• A layer of the retina called the retinal pigment epithelium (RPE) is disrupted by deposits called drusen, or other age-related changes. These changes, if severe enough, may cause vision to deteriorate. When the macula breaks down, you lose your central vision, but it does not affect your peripheral (side) vision.
• A leading cause of severe vision loss in people over 65 years of age ,associated with the aging process; the macula may lose effectiveness over time.

Ophthalmic Features

• Early AMD may be hardly noticeable, and may only occur in one eye.
• Words on a page may look blurred.
• It may be difficult to recognize people’s faces.
• A dark or empty area may appear in the center of vision.
• Straight lines may look distorted.
• With AMD, dark areas may appear in your central vision

Two types of AMD

• Atrophic (Dry) AMD - Caused by aging and thinning of macular tissues when drusen are present.
  • Vision loss is usually gradual.
  • Most common form.
• Exudative (Wet) AMD - Caused when abnormal
  • Blood vessels form underneath the retina. These vessels leak  blood/fluid and blur central vision.
  • Vision loss may be rapid and severe.

Investigations

• Many people do not realize they have a problem until vision blurs.
• Your ophthalmologist can detect early AMD  during an eye exam that includes:
• Ophthalmoscopic examination
  • Fluorescein angiography - Dye is injected into your arm where it travels through the body to the blood vessels in your eye.
  • Special photographs are taken of your eye; dye will highlight abnormal blood vessel growth under the retina

Make most of your vision

• If you have been diagnosed with AMD, you must monitor your vision every day with an Amsler Grid.
• With AMD, Amsler Grid may contain blurry or wavy lines.
• Preserve good vision with regular eye exams

                                         
Amsler Grid, as seen through a normal eye      Amsler Grid, as might be seen through an eye with AMD

Treatment (Dry AMD)

• There is no treatment for dry AMD.
• Nutritional supplements may help slow progression and impact of AMD:
• Vitamins C, E
• Beta carotene
• Zinc

(Vitamin supplements are not cures for AMD, nor can they restore vision already lost from AMD.)

Treatment (Wet AMD)

1. Thermal Laser Therapy - Used when abnormal blood vessel growth is not under center of macula. High-energy, focused light beam treats tiny area of retina by “burning” it; destroys abnormal underlying blood vessels, preventing further leakage/bleeding/growth
• Following treatment, your vision may be more blurred than before; will stabilize within a few weeks.
• Scar forms where treatment occurred, creating a permanent blind spot that might be noticeable in your field of vision.
• Likely that 50% of wet AMD patients who have laser procedure will need re-treatment within 3 to 5 years..
2. Photo Dynamic Therapy (PDT) - If abnormal blood vessels grow under center of macula, PDT may be a treatment option. Uses a combination of a light-activated (photo- sensitive) drug and a special low-power (cool) laser.
• Photosensitive drug injected into vein in arm, where it travels throughout the body; attaches to molecules found in abnormal blood vessels. Laser light targeted directly on the abnormal vessels, activating the drug; drug causes damage specifically to those unwanted blood vessels. After PDT, abnormal blood vessels may re-open; multiple treatments may be required.
3. Anti-VEGF treatment - A certain chemical in your   body is critical in causing abnormal blood vessels to grow  under the retina, and is called vascular endothelial growth factor, or VEGF. There are several drugs (anti-VEGF) that can block the trouble-causing VEGF. Blocking VEGF reduces the growth of abnormal blood vessels, slows their leakage, and helps to slow vision loss.
• The anti-VEGF drug is injected into your eye with a very fine needle.(Your ophthalmologist will clean your eye to prevent infection and will administer an anesthetic eye drops to your eye to prevent pain.)
• Patients receive multiple anti-VEGF injections over the course of many months.
• In some cases, your ophthalmologist may recommend combining anti-VEGF treatment with other therapies (i.e. some patients also receive photodynamic laser therapy).

What happens when AMD cannot be treated?

• People with wet or dry AMD who cannot be treated will not become blind—they will still have peripheral (side) vision.

• With special low-vision rehabilitation, devices and services, people can often learn how to “see” again with remaining vision.

Vision Rehabilitation

• Learn new strategies to accomplish daily activities, Skills/devices/techniques help people with advanced AMD regain confidence and live independently despite loss of central vision.
• Low Vision Aids- Optical low-vision devices use lenses to magnify objects:
• Magnifying spectacles
• Hand magnifiers
• Stand magnifiers
• Video magnifiers
• Telescopes
• Large-print books, newspapers, magazines, playing cards, checks
• Writing/signing guides
• High contrast/large number telephones, thermostats, watches, remotes
• Talking books, watches, timers, medical devices