Age-Related Macular Degeneration (AMD)

AMD is a common eye disease that affects more than 2 million Canadians and is the leading cause of vision loss in Canada. The risk of AMD increases as you age and leads to a loss of vision over time. It is most common in people over 50.

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Understanding how the eye works

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Our eyes are like a camera.  The iris and the pupil control how much light come into the eye, the lens helps focus the light to create a clear picture on the retina. The retina is a light-sensitive layer at the back of the eye that acts like the film in a camera. It captures the images focused by the lens and sends the images as signals to the brain. The macula is the center of the retina and is responsible for detailed central vision.  The optic nerve sends signals from the retina to the brain to interpret the image. When you have AMD it affects this process.

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What is AMD?

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AMD is a painless disease of the eye that leads to vision loss over time and can affect one or both eyes.

In AMD there is excessive growth of fragile blood vessels in the retina. These blood vessels are weak and can begin to leak fluid and blood into the back of the eye (macula). This is what impairs your vision, or makes it harder to see the whole "picture".

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AMD is usually related to aging and most often affects people 50 years of age or older.  There are several factors that can increase the risk of the disease.  Some of these factors cannot be controlled, while some of them can.

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Uncontrollable factors: Age, genetics, family history

Controllable factors: smoking, diet, weight, blood pressure, sun exposure

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There are two types of AMD: - Dry AMD and Wet AMD 

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Dry AMD is the early/stable stage of the disease and there is no treatment for this.  For dry AMD the best thing you can do is continue with regular appointments and closely monitor your vision for any changes. 

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Wet AMD is the late form of AMD and it can lead to sudden vision loss.  Wet AMD is when abnormal blood vessels begin to grow in the back of the eye to try to repair damage to the macula that occurred in the dry stage.  These blood vessels are very fragile and can leak fluid and blood into the retina causing further damage and leading to vision loss.  Once wet AMD is present in one eye you are at increased risk of developing it in the other eye.

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AMD can impact the way objects and people are seen.  It affects the macula which is responsible for your central vision and allows you to see colors and sharp detail.  If you develop wet AMD you may notice increased blurred vision, straight lines appearing to be wavy or distorted, blind spots in the central vision, words on a page seeming to be wavy, and loss of color perception.  

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The treatment for wet AMD is a series of monthly injections into the eye called anti-VEGF therapy.  You will be offered Eylea, Avastin, or Lucentis depending on the severity of your disease, age, and financial coverage options.  Vascular endothelial growth factor (VEGF) is a protein that plays a role in making the abnormal blood vessels that grow in wet AMD.  Eylea, Avastin, and Lucentis help stop the growth of these blood vessels by blocking VEGF.  It has been shown to help stabilize vision loss from wet AMD and in some cases improve vision.

 

Living with AMD

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Anti-VEGF therapy has been shown to help slow the vision loss from wet AMD, however, there are some simple lifestyle changes you can make to slow the progression of the disease.  They are as follows:

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• Make sure to keep your regularly scheduled appointments with Dr. Varma to ensure close monitoring of your disease.

• Monitor and report any vision changes to the office as soon as possible.  You will be given an Amsler grid and instructed on its proper use.  This is a grid or series of horizontal and vertical lines with a black dot in the center.  When you look at the grid you will focus on the black dot and check to see how the lines appear to you.  When you first start using the grid you may already have some areas of distortion and it is helpful to mark these areas.  You should check your Amsler grid daily with each eye separately and report any new areas of distortion.

• Do not smoke, if you do smoke you should consider stopping even if it means speaking to your family physician to get help.

• Eat a healthy well-balanced diet with fresh fruit, dark green leafy vegetables, foods high in Omega 3s (ie: fish and nuts)

• Take an ocular multivitamin such as Vitalux or PreserVision

• Exercise regularly to maintain a healthy weight

• Wear sunglasses to protect your eyes from UV rays

 

Coping with vision loss​

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Vision loss can be challenging and life-changing.  It can impact your everyday life and make you less independent.  It will take time to adjust to living with vision loss whether it be minimal or extensive.  The CNIB (Canadian National Institute for the Blind) has many resources for coping with vision loss.  If this is something you are interested in Dr. Varma can refer you to them.

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