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Age-related macular degeneration and eye health

It is common for people over 50 to start having issues with their eyesight, and you can never really know the importance of your vision until you lose it.

Key points:

  • Age-related macular degeneration is the most common form of eye disease in Australia

  • Macular degeneration doesn't necessarily mean a full loss of vision

  • Diet and lifestyle can have an impact on your eye health

Woman receiving eye drops for her AMD.
The macula is the part of your eye at the very centre of the retina, providing you with central vision and colour to your vision. [Source: iStock]

Age-related changes to your vision could be as simple as needing glasses to see your television or for reading, but in some cases, eye diseases can become a problem.

The leading cause of eyesight loss in Australia is macular degeneration. When you reach the age of 50, around one in seven people have a high risk of developing the disease and nearly 15 percent of Australians over 80 years of age have macular degeneration, with 160,000 people experiencing vision loss or blindness from macular degeneration.

Even more concerning is that macular degeneration is progressive and painless, so you may not even release you are developing it until it's too late.

What is macular degeneration?

Age-related macular degeneration (AMD) is an umbrella term for a group of chronic and degenerative retinal eye diseases which can result in the loss of central vision while leaving the peripheral or side vision intact.

While MD can be age-related, there are a number of factors that can increase the likelihood of you developing the eye disease, such as a family history of eye disease or MD, if you are a smoker, or have diabetes.

There are 22 different conditions that can affect your macula and can result in vision loss or blindness.

Dee Hopkins, Chief Executive Officer of the Macular Disease Foundation Australia (MDFA), says, "Even with AMD, you don't go black blind always. It may mean you retain some level of peripheral vision, so you are without your central vision."

The macula is a part of your eye at the very centre of the retina, which provides you with central vision and most colour to your vision.

Your macula is responsible for reading, face recognition, driving a car, colour, and other things that require fine detail vision.

MD affects a layer of cells in the eye, called the retinal pigment epithelium (RPE), which is underneath the retina. The RPE passes oxygen, sugar and essentials up to the retina while also removing waste products. However, if there is a build up of "drusen", which are yellow spots, it can increase the likelihood of developing MD and resulting in vision loss.

Many older people that are diagnosed with MD can develop mental health issues due to the feelings of loss they may experience.

Ms Hopkins explains, "Well, it all starts really falling apart when it deteriorates to an extent when you can no longer drive. At that point, people lose their independence, where they have mental health issues and people get quite depressed about that. Not being able to do things by yourself anymore, it is a bit of a downward spiral for people."

Stages of macular degeneration

In the early stages of AMD, it will have little to no impact on your vision and any symptoms are easily missed. But it can progress to the immediate stage, where it may be easier to notice changes to your central vision.

During this stage, there isn't a lot of treatment, however, it is important that you see your eye doctor to prepare for the future of your vision.

Depending on how your AMD progresses, if you reach the later stages of vision loss, it could lead to either dry (atrophic) macular degeneration or wet (neovascular) macular degeneration.

Dry MD means you will gradually lose your central vision. There is also no treatment for the dry form of MD.

Wet MD leads to rapid loss of your central vision, however, there is treatment for wet MD. Your vision loss in one eye could go unnoticed if your other eye is unaffected. Regular checkups with an optometrist in both eyes can help with earlier diagnosis.

Detection and symptoms

Getting a diagnosis early is critical to saving your vision and potentially improving your eyesight.

While bad vision is considered something you develop as you grow older, this doesn't mean you should not regularly visit an optometrist.

Since the early stages of MD aren't as easy to recognise, regular check-ups can be a vision saver.

However, there are some symptoms you may be able to spot.

These include:

  • Difficulty reading or other activities that require detailed vision

  • Distortion when looking at lines that should be straight but appear wavy or bent

  • Difficulty recognising faces

  • Dark patches appear in the centre of your vision

Other symptoms that may suggest an issue include:

  • The need for increased illumination

  • Sensitivity to glare

  • Decreased night vision

  • Poor colour sensitivity 

"Physically, the things you will have issues with are reading - reading labels, sometimes you will get things mixed up with medicines, that can have a detrimental effect. Also, the disease progresses until there is no vision, so there is more risk. People have eight times more risk of falling and fractures," explains Ms Hopkins.

"People have greater risks when their vision is lost like that and they are seriously impacted."

If you recognise any of these symptoms, visit your optometrist or doctor, and get a referral to an ophthalmologist if MD is noticed or diagnosed.

Prevention and treatment

If you have an early detection, there are lifestyle changes or treatments that can slow the progression or even save your sight.

Lifestyle is important to helping prevent MD. For instance, smoking is a cause of MD, so you can imagine removing this risk factor can greatly decrease your likelihood of developing the eye disease.

Smokers also tend to develop MD ten years before non-smokers who develop MD, so rather than developing MD in your 60's, you could be diagnosed with MD when you are 50.

Exercise is another important component of lifestyle and can also benefit your eye health.

If you already have low vision or struggle with your mobility, you are less likely to do exercise, which results in the weakening of your muscles and bones, and also leads to chronic health conditions, like diabetes or heart diseases.

Whereas a physically active older person has a higher likelihood of maintaining a healthy weight and staving off conditions, like diabetes that in turn could increase the likelihood of developing MD.

Nutritionally, eating healthy foods full of vitamins and minerals is a great preventative for reducing your risk of developing MD.

The old saying suggests that eating carrots helps with vision, and that may be right on the money!

Limiting your fat and oil intake, eating dark green leafy vegetables and fresh fruit, or eating fish two to three times a week, can all impact your eye health.

If you are struggling to take in the nutrients or vitamins your body and eyes need, supplements can be a helpful alternative, however they should only be taken on the direction of medical advice.

People who have been diagnosed with AMD may be taking special supplements called AREDS, or Age-Related Eye Disease Study.

AREDS are supplements with high dose nutrients and have a special formula that slows AMD down for people in the intermediate stage.

Evidence shows that AREDS slows the progression of AMD in people by 20 to 25 percent and can delay vision loss.

While lifestyle is an important factor, Ms Hopkins suggests seeing your optometrist once a year for a check up.

Treatment for people with wet MD doesn't solve the disease, but can maintain your current level of vision.

There are injections available for people with wet MD that can be administered monthly. After a period of time, these injections are only required on an indefinite basis.

Dry MD, or early and intermediate stages, doesn't have any treatment besides lifestyle and diet changes.

Maintaining your eye health

Ms Hopkins says that MDFA used the terminology 'SAFE' as a reminder to keep on top of your eye health:

  • S is for smoking, which older people should give up

  • A is for age, if you are over 50, you are probably at risk of MD

  • F is for family connection. Is there a person in your family that has MD?

  • E is for eye examinations, which ideally should be undertaken every 3 years with a request to specifically have your macula checked.

"Anyone living with neovascular or late stage AMD, if they are getting treatment, the most important method is to keep in touch with their ophthalmologist and make sure they keep up their treatment. Because when you stop treatments for AMD, over a period of time, you will go blind," Ms Hopkins adds. 

What concerns do you have about your eye health? Tell us in the comments below.

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The importance of elderly nutrition
Keep mobile and stay independent
Hydration for elderly people and the dangers of dehydration

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