Age-related macular degeneration

Age-related macula degeneration (ARMD) is most commonly seen in people over the age of 80, though it can be seen in some people as early as 50s or, more subtly after 60.

There are two basic types – dry and wet. The dry kind is the most common and changes usually slowly over many years. The wet kind affects vision quicker in days or weeks but can now be treated effectively. The earliest signs of ARMD are yellow dots seen under the retina called drusen. These earliest changes are asymptomatic and usually noted coincidentally at an optician or ophthalmology visit.

The macula is the centre of the retina where light is best focused and the detailed image is formed. The rest of the retina gives you peripheral vision that is not detailed. When you look at the world everything seems to be in focus but this is a trick of the brain. Only the very central two degrees of vision is truly sharp.

You can experience this for yourself by looking through a tiny hole in a piece of card. It should be sharp in the centre, but your vision is restricted. Now put the card down and instead look at the tip of your finger close-up. While looking at your finger hold up some writing to the side and keep looking straight at your finger. Can you read the writing without looking at it directly? It has to be very large letter for you to see what it is. This is what it is like to have ARMD with central loss of vision.

Key points about ARMD

• If you develop ARMD and it becomes severe, it will not cause total blindness, such that you would see no light at all. You will always have peripheral and navigation vision. With magnifiers and vision aids you could see more detail. People with the most advanced ARMD can still see and navigate around their homes (as long as they don’t also have advanced glaucoma too). How much and to what extent the macula is affected, will determine how well, low vision aids and magnifiers will improve vision.    You can buy magnifiers or ask for guidance from registered sight charities or an optician with low visual aid experience. Modern computer tablets allow people with ARMD to have a bright image that can be easily magnified.

• The good news is wet ARMD can be treated and responds very well in the majority of people with around two in five people returning to driving vision standards after three treatments. You will be looked after by a retinal specialist for the course of treatment with can be required over several years with two to three monthly checks.

• To try and prevent ARMD, a healthy diet is recommended, specifically leafy green vegetables such as: kale, broccoli and spinach. It is well recognised that smoking is a significant risk for developing ARMD, especially if there is a family history of the condition. For people with drusen or early ARMD, supplementing the diet with capsules of concentrated plant extracts has shown benefit. These food supplements can be bought at pharmacies or health shops. Examples are macushield and ocuvite.

• To test your own vision, an AMSLER grid can be used daily to quickly assess for any new distortion and possible changes. If you notice consistent new changes over a few days, then seek help and a quick referral via your optician or GP.

• Visual hallucinations can occur when vision is reduced even if this is just in one eye.   These hallucinations look very real and can be anything from people to animals to paintings, flowers scenes almost anything your brain has witnessed before.  Hallucinations with vision impairment was first described by Charles Bonnet in 1769. It is important to know these hallucinations do not occur in most people. If they do, they do not usually last long and become less frequent with time. It is always clear these visual images are not really there. Sufferers remain fully alert and are not influenced by them.

Scarring after wet AMB	Wet AMD	Dry AMD with Drusen	Bleeding and scarring in wet AMB