Macular Degeneration

The macula is responsible for seeing fine details clearly. A person with AMD loses the ability to see fine details, both close-up and at a distance. This affects only the central vision. The side, or peripheral, vision usually remains normal. For example, when people with AMD look at a clock, they can see the clock’s outline but cannot tell what time it is, or they will lose the ability to recognise people.

There are two types of AMD. Most people have a form called “early” or “dry” AMD, which develops when there is a waste build-up under the macula. This state is compatible with normal or near normal vision. A minority of patients with early (dry) AMD can progress to the vision-threatening forms of AMD called late AMD. The commonest form of late AMD is “Neovascular ” or “wet” AMD.

What is Wet AMD ?

Wet AMD is when new weak, fragile blood vessels leak into in the retina tissue, this is the fine layer at the back of the eye. If leakage continues, it can cause irreversible damage to your vision.

What treatment is available ?

Wet AMD can be treated if caught early. At present the most effective treatment is in the form of injections of anti-VEGF agents into the eye.

How do injections of Anti-VEGF work ?

It prevents the affected blood vessels from growing and leaking and may even repair some
of the damage that has been done.

How well do they work ?

Over the course of treatment, most patients find that their vision stays the same, and for some, it gets better. Not every person will have noticeably better vision with this therapy, but without treatment, your eyesight could deteriorate rapidly.

Are anti-VEGF injections right for me ?

We will determine if the treatment is appropriate for you. Only patients with active leaking of blood and fluid can benefit from it. The treatment that’s right for you will depend on the specific condition of your central retina (macula), your vision at presentation and whether there is scarring at the centre. We will test your vision, perform scans and photographs of the eye which show us the different layers of the retina. These scans can show us if there is blood or fluid present within the retinal layers and help us decide.

How are Anti-VEGF injections given ?

Firstly, the pupil of the eye to be treated will be dilated. The doctor/practitioner will numb your eye with drops. He / she will then clean your eye thoroughly. You may feel pressure on your eye when receiving an injection but no significant pain. It is given by a fine injection into the white of your eye (sclera) from where it disperses into the back chamber of your eye.

How long will I need treatment ?

Most people will start with a course of three injections, each one no less than one month apart, following which you will be required to attend clinic for regular check-ups to determine if further treatments are required to stabilise your vision. It is not uncommon for patients to be still receiving treatment after two years but less frequently.

Are there any risks ?

Serious complications affecting the eye itself are rare, fewer than one patient out of every 1000 experience serious problems.

Possible complications include:

• Retinal detachment
• Bleeding
• Cataract (clouding of the lens of the eye)
• Increased pressure in the eye
• Infection in the eye. Although rare it can be very serious, it is very important to pick it up early.

Tiny amounts of the drug can get into the blood supply and because of the way the drug works, it has been suggested that there might be a slight increase in risk of strokes and heart attacks. In studies so far, the rate has been low, three out of every 1000 patients, which is similar to the rate expected in this age group. It is possible that the rate might be higher for people who are already at higher risk.

What Anti-VEGF injections are available at Paragon clinic ?

There are several brands of Anti Vascular Growth Factor Drugs that are commonly used for wet AMD. They are all proven to be effective in stabilising Wet AMD. The information about each drug will be discussed with you to enable you to make an informed decision about which you want to receive.

The other form of AMD that you may have heard about is Dry AMD

Dry AMD is a slow deterioration of the cells of the macula, often over many years, as the retinal cells die off and are not renewed. The term ‘dry’ does not mean the person has dry eyes, just that the condition is not wet AMD. The progression of dry AMD varies, but people often carry on as normal for some time.

There is currently no treatment for dry AMD. You might be referred to a consultant if the optometrist needs to confirm their diagnosis, or thinks you need to use a low vision service.

Although there’s no treatment, that doesn’t mean there’s nothing to be done. There are lots of support services that can talk you through ways to make life easier, adapt to sight loss, and answer your questions. You will find links to these services in the ‘useful contacts’ tab. You may be referred for a low vision assessment.