence the risk of developing AMD – but the extent of these potential links isn’t fully established.

What are the signs and symptoms of age-related macular degeneration?

Age-related macular degeneration doesn’t cause pain or affect the appearance of the eye, so symptoms usually start with a person noticing changes in their vision. These can develop very slowly or rapidly (either way, it’s vital to get symptoms checked immediately). One or both eyes can be affected, although most people who are diagnosed with AMD will eventually have macular damage in both eyes.

Visual changes may be slightly different for everybody, but these are the signs and symptoms that are typically associated with AMD:

Difficulty seeing details

One of the first things a person may notice is they are finding it increasingly difficult to see details. For example, they may be struggling to read small print, see clearly while driving or what’s happening on the TV screen.

Reduced central vision

A person may start to find that their vision is becoming blurry or smudged in the central area. This may develop into a blank or dark spot at the later stages of AMD.

Distorted lines

Straight lines may appear wavy or crooked in the middle. While reading, the lines in the middle of the page may become very blurred and distorted.

Changes in colour perception

People may notice their perception of colour is decreasing – and colours aren’t as vibrant as they used to be.

Sensitivity to light

A person may become more sensitive to bright light – or they may have more difficulty seeing in low lighting.

Hallucinations

Some people who have lost a lot of vision because of AMD may experience seeing things – such as shapes, colours or figures – that are not really there.

How is age-related macular degeneration diagnosed?

Getting diagnosed with age-related macular degeneration as early as possible is vital, as damage to the macula can’t be reversed. This is especially important for wet AMD, which requires an urgent referral to a specialist.

AMD is usually diagnosed following routine eye tests. Alongside testing a person’s vision and asking about any changes they’ve noticed, an optometrist will look at the back of the eye using a special light and magnifying glass to check for signs of damage. If a person’s symptoms are severe or progressing or significant damage is detected, they will be referred to a specialist (ophthalmologist) for further tests. These may include:

• Optical coherence tomography (OCT) – this is a type of scan of the retina that can detect changes to the macula more reliably and earlier than other imaging tests. By looking at the OCT scans, the eye doctor will be able to see very detailed pictures of the inside of the eye which helps diagnose and monitor the condition.
• Fluorescein angiography – this procedure may be carried out to see what’s happening with the blood vessels in the retina. It involves injecting a special yellow dye into the arm which then travels to the blood vessels in the eye, enabling the specialist to examine them more closely. This shows whether there are any abnormal new blood vessels growing under the retina.

How is age related macular degeneration treated?

Treatments for dry AMD

Unfortunately, there are currently no treatments available for dry AMD. Regular check-ups and tests can help monitor changes. There’s some evidence that diet or supplements may help slow down the progression of macular damage:

Nutritional supplements

Taking high doses of vitamins A, C and E, the mineral zinc, copper and the micronutrients lutein and Zeaxanthin in combination could potentially help slow the progression of dry AMD. Specifically formulated supplements are available to buy over the counter at pharmacists, but further investigation into the potential benefits of nutrition is needed. It’s best to speak to your GP, Optician or eye doctor who may be able to give you personalised advice. They are not currently available on prescription.

Diet

A balanced diet with plenty of fresh fruit and vegetables is good for general health and may benefit eye health.

Treatments for wet AMD

Treatments are available for wet AMD that can help to stop further sight loss. However, they can’t ‘undo’ damage that’s already occurred, so starting treatment as early as possible can make a big difference.

Anti-VEGF medications

Several anti-vascular endothelial growth factor (anti-VEGF) drugs are available for treating wet AMD. VEGF is a substance produced in the body that encourages the development of new blood vessels. In wet AMD, too much VEGF is produced in the eye, which leads to the growth of new abnormal blood vessels. Anti-VEGF drugs interfere with this substance and stop the vessels from growing, reducing further damage to a person’s sight.

These medications need to be delivered directly into the eye by injections that are administered at a hospital. Anaesthetic drops will be applied first, so the procedure isn’t painful. A person will normally start with a course of three injections, once a month for three months. They may then be given further injections if necessary.

Laser therapy may also be suitable in some cases.

Photodynamic therapy (PDT)

While it is rarely used, some people with wet AMD may be offered photodynamic therapy. This treatment involves injecting a light-sensitive drug into their arm. The drug will travel through the bloodstream to the eye where it is then activated using a laser beam, shutting down the abnormal blood vessels.

What research is underway for age related macular degeneration?

Fight for Sight’s goal is for a new treatment to be developed within the next ten years. 

Macular degeneration is the most common cause of severe sight loss in the UK, and figures are on the rise. Although some treatments are available for wet macular degeneration, there are no treatments currently available for dry macular degeneration and the condition continues to have a huge impact.

Our ambition

Fight for Sight’s goal is for a new treatment to be developed within the next ten years – to help save hundreds of thousands of people from losing their sight.

Our research

We are currently investing in 22 research projects to help find new and more effective treatments. For example, Professor Heping Xu is leading research at Queens University Belfast. He is using a range of techniques to investigate what’s happening within the molecules (components that make up cells) when scarring of the retina occurs during macular degeneration. Understanding this better could lead to developing new targeted treatments.

Working in partnership

Fight for Sight has also partnered with the Macular Society, Blind Veterans and Scottish War Blinded to form Action Against Age-Related Macular Degeneration. By funding further research together, our goal is to understand more about the condition and make tackling the leading cause of severe sight loss a reality.

Podcast on developments in macular degeneration research

In the first episode of our eye research podcast, Professor Pete Coffey, based at the Institute of Ophthalmology talks to Fight for Sight about the devastating impact of age-related macular degeneration and hopes for a potential new treatment.

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What can I do to prevent age related macular degeneration?

Have your eyes tested every two years, even if you think your vision is fine. An eye test can potentially spot early signs of AMD before you’ve even noticed any symptoms. If you’ve been advised that you are more at risk of AMD (e.g. the condition runs in your family), you are recommended to have more frequent eye tests. Also, any new or unusual changes to your vision should always be checked out immediately, even if you’ve recently had a routine eye test, and sudden severe reduced vision should be treated as an emergency.

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Last updated January 2023
Approved by Professor David Steel, Newcastle University