MACULAR DEGENERATION SCREENING AND MANAGEMENT WITH INTRAVITREAL TREATMENT WITH ANTI-VEGF
This is a condition of the elderly (over 50 years) where the central part of the retina called the macula is damaged. It leads to the loss of central vision leaving behind only peripheral vision and does not typically cause complete blindness.
However, if advanced, daily activities such as cooking and watching TV become impaired. Risk factors include age, race, smoking and genetics (positive family history). In general, there are 2 types of ARMD.
- 1. ‘Dry’ ARMD (accounts for 80% of cases and is slowly progressive)
- 2. ‘Wet’ ARMD (20% of cases where progression may be more rapid).
The risk of ARMD may be reduced by not smoking, exercising regularly, maintaining normal blood pressure and cholesterol levels and eating a healthy diet rich in green, leafy vegetables and fish. In intermediate disease, your ophthalmologist may prescribe a combination of high dose vitamins and minerals which may slow disease progression (AREDS and AREDS 2 trials). Advanced ‘wet’ ARMD may be treated with anti-VEGF (vascular endothelial growth factor) injections, PDT (photodynamic therapy) or laser therapy.
Overview – What is Age-related Macular Degeneration (AMD)
Age-related macular degeneration is an eye condition that can blur your central vision. In this condition, ageing damages the macula, which is the part of the eye that controls sharp, forward-looking vision. For older adults, age-related macular degeneration is a leading cause of vision loss. Though it may not lead to complete blindness, the vision impairment it causes makes it challenging to do simple everyday tasks including reading and driving. Some people experience Age-related macular degeneration very slowly, while others experience it much faster. it may take a long time for you to notice vision loss if you have early age-related macular degeneration. That is why regular eye check-ups at an eye clinic in Singapore is so important.
Causes of Age-related Macular Degeneration
While more extensive and comprehensive research is required to uncover the actual cause of age-related macular degeneration, it is revealed that a combination of heredity and environmental factors play a part. Smoking, obesity and diet can affect the progression of age-related macular degeneration. As the tissue in your macula thins over time, you may lose cells responsible for your vision.
Symptoms of Age-related Macular Degeneration
Age-related macular degeneration may develop gradually and without pain. One of the symptoms include visual distortion such as straight lines seeming bent. The development of new blood vessels under the retina can cause "wet" macular degeneration in some people with dry macular degeneration. These vessels may bulge or pucker the retina during the early stages of wet macular degeneration, which results in vision distortion.
Another symptom involves poor dark adaptation. The ability of your eyes to adjust from seeing in light to seeing in the dark is known as dark adaptation. Dark adaptation declines at the earliest stages of age-related macular degeneration. Night vision difficulties worsen with the progression of the disease. Other symptoms may also include increased blurriness, difficulty recognising faces and decreased brightness of colours.
Prevention of Age-related Macular Degeneration
There are a few ways in which you can lower your risk of age-related macular degeneration. Firstly, is to stop smoking. Smoking is a risk factor for age-related macular degeneration and quitting can help save your vision. Secondly, use sunglasses especially when the sun is glaring outdoors. The long-term exposure to bright light may increase the risk of age-related macular degeneration and also cause permanent damage to the retina. Thirdly, always go for regular eye examinations. Regular eye examinations at an eye clinic are very important, especially when you age with risk factors associated with age-related macular degeneration.
Treatment for age-related Macular Degeneration
Treatment options depend on the type of age-related macular degeneration you have. Unfortunately, there is no treatment for dry age-related macular degeneration, but vision aids can help minimise its effects. With regards to wet age-related macular degeneration, eye injections and photodynamic laser therapy are viable treatment options.
For eye injections, your eye doctor may inject anti-angiogenic drugs into your eye. These medications prevent new blood vessels from forming and block leaks from abnormal vessels that cause wet macular degeneration. In photodynamic laser therapy, medication is injected into your bloodstream and absorbed by the blood vessels in your eye. A laser that activates the drug is then shone into the eye, damaging abnormal blood vessels. Ultimately treatments vary based on conditions. Talk to your eye doctor in Singapore to better understand the most suitable treatment for you.
Risk Factors of Age-related Macular Degeneration
There are several risk factors affecting age-related macular degeneration with the most prevalent one being age. This is the top risk factor that puts patients at risk and it is one of the leading causes of vision impairment in the elderly. Race and ethnicity are also risk factors. Whites are most likely to develop age-related macular disorder, followed by the Chinese and Hispanics/Latinos, while African-Americans have the lowest risk.
Apart from genetics, health and lifestyle choices may impact age-related macular degeneration as well. Those that have suffered from strokes, anginas or heart attacks may find themselves at a 1.5 times higher risk for age-related macular degeneration as compared to someone that has not. High cholesterol, long exposure to the sun and smoking may also increase that risk.
‘Wet’ macular degeneration is due to abnormal blood vessels proliferating in the retina resulting in the loss of central vision.
Loss of central vision due to macular degeneration.
‘Wet’ macular degeneration is treated with anti- VEGF injections.
Several types of anti-VEGF medicines for intra-ocular use are now available.
Dr Eugene Tay
Senior Consultant Ophthalmologist
Eye Specialist Clinic in Singapore
Over 20 years of clinical experience
He graduated from St Bartholomew’s Hospital Medical College of the University of London in 1997 and is one of few surgeons to have received all basic, advanced and sub-specialty/fellowship training at the internationally renowned Moorfields Eye Hospital in London. Therefore, he is well positioned to own his very own eye clinic in Singapore. He trained to sub-specialist fellowship levels in laser refractive and anterior segment surgery at the Gimbel Eye Centre in Canada and also Oculoplastic surgery at Moorfields Eye Hospital. With Dr Tay’s unrivalled expertise, Nova Eye Centre is the eye specialist clinic of choice in Singapore.