There is currently no cure for dry age-related macular degeneration (AMD).
With dry AMD, the deterioration of vision is very slow. You will not go completely blind as a result of dry AMD, and your peripheral (outer) vision should not be affected.
Help is available to make tasks such as reading and writing easier. Getting practical help may improve your quality of life and make it easier for you to carry out daily activities.
You may be referred to a low vision clinic. These clinics can provide useful advice and practical support to help minimise the affect dry AMD has on your life. For example, things that may make it easier for you to carry out close, detailed work include:
- magnifying lenses
- large print books
- intensive (very bright) reading lights
There are also a number of devices that can help you adjust to low vision, such as screen-reading software on your computer so you can ‘read’ emails, documents and browse the internet.
Read more about living with visual impairment.
Dry AMD and diet
There is some limited evidence that a diet high in vitamins A, C, and E – as well as a substance called lutein – may slow the progression of dry AMD and reduce your risk of getting wet AMD.
These contain molecules called antioxidants that may be able to help maintain healthy tissue and prevent further damage.
Foods high in vitamins A, C, and E include:
- oranges
- kiwi
- green leafy vegetables
- tomatoes
- carrots
Green leafy vegetables are also a good source of lutein, as are:
For more information see the Macular Society’s factsheet on Nutrition and your eyes (PDF, 71kb).
So far, there is no definitive proof that this type of diet is effective in everyone with dry AMD, but eating a diet as healthy as this will bring other important health benefits.
Dietary supplements are also available, but you should check with your GP before taking them as they are not suitable for everyone.
Wet AMD
There are two main treatment options for wet AMD:
- using a type of medication called anti-VEGF medication to prevent the growth of new blood vessels
- using laser surgery to destroy abnormal blood vessels
Anti-VEGF medication
Anti-VEGF medication is a newer type of treatment that can also help stop the progression of wet AMD.
VEGF stands for 'vascular endothelial growth factor'. It is one of the chemicals responsible for the new blood vessels that form in the eye as a result of wet AMD. Anti-VEGF medicines work by blocking this chemical and stopping it from producing the blood vessels.
The anti-VEGF medication has to be injected into your eye using a very fine needle. You will be given a local anaesthetic so the procedure does not hurt.
Anti-VEGF medication is primarily used to stop wet AMD from getting worse. However, in some cases it has also been shown to restore some of the sight lost as a result of macular degeneration. It is important to be aware that your sight will not be restored completely, and not everyone will see an improvement.
The only anti-VEGF medication currently on NHS prescription is called ranibizumab, and it will only be presecribed if there is clear evidence that using the medication would help improve or maintain your eyesight.
Current recommendations are that ranibizumab should only be used if:
- your visual acuity (your ability to detect fine details or small distances) is between 6/12 and 6/96 – this means your central vision is at least good enough to see something at six metres that a person with normal eyesight could see at 96 metres
- there is no permanent damage to the fovea, which is the part of the eye that helps people see things in sharp detail
- the area affected by AMD is no larger than 12 times the size of the area inside the eye where the optic nerve connects to the retina
- there are signs the condition has been getting worse
Your ophthalmologist should be able to tell you if you are suitable for treatment with ranibizumab.
Other anti-VEGF medicines, such as pegaptanib, are available, but you will have to pay for treatment and these types of medication can be very expensive. A two year course of pegaptanib can cost over £9,000.
Ranibizumab
Studies show that ranibizumab can help slow loss of visual acuity in over 90% of people, and may even increase visual acuity in around a third of people.
You will be given one injection of ranibizumab into your affected eye once a month, for three months. After this time, you will have a break which is known as a 'maintenance phase'. During the maintenance phase, your visual acuity will be monitored.
If your vision deteriorates by a loss of one line on the Snellen chart (a chart with blocks of letters that gradually get smaller) during this maintenance phase, you will be given another injection of ranibizumab. This monitoring will continue, and you will have injections as necessary, with at least one month in between injections.
The NHS will cover the cost of the first 14 injections in each eye treated. If, after having 14 injections, you need further treatments, the manufacturer of ranibizumab has agreed to cover the cost.
If your condition does not show signs of improvement after treatment with ranibizumab, or continues to get worse, your treatment will be stopped.
Common side effects of ranibizumab include:
- bleeding from your eye
- pain in your eye
- inflammation or irritation of the eye
- feeling like there is something in your eye
For a full list of side effects, visit the medicines information for ranibizumab.
Surgery
Photodynamic therapy
Photodynamic therapy (PDT) was developed in the 1990s. It involves having a light-sensitive medicine called verteporfin injected into a vein in your arm. The injection lasts around 10 minutes.
The verteporfin attaches itself to the abnormal blood vessels in your macula (the part of your eye responsible for central vision).
A low-powered laser is then shone into your damaged eye, over a circular area just larger than the lesion (wound) in your eye. This usually takes around one minute.
The laser is not powerful enough to damage your eyes, but the light from the laser is absorbed by the verteporfin and activates it. The activated verteporfin destroys the abnormal vessels in your macula without harming any of the other delicate tissues in your eye.
Destroying the blood vessels stops them leaking blood or fluid, preventing damage and therefore stopping the macular degeneration from getting worse.
You may need this treatment every few months to ensure any new blood vessels that start growing are kept under control.
Who can use PDT?
PDT is not suitable for everyone. It will depend on where the blood vessels are growing, and how severely they have affected your macula.
PDT may be suitable if your visual acuity is 6/60, or better. This means you can see from a distance of six metres what someone with normal vision can see from a distance of 60 metres. Around one in five people with wet AMD are suitable for PDT.
Laser photocoagulation
Laser photocoagulation can also be used to treat some cases of AMD.
This type of surgery is only suitable if the abnormal blood vessels are not close to the fovea, as performing surgery close to this part of the eye can cause permanent vision loss.
Around one in seven people are suitable for treatment with laser photocoagulation.
Laser photocoagulation uses a powerful laser to burn sections of the retina. These sections harden, which prevents the blood vessels from moving up into the macula.
The surgery is performed under local anaesthetic to numb the eye, so it is not painful.
You should be aware that an inevitable side effect of laser photocoagulation is that you will develop a permanent black or grey patch in your field of vision. This loss of vision is usually (but not necessarily always) less severe than untreated wet AMD.
If you're considering laser photocoagulation, you need to discuss the pros and cons of this treatment with the doctor in charge of your care.
As the results of laser photocoagulation tend to be less effective than the other treatments discussed above, it now tends to only be used in people who are unable to be treated with ranibizumab or PDT.
Newer types of surgery
In recent years two new surgical techniques have been introduced to treat wet AMD.
These are:
- macular translocation – where the macula is repositioned over a healthier section of the eyeball not affected by abnormal blood vessels
- lens implantation – where the lens of the eye is removed and replaced with an artificial lens designed to enhance central vision
Both approaches tend to achieve better results in restoring vision than conventional surgery, but there are also disadvantages, such as:
- access to these treatments is limited and may only be available in the context of a clinical trial
- as these are new techniques it is uncertain whether they are safe and effective in the long term
- they carry a higher risk of serious complications than conventional surgery
The National Institute for Health and Care Excellence has information sheets on macular translocation (PDF, 57kb) and lens implantation (PDF, 50kb.
