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Age-Related Macular Degeneration (AMD):

What is AMD?

With increasing age some cells at the macula degenerate, stop working normally and cause visual loss. This is the commonest cause of visual loss in the over 65s. There are two types of AMD: "dry" and "wet":

"Dry" AMD is the most common form of the condition. It develops very slowly causing gradual loss of central vision with distortion. However, reasonable vision is usually maintained. There is no medical treatment for this type. Aids such as magnifiers can be helpful with reading and other small detailed tasks.

"Wet" AMD results in new blood vessels growing behind the retina, this causes bleeding and scarring, which can lead to significant sight loss. "Wet" AMD can develop quickly and sometimes responds to treatment in the early stages. It accounts for about 10 per cent of all people with AMD, but 90% of those with severe visual loss.

What are the symptoms of AMD?

Patients notice a blurring of central vision with distortion. Objects may appear to be an abnormal size or shape, and straight lines will appear wavy or blurred. This may happen gradually or more rapidly over a few days. If a haemorrhage develops on the surface of the retina, patients may notice the sudden appearance of a black spot obscuring the vision. If you do notice such symptoms you should arrange an urgent eye examination.

Will I go blind?

AMD very rarely leads to complete sight loss because only the central vision is affected. This means that almost everyone with AMD will have enough side (or peripheral) vision to get around and keep their independence. Now, with new anti-VEGF treatments, patients with "wet" AMD can be treated and significant visual loss can often be prevented. The outlook for patients with "wet" AMD is therefore much improved.

What should I do if I think that I may have AMD?

If you have gradual symptoms of blurring of vision you may wish to see your optometrist in the first instance. If distortion is a symptom then you should be seen by an eye specialist. If you have sudden and rapid development of symptoms, or if one eye is already affected by AMD, then you should see an eye specialist urgently. If you are a private patient Mr Charles is able to offer urgent appointments. Otherwise your optometrist will be able to advise you and you should be referred to your local NHS ophthalmic unit promptly.

What to expect at your eye examination

When you see Mr Charles you will have a full examination of the eyes: including measurement of vision, examination of the anterior part of the eye and then examination of the back of the eye after dilation of the pupils with eye drops. If AMD is suspected Mr Charles will arrange further tests including fluorescein angiography and optical coherence tomography to confirm the diagnosis and give further information useful for treatment. Mr Charles will discuss these tests with you at your consultation.

OCT before AMD surgery   OCT after AMD surgery

OCT scan before treatment showing
thickening of retina and subretinal fluid


Same patient after course of anti-VEGF injections. Retinal profile now almost
normal and vision improved.

Can "wet" AMD be treated?

Yes. The mainstay of modern treatment of wet AMD is Anti-Vascular Endothelial Growth Factor (anti-VEGF) treatment. This treatment involves a tiny injection into the vitreous jelly inside the eye (an intravitreal injection). Anti-VEGF treatments stop new blood vessels from growing and inactivates them. If given soon enough anti-VEGF treatments can stop vision getting worse. In some cases sight can improve. The key is to have early treatment before significant visual loss has occurred. Anti-VEGF injections are given into the eye over a period of months, usually starting with three injections 4 weekly intervals. There are 2 different licensed anti-VEGF agents in regular use:

Lucentis: specifically developed and licensed for use in AMD, Lucentis has been found to be very effective when given as an intravitreal injection.

Eylea: new anti-VEGF agent approved in the UK in 2013 with a longer period of action. Trials suggest it is as effective and as safe as Lucentis but can be administered less frequently. Injections may be given 2 monthly, rather than monthly, after the initial 3 doses.

Avastin: another anti-VEGF agent first used in the treatment of colon cancer. Found to be effective in treatment of AMD when given by intravitreal injection. Appears to be as effective as Lucentis, but unlike the drugs above is not a licensed product and is unlikely to become so.

Do intravitreal injections hurt?

Clearly the idea of having an injection into your eye is not a pleasant thought. However, the eye is easily anaesthetised using eyedrops which "freeze" the eye so that do you not feel the injection, or at most just a tiny pinprick sensation. Patients are usually amazed at what a painless procedure it is!

What are the risks of intravitreal injection?

Intravitreal injection is a very safe procedure. The major risk is of infection inside the eye after the injection which can damage the vision although fortunately this is extremely uncommon. All intravitreal injections are given using sterile operating procedures in a dedicated clean room, only used for this purpose, or an operating theatre, so that there is the smallest possible risk of any infection.

Mr Charles has a longstanding interest in AMD. He set up the Macular Treatment Centre at the Manchester Royal Eye Hospital back in 2000 with Professor Paul Bishop. Initially patients were treated with photodynamic therapy, but this has been replaced by the intravitreal anti-VEGF treatments. Mr Charles performed the first intravitreal Lucentis injection at the Manchester Royal Eye Hospital in 2007 and has extensive experience of both intravitreal Lucentis and Avastin therapies.

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