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What do patients experience before age-related macular degeneration AMD treatment?

With age-related macular degeneration or AMD, for short, the symptoms vary. You may have patients who have no symptoms; they have been told they have age-related macular degeneration by their opticians, but generally, their lifestyles haven’t been impacted in any way. That group of patients may have a family history of AMD and they are concerned so they come to see me, because of the fear of developing a sight-threatening condition. AMD is something that develops generally quite slow, but there are subgroups of patients who want to be reassured that they haven’t got any early signs and want to see if they can prevent it. There are practical conversations with my patients about living a healthy lifestyle, eating a balanced and stop smoking, if they do.

Then we move on to a group of patients who have started to notice symptoms and they are not quite sure what it is. They go to their opticians who may diagnose macular degeneration and seek an opinion from a specialist to see whether there are any signs of progression or whether we can categorise it. We categorise macular degeneration into two types; dry and wet, and people are very worried about developing the wet variety, partly because it can blur their central vision quickly. So, I get a group of patients who sometimes have a sudden blur in the centre of their vision which impacts them severely. They may start to notice they can’t focus on making a cup of tea, looking at the television, reading their letters, writing their correspondence or using their phones. They tend to notice quite suddenly, if it is wet macular degeneration which is a worrying symptom, because obviously we like to see patients early for that so they can be treated.

Those sort of patients come and see me and are anxious, because they’ve been told by their opticians that they have something that’s rapidly evolving and changing quickly. Those patients come to me and they get reassured fairly quickly, because we can instantaneously look at the back of their eye and make sure they have the correct imaging techniques. We reassure them that if they have any signs that need treating, they can get treated quickly. So those sort of patients are seeking urgent reassurance, they want to know whether they’ve got something that needs treating urgently and that’s a very sensible approach from a lot of my patients who are very aware of their eye diseases. If you’re unfortunate to have macular degeneration in both eyes it can be quite difficult. There is a degree of adaptability, but if your central vision is blurred and every time you looked at an object it was blurry, you would get very frustrated. Most of my patients describe this frustration, “I can’t read, I can’t do the things that I used to be able to do. I’m not recognising the bus numbers, I’m not recognising faces.”

That’s quite distressing, especially for elderly parents, grandparents, people who want to live their lives, are being impacted by that sort of disability. Once they’ve had a diagnosis of wet macular degeneration, which is the treatable form of macular degeneration, the improvement is gradual. There is hopefully an improvement over a period of time, because the treatment is a general course of treatment, and most patients worry about having treatment for the long-term. They can realise that once they notice visible improvements in symptoms such as distortion, the blur becoming less prominent and restoration of their vision, they start to understand that actually, it is a long-term process. They are very happy to have this treatment eventually. There is always reticence at the beginning to have treatment, but once they see the effects which are pretty much instantaneous and their vision improves quite quickly, they continue to want to be treated and would never miss a treatment.

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