Age-related Macular Degeneration

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                                                        Patient Information for the
                                                 Gloucestershire Health Community




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                                     e rAge-related macular


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                                           degeneration




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     GHPI0691_12_06
  Author: Opthalmology
Review due: December 2009
This leaflet sets out to answer some of the questions most      Who can I contact for further information?
commonly asked by patients. We hope you will find it
                                                                If you have any questions about your condition not covered




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helpful.
                                                                in this leaflet please speak to one of the medical or nursing
                                                                staff at:




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Where is the macula?




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                                                                Cheltenham General Hospital eye clinic 08454 223200
The eye is shaped like a ball.
                                                                Gloucestershire Royal Hospital eye clinic 08454 228358




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The pupil, close to the front, is the opening which allows




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light to enter the eye.
                                                                Other useful contacts:
Just behind the pupil is the lens which focuses the light on




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                                                                Royal National Institute of the Blind
the retina at the back of the eye.                              Telephone: 0845 766 9999
                                                                Website: www.rnib.org.uk




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The retina is a delicate tissue which converts the light into
images and sends them to the brain along the optic nerve.
                                                                Macular Disease Society
The macula is a small area at the very centre of the retina     Telephone: 0845 241 2041




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and is responsible for seeing fine detail and colours.          Website: www.maculardisease.org

                                                                Driver and Vehicle Licensing Agency (DLVA)




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                                                                Telephone 0870 240 0009




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                                                                Website: www.dvla.gov.uk




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do not meet the visual requirements for driving and it is     What is age-related macular degeneration
certainly preferable that you do not drive to or from your    (AMD)?




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appointment.
                                                              AMD is a condition which occurs later in life and is an
The eye specialist will give you information about the type   increasingly common disorder affecting people over the age




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of AMD you have and whether there is any treatment




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                                                              of 60.
available. The specialist will arrange any treatment that
is appropriate and a visit to the Low Vision Aid clinic if    In AMD disturbances occur in the macular area causing




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necessary.                                                    problems with the centre of the vision. There is no specific




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                                                              medical treatment for most cases but new symptoms of
                                                              distortion or sudden deterioration of vision need to be
New treatments




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                                                              assessed immediately as treatment can sometimes be of
Wet AMD can now be treated with new drugs that are            benefit.




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injected into the eye (anti-VEGF therapy). Abnormally
high levels of a specific growth factor occur in eyes with    Types of AMD
wet AMD and promote the growth of abnormal new
                                                              Dry AMD




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blood vessels. This drug treatment blocks the effects of
the growth factor. The new treatments are expensive and       With age the delicate cells at the back of the eye become




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unfortunately are not yet available under the National        less efficient at doing their job and waste products (drusen)




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Health Service. The specialist you see will be able to give   accumulate. Cells in the macula may slowly wear out causing
you further information and advise whether any of these       loss of sight in the central part of the field of vision.
new treatments might help you.                                The peripheral (or side) vision is not affected, 90% of cases




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                                                              of macular degeneration are of this type.
                                                              In the early stages there are often no difficulties with




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                                                              the eyesight but changes can be seen at the back of the
                                                              eye when examined. The central vision declines slowly
                                                              over many years. In advanced cases it may be difficult to
                                                              recognise faces. A grey or black patch may be seen in the
                                                              centre of the vision and reading might not be possible
                                                              unless a very strong magnifier is used.


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Peripheral vision always remains, so that the affected            Wet AMD
person can see to move around.
                                                                  A small proportion of this type of macular degeneration




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Wet AMD                                                           may be treatable with laser treatment. In order to decide
                                                                  whether treatment is possible, a test called a fluorescein




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Distortion of vision is an important warning sign of early




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wet AMD. Objects appear misshapen and straight lines              angiogram is performed. In this test, a special set of
appear bent. In this form of AMD tiny blood vessels develop       photographs is taken to outline the blood vessels at the




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under the macula and these leak fluid or bleed. These             back of the eye.




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blood vessels may develop quickly and result in more rapid        If the new blood vessels are away from the absolute centre
deterioration of vision.                                          of the vision a laser can be used to destroy the vessels to try




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Look out for new symptoms of distortion or sudden                 and limit the damage they cause.
deterioration of vision and see an optician or eye doctor         If the new blood vessels have already grown under the




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straight away if this occurs.                                     centre of the vision this type of laser would cause damage
The Amsler grid included on page four may be used to              and is not recommended. A newer form of laser treatment
check distortion of vision.                                       called photodynamic therapy (PDT) may be considered




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                                                                  under these circumstances. In this treatment a dye is
Using your reading glasses, if you wear them, hold the chart
                                                                  injected into the blood stream and attaches to the new
at a comfortable distance away.




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                                                                  blood vessels. A gentle laser can be used which only treats




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•   Cover one eye                                                 the new blood vessels without harming the centre part of
•   Focus on the dot in the centre of the chart                   the vision. The treatment usually has to be repeated several
•   Are any of the lines wavy, blurred or distorted?              times over a couple of years.




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•   Are there any missing areas or dark areas in the grid?
                                                                  What happens now?




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•   Can you see all corners and sides of the grid?
•   All lines should be straight, all intersections should form   Your optician will refer you to see an eye specialist at the
    right angles, and all the squares should be the same size     hospital for assessment of your condition. The vision will
                                                                  be tested in both eyes using an eye chart and you will be
                                                                  given eye drops which enlarge your pupils. This allows the
Don’t forget to test both eyes (each eye separately)              eye specialist to look at the macular area at the back of
                                                                  the eye. The drops take about 30 minutes to work and may
                                                                  blur your vision for several hours. Many patients with AMD
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Can I continue to drive with macular                         Amsler Grid
degeneration?




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The law requires you to inform the Licensing Authority
(and insurance company) of any change in health or sight




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likely to affect the safety of your driving. You must be




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able to read a number plate at 20.3 metres (25 yards) in
good daylight and with spectacles if worn. You must also




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have an adequate field of vision. To drive when unable




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to meet both these requirements is a criminal act and
invalidates insurance. Inability to meet these standards




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requires you to notify the Licensing Authority. You should
not drive until you have had confirmation that your vision




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meets the standards. A report may be requested from
your ophthalmologist. Standards are more stringent for
vocational drivers.




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Treatments




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Prevention
There is evidence that avoiding smoking and eating a
healthy balanced diet with plenty of fresh fruit and dark




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green, orange and yellow vegetables can help to prevent
AMD.




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Dry AMD
There is no specific treatment but magnifying aids and
bright focused lights for reading can be helpful. An
assessment can be made for various magnifying aids at the
Low Vision Aid clinic at Gloucestershire Royal Hospital or
Cheltenham General Hospital.
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                                                               print to see more clearly is not bad for your eyes. Losing the
                                                               vision in one eye does not cause extra strain on the other.




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                                                               Is there anything that will help me see




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                                                               better?




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                                                               To make the most of your peripheral vision learn to move




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                                                               your eyes until the image of the thing you wish to see is
                                                               focused on the most useful area of the retina. For most




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                                                               people with AMD the best position is fixing your sight
                                                               slightly above or to the side of the object you want to see.




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                                                               Will a new pair of glasses help me see more
                An example of distortion                       clearly?
Any irregularity should be reported to your optician or eye    Stronger lenses will not repair the damage that has occurred




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doctor immediately                                             at the back of the eye. Magnifying devices known as low
The Amsler Grid is helpful in revealing signs of wet AMD       vision aids enable most patients to continue to perform




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although it is not a substitution for regular eye tests.       normal everyday tasks such as reading newsprint or price




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                                                               tickets. They include very simple hand held magnifiers,
                                                               telescopic spectacles or more complex electronic devices. All
Will I go blind?                                               Low Vision Aids require adaptation and determination from




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AMD is not painful, and almost never leads to total            the user.
blindness. Only the central (reading) vision is affected and   When you read, have the light from the window behind




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the surrounding vision remains normal. Useful side vision      and to the side of you. Direct the light from an angle
that allows you to see to get around is retained in both       poise lamp onto the page. Try changing your light bulbs to
forms of AMD.                                                  stronger ones. If your vision is poor in sunlight, try using
                                                               a broad rimmed hat, visor or sunglasses: the best colour is
Will it help my sight if I use my eyes less?                   reddish-brown.
You cannot wear your eyes out. Going closer to the TV or

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Description: Age-related Macular Degeneration