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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.

Last updated: July 28th 2020
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]

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]

Key points:

  • Age-related macular degeneration (AMD) is the most common form of eye disease that causes permanent vision loss in Australia
  • AMD doesn’t necessarily mean a full loss of vision
  • Diet and lifestyle can have an impact on your eye health

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 bigger problem.

The leading cause of permanent eyesight loss in Australia is age-related macular degeneration (AMD). Around one in seven people (1.4 million) aged 50 and over have AMD.

Around 249,000 people have late-stage AMD and experience vision loss or blindness in Australia.

Even more concerning is that AMD 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 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 some peripheral or side vision intact.

While AMD 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 AMD or if you are a smoker.

Dr Kathy Chapman, Chief Executive Officer (CEO) of Macular Disease Foundation Australia (MDFA), says, “Even with AMD, you don’t go black blind. It is your central vision which is most affected, and you may retain some level of peripheral 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.

AMD 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 AMD can develop mental health issues due to the feelings of loss they may experience.

Dr Chapman explains, “Once someone’s vision deteriorates to an extent when you can no longer drive, it results in a loss of their independence. This is when depression can set in, as not being able to do things by yourself anymore can understandably be very upsetting for many people.

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 intermediate 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) AMD or wet (neovascular) AMD.

Dry AMD means you will gradually lose your central vision. There is also no current treatment for the dry form of AMD, but research is exploring some potential therapies.

Wet AMD leads to rapid loss of your central vision, however, there is treatment for wet MD.

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.

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 an earlier diagnosis.

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 – such as reading labels. Sometimes you will get things mixed up with medicines, that can have a detrimental effect,” explains Dr Chapman.

“Also, the disease can progress until there is no vision, which puts people at more risk of other problems. People have eight times more risk of falling and fractures.

“People have greater risks of accidents and falls when their vision is lost.”

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

Prevention and treatment

If macular disease is detected early, there are lifestyle changes or treatments that can slow the progression or even save your sight.

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

Smokers also tend to develop AMD ten years before non-smokers who develop AMD, so rather than developing AMD in your 60’s, you could be diagnosed with AMD 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.

Nutritionally, eating healthy foods, such as fruit and vegetables which are full of vitamins and minerals, is great for reducing the risk of AMD progression.

Eating dark green leafy vegetables and fresh fruit, or eating fish two to three times a week, can all positively 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 2, formulation.

These supplements have high dose nutrients which aim to slow down the progression of AMD for people in the intermediate to late stage.

The MDFA says that the latest research has shown the updated AREDS2 (Age-Related Eye Disease Study #2) formula is both safer and better at slowing the progression of AMD than the original AREDS formula – giving a 30 percent reduction in the overall progression to the later stage at which vision loss occurs.

While lifestyle is an important factor, MDFA recommends seeing your optometrist once a year for a check-up.

Treatment for people with wet AMD doesn’t solve the disease but can maintain your current level of vision.

There are injections available for people with wet AMD that can be administered every four to 12 weeks and are required on an indefinite basis.

For late-stage dry AMD, and the early and intermediate stages, there currently isn’t any treatment besides lifestyle and dietary measures. However, important medical research is looking into new therapies for these harder to treat conditions.

Maintaining your eye health

Dr Chapman 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 AMD
  • F is for family connection. Is there a person in your family that has AMD?
  • E is for eye examinations, which ideally should be undertaken every one to two 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 advice is to keep in touch with their ophthalmologist and make sure they keep up their treatment. Because stopping treatments for AMD, over a period of time, will lead you to blindness,” Dr Chapman adds.

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

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