Age-related macular degeneration

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

“So many people have a connection to sight loss, whether it's first-hand experience or through a loved one. I believe the only way forward is through eye research. I want to support Fight for Sight and their mission to prevent sight loss.”

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

More about our research

What is macular degeneration?

Macular degeneration, also known as macular disease or age-related macular degeneration (AMD), causes loss of central vision as a result of damage to the macula – a tiny collection of light-sensitive cells found within the retina at the back of the eye. These cells are vital for seeing detail. 

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 macular degeneration – ‘dry’ and ‘wet’. Dry macular degeneration 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 macular degeneration from getting worse, but there’s currently no treatment for dry macular degeneration. For both types, once damage has happened, it’s irreversible. This is why funding vital research into macular degeneration 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.

What causes 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.

Exactly why some people develop macular degeneration while others don’t is not yet clear, but a number of risk factors have been recognised. Age is the biggest risk factor – the condition is mostly diagnosed in people aged 65 and over, although it can occur in younger adults too. More women are affected than men (but it’s believed this is largely because women tend to live longer) and people of African descent are generally less at risk. Macular degeneration can sometimes run in families too, although it’s not always inherited. Smoking is known to be a key risk factor, and studies have also linked obesity with a higher risk of macular degeneration. Other research has suggested that diet, and damage from high levels of sun exposure, may play a role – but the extent of these links isn’t fully established. 

While wet and dry macular degeneration cause similar central sight loss, there are some differences that set them apart:

  • Dry macular degeneration is the most commonly diagnosed type, accounting for around 90% of cases. It tends to develop far more slowly over time, so sight loss happens very gradually. With dry macular degeneration, layers of the macula become progressively thinner, causing it to function less effectively.
  • Wet macular degeneration can develop very rapidly, resulting in more sudden sight loss. This type occurs when unhealthy new blood vessels begin to grow under the macula and leak blood and fluid (this is why it’s called ‘wet’ macular degeneration), which then causes scarring to develop within the macula cells. People with dry macular degeneration can sometimes go on to develop wet macular degeneration later.

What are the signs and symptoms of macular degeneration?

Macular degeneration doesn’t cause pain or affect the appearance of the eye, so symptoms usually start with noticing changes in 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 diagnosed will eventually have macular damage in both eyes.

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

  • Difficulty seeing details. People may find it increasingly difficult to read small print and see clearly while driving, or see what’s happening on the TV screen, for example.
  • Reduced central vision. The centre of somebody’s vision may become blurry, smudged or, when damage is more severe, a blank or dark spot may develop.
  • Distorted lines. For example, 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. 

How is macular degeneration diagnosed? 

Macular degeneration 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 microscope to check for signs of damage.

If symptoms are severe or progressing or significant damage is detected, patients will be referred to a specialist (ophthalmologist) for further tests, including a scan of the retina - called an optical coherence tomography (OCT). Sometimes, a procedure called a fluorescein angiogram may also be carried out – this involves injecting a special dye into the arm which then travels to the blood vessels in the eye, enabling the specialist to examine them more closely.

Getting diagnosed as early as possible is vital, as damage to the macula can’t be reversed. This is especially important for wet macular degeneration, which requires an urgent referral to a specialist. National guidelines suggest that a patient referred with possible wet AMD to a hospital specialist should be seen within 2 weeks of referral. 

How is macular degeneration treated? 

There is currently no treatment for dry macular degeneration. Regular check-ups and tests can help monitor changes.

There’s also some evidence that, in some cases, diet or supplements may help slow down the progression of macular damage. Vitamins A, C and E, zinc, copper and lutein have been associated with possibly slowing dry macular degeneration. Specifically formulated supplements are available, but further investigation into the role nutrition plays is needed. It’s best to speak to your GP who can give you personalised advice. They are not currently available on prescription. 

Treatments are available for wet macular degeneration – but while effective at preventing further damage, they can’t ‘undo’ damage that’s already occurred, so starting treatment as early as possible can make a big difference.

This usually involves injecting a special formula into the eye, which stops the unhealthy blood vessels from growing and causing further damage. Anaesthetic drops will be applied first, so the procedure isn’t painful. Laser therapy may also be suitable in some cases.

What research is underway? 

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.

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. We are currently investing in 22 research projects to help find new and more effective treatments. 

Professor Heping Xu is leading research at Queens University Belfast, 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. 

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. 

Overview of our macular degeneration research

Podcast on developments in macular degeneration research

 

In the first episode of our eye research podcast, Prof Pete Coffey, based at the Institute of Ophthalmology talks to Fight for Sight about the devastating impact of age-related macular degeneration and how stem cell patches offer hope of a new treatment.



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What can I do?

Have your eyes tested every two years, even if you think your vision is fine. An eye test can potentially spot early signs of macular degeneration before you’ve even noticed any symptoms. If you’ve been advised that you are more at risk of macular degeneration (e.g. the condition runs in your family), you are entitled to more frequent free 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 May 2019
Approved by Professor Andrew Lotery, University of Southampton

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