What it is
In short: age-related macular degeneration (AMD) affects the centre of your vision. There are two main types. Wet AMD can change your sight quickly and is usually treated with injections into the eye. Early dry AMD is usually monitored with regular checks.
AMD affects the macula, the small area at the centre of the retina (the layer at the back of the eye that senses light). The macula gives you the detailed vision you use to read, recognise faces and see things straight ahead.
The two main types are:
- Dry AMD: changes build up under the retina, including small deposits called drusen, and the cells that support vision are affected. Dry AMD can be early, intermediate or late. The late dry form, called geographic atrophy, is where patches of the retina are lost.
- Wet AMD: abnormal blood vessels grow under or into the retina and leak fluid or blood. This can change your sight quickly.
A type of wet AMD called polypoidal choroidal vasculopathy (PCV) is more common in people of Asian descent. In PCV, the abnormal blood vessels form small bulges, called polyps, under the retina.
Dry AMD can turn into wet AMD, so the type and stage in each eye are checked over time. Age, family history and smoking all affect your risk.
Symptoms
Early AMD may cause no symptoms. Later, you may notice:
- difficulty reading in dim light
- blurred central vision
- needing more light for close work
- straight lines looking bent
- parts of words or faces looking missing
- colours looking less clear
One eye can make up for changes in the other, so you may not notice a problem at first. Dr Chin may show you how to check each eye on its own, sometimes using an Amsler grid, a square of straight lines. A home check cannot diagnose AMD or replace your examinations, but noticing a change can help you get checked quickly.
When it is urgent
Contact an eye doctor quickly, ideally the same day, if:
- straight lines suddenly look wavy
- a new blank or dark patch appears in the centre of your vision
- your central vision gets worse
Do not assume a sudden change is just the dry AMD slowly getting worse.
Call the clinic at +65 6694 0400. Outside clinic hours, call the 24-hour answering service at +65 6535 8833. If your sight drops suddenly and badly, or you cannot be seen quickly, go to a hospital A&E with eye services.
What the assessment involves
Your vision is checked in each eye, and Dr Chin examines the retina, usually after drops to widen your pupils. The drops take 20 to 30 minutes to work and blur your sight for a few hours. Allow about 90 minutes to two hours for the visit, and arrange for someone to drive you home.
An OCT scan takes detailed cross-section pictures of the macula. It shows fluid and changes in the layers of the retina.
Other tests depend on what is found:
- photographs of the retina, including a type called autofluorescence, to record dry changes
- a dye test (angiography), or a type of OCT scan that maps blood vessels, to look for wet AMD, including PCV
Not everyone needs every test. The assessment also looks for other causes of reduced sight.
Good questions to ask:
- Which type of AMD do I have in each eye?
- Is there any sign of active leaking now?
- What will my next appointment check for?
If a scan is repeated, Dr Chin can explain which changes would affect the plan.
Treatment options
Treatment depends on the type and stage of AMD.
Early and intermediate dry AMD
Early dry AMD is usually monitored with regular checks. Stopping smoking, eating a balanced diet and asking your usual doctor about blood pressure and cholesterol are part of looking after your eyes and your general health.
A vitamin and mineral formula called AREDS2 may be suggested for some stages, including intermediate AMD. It is not meant for everyone with ageing eyes, and it does not replace a balanced diet. Before taking it, talk to Dr Chin about which product to use, your other medicines, and whether you smoke or used to smoke.
Geographic atrophy
Treatment for geographic atrophy is different from treatment for wet AMD. What is available varies between countries and depends on what is found in your eye. Dr Chin can explain the options in Singapore and their limits.
Wet AMD
Wet AMD is treated with anti-VEGF medicine. VEGF (vascular endothelial growth factor) is a signal in the eye that drives leaking and the growth of abnormal blood vessels. The medicine blocks it. The eye is cleaned and numbed, then the medicine is injected into it. Treatment usually means repeated injections, with examinations and scans before or alongside them. The time between injections is adjusted to what the scans show and the medicine used.
Photodynamic therapy, which uses a light-sensitive medicine and a laser, is used for some patients, mostly those with PCV. It is often combined with injections.
Injections have risks, including infection and inflammation, and you will need ongoing checks. Everyone's eyes respond differently, so Dr Chin will talk you through what to expect for yours.
Recovery and follow-up
AMD care usually means regular checks over time, rather than a single recovery period. Keep your appointments, even if your sight feels the same. Tell the clinic about any new symptoms between visits. Follow the instructions you are given after an injection or other treatment. If pain, redness or blurred vision gets worse after an injection, get checked straight away.
If your central vision is limited, practical help can make everyday tasks easier, alongside medical care:
- magnifiers
- brighter or adjustable lighting
- large print
- accessibility settings on your phone
Low-vision services can work out which of these suit you. If changes in your sight make it hard to see detail or read signs, talk to Dr Chin about driving.
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