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Age-related macular degeneration (AMD) is the leading cause of vision loss if you are aged 50 years or older. It involves age-related damage to your macula, which is the small but extremely important area located at the centre of the retina, the light-sensing tissue that lines the back of your eye.

The macula is responsible for seeing fine details clearly and defining colours. If you have AMD you lose the ability to see fine details, both close-up and at a distance. If you cannot see clearly, you also will not be able to see colour. This affects only your central vision. Your side or peripheral vision usually remains normal.

AMD is increasingly becoming treatable as new drug advances become available.

Retina Care at Clinica London

Clinica has five medical retinal specialist Consultants: Professor Michel Michaelides, Mr Jaheed Khan, Ms Esther Posner, Ms Evgenia Anikina and Mr Julian Robins. They are all highly skilled retinal specialists who will provide AMD diagnosis with OCT and treatment of your AMD with eye injections.

Check your Vision Regularly

 

If you are over 50 years old and you think you may have AMD or be at risk of developing this because it runs in your family, you should book an AMD assessment with one of the Retina Care Consultants at Clinica London. They will take a history, examine you and do an OCT test, then advise. The advances of recent years with anti-VEGF injections signifies considerable progress in the management of your AMD.

If you catch your AMD early this helps optimise the timing and effectiveness of treatment.

MORE ABOUT AMD

Types of AMD

 

It is important to be aware of the risk of AMD and to have your eyes checked regularly. There are two main types of AMD, the Dry and the Wet. Differentiating these using OCT helps your AMD treatment.

1. Dry AMD

Dry AMD develops when there is a waste build-up under your macula and is compatible with normal or near-normal vision in the early stages but it can cause a gradual reduction in your vision. Most people (about 80%) have this form of AMD.

2. Wet AMD

A minority of patients with dry AMD  can progress to wet AMD. Wet AMD occurs when abnormal blood vessels grow underneath your retina and this can cause a rapid change in central vision, often with distorted or wavy lines or blotches in vision. These unhealthy vessels leak blood and what is called ‘fluid’ under and inside the retina, which can prevent your retina from working properly. It is very important to start AMD treatment quickly when wet AMD is diagnosed, to reduce the risk of permanent loss of your central vision. You should regularly carry out a central vision check, either with your optometrist or with a medical retinal specialist.

 

Age-Related Macular Degeneration 1

 

 

Do I have AMD?

AMD diagnosis is confirmed from a retinal scan called an OCT. At Clinica London, the Retina Care specialists regularly do OCT scans on all retinal patients as it shows with amazing detail the fine microscopic structure of the retina and its changes in AMD, and helps plan AMD treatment.

The OCT Scan

If you think you may have AMD, the retinal care specialist ophthalmologist at Clinica will examine you and perform the OCT (ocular coherence tomography) and take photographs of the back of your eye which will show us the different layers of your retina and whether there is blood or fluid within the retinal layers, in order to help them confirm the diagnosis.

Sometimes after examining your eye, the consultant will undertake further tests such as a retinal angiogram to determine your precise macula lesion type, location and extent of sub-retinal bleeding.

The OCT will help the retina care consultant to decide the correct treatment for you.

Treatment

AMD can be treated with eye injections of Anti-VEGF

Intravitreal eye injections of anti-vascular endothelial growth factor (anti-VEGF) is the treatment of choice for your macula degeneration. Anti-VEGF medication is injected in a tiny amount into the eye under a local anaesthetic with you as an out-patient.

Treatment is highly successful at improving and/or stabilising wet AMD in the majority of patients if started quickly after diagnosis. More than one injection will be required.

What is anti-VEGF?

The Anti-VEGF medications are a group of drugs that work by blocking the effects of a growth factor that blood vessels need in order to form and keep leaking and are most effective when used in the early stages of AMD condition. The anti-VEGF drugs stop the growth of new blood vessels, thereby reducing the risk of scarring and further sight loss.

Anti-VEGF treatment options in wet ARMD include bevacizumab (Avastin, Genentech, San Francisco, CA), which is a full-length anti-VEGF antibody, ranibizumab (Lucentis, Genentech), which is an affinity-matured fragment, aflibercept (Eylea, Regeneron, Tarrytown, NY), another anti-VEGF and  Brolucizumab.

Will I be suitable for treatment with anti-VEGF?

Not everyone with wet AMD will be suitable for anti-VEGF treatment.

Anti-VEGF medication is most effective when treating blood vessels that are ‘active’ or ‘leaking’, the wet type AMD. Treatment should be started as soon as possible after the diagnosis is made, in order to optimise success.

If wet AMD was diagnosed some time ago, and there has been ‘maturing’ of blood vessels, then it is unlikely that a person will be suitable for treatment. This is because the process of fluid and blood leakage from new blood vessels occurs for a while and then dries up, eventually leading to scar tissue formation (similar to what happens when a skin wound heals). Scar tissue in the macula causes permanent vision loss and will not respond to any current treatment.

What happens on the day of treatment?

The whole treatment takes 10 minutes but the intravitreal injection itself takes less than 20 seconds. You will lie comfortably on a surgical couch in the Clinica treatment room. Local anaesthetic drops will be applied to your eye to minimise discomfort and your retinal care consultant will clean and cover the area around your eyes with a small sterile drape.

A small speculum will be used to keep your eye open and further anaesthetic drops will be administered. The injection site is marked gently and your eye is stabilised with a cotton bud.

A few seconds later the eye injection is given with a fine needle by the retina care consultant.

Age-Related Macular Degeneration 2

After the Intravitreal Injection

You will be prescribed eye drops to put in four times a day or more often if needed for 1-2 days. This is to ease any scratchy feeling in the eye which is common for a day or so. A follow-up appointment will be arranged. Most patients will require further injections depending on the leakiness of the blood vessels.

Possible Complications of AMD Treatment

As with any medical procedure, there is a small risk of complications with intravitreal eye injections for AMD. However, significant loss of vision due to treatment is very uncommon.

Common side effects:

  • Blobs or small specks in your vision may be noticed for a few days after the injection. Also, there could be transient flashing lights or swirls of light immediately after the injection.
  • Red-eye (there is usually a bleed on the subconjunctival space at the point of the injection which clears in a week or two.
  • Sore and gritty eye (slight ache and discomfort lasting a day or two).

Rare side effects:

  • Serious eye infection (1 in 2000-3000 cases)
  • Detached retina
  • Increase in eye pressure
  • Blood clots and bleeding in the eye
  • Inflammation inside the eye
  • Cataract

How can I improve my eye health?

General health advice if you’ve been diagnosed with AMD:

It is very important that you stop smoking as this is known to increase the risk of AMD developing and progressing.

There are a number of multivitamin supplements based on a very large medical trial known as AREDSII and your retina care consultant will discuss if these may be helpful for you in helping reduce the rate of progression of the disease.

Help with your vision from Clinica´s Low Vision Optometrist

Vision aids and other practical support can be very helpful and there are a number of Apps to help minimise the impact of reduced vision on a day to day activities.

At Clinica London, we have a Low Vision Optometrist called Ms Hannah Dunbar who advises on magnifying and other aids for maximising your vision with AMD.

The Macular Society (https://www.macularsociety.org/) is also a very helpful source of information and support.

Ms Esther Posner

Consultant Ophthalmic Surgeon
Medical Retina Specialist

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