AMD: The Leading Cause of Vision Loss in Seniors – What You Should Know

Age-related macular degeneration, or AMD, is the leading cause of central vision loss in people over 60 years of age. With an ageing population, there will be an increase in incidence and prevalence of AMD in Singapore over the next few decades. 

In this guide, you can learn more about AMD, its symptoms, preventive measures and treatment options.  

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What Is AMD and How Does It Affect Vision?

AMD is an eye condition that damages the macula, which is the central part of the retina. The macula is responsible for providing us with central, sharp vision, and is critical for many daily activities including driving and reading. 

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Types of AMD

There are two main types of AMD: dry, which is more common, and wet, which is rarer but more severe.

1. Dry AMD

Approximately 85% to 90% of AMD cases are dry AMD, characterised in the early stages by proteinaceous deposits called drusen. This is asymptomatic initially, and is usually detected during screening, or when an individual presents with other ophthalmic issues. In the later stages of dry AMD, there is gradual thinning of the macula which result in central visual loss.

Yellow deposits (drusen) scattered throughout the retina. These deposits do not cause visual impairment. 

Progressive thinning of the macula resulting in geographical atrophy and late stage central visual loss. 

2. Wet AMD

Wet AMD is less common, but more severe. This can present with acute central visual loss when abnormal vessels deep to the retina bleed suddenly.  

Polypoidal Choroidal Vasculopathy (PCV) is a variant of AMD that can occur in younger individuals. It can present similarly with acute loss of vision or wavy vision, due to accumulation of blood and/or fluid underneath the retina.

Angiography showing abnormal blood vessels which cause accumulation of fluid in the deep layers of the retina. 

Why Seniors Are More at Risk for AMD

With an increase in age, there is degeneration of cells in the body, including those in the retina. In addition, the incidence of hypertension, and exposure to other risk factors such as sunlight and cigarette smoke increases. 

As our bodies age, their natural self-repair functions are reduced and waste deposits can accumulate under the retina. 

Common Signs and Symptoms of AMD

The following are common symptoms of AMD and should cause you to consult an eye specialist promptly:

• Gradual blurring of central vision in one or both eyes
• Straight lines appearing wavy or distorted
• Sudden darkening of central vision 

Is AMD Treatable or Curable?

Dry AMD has no cure at present but there are prevention strategies to reduce your risk of AMD. 

• AREDS2 supplements
• Avoid risk factors, e.g. sun exposure and smoking
• Control blood pressure
• A healthy diet rich in leafy greens, antioxidants, and omega-3 fatty acids

Wet AMD has several treatment options. The goal for treatment is to reduce the amount of blood and fluid in the retina that is causing visual loss. 

1. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections
   
   • To stop the growth and leakage of abnormal blood vessels 
2. Photodynamic therapy
   
   • To seal off abnormal, leaking blood vessels 
3. Focal Laser Therapy 
   
   • Rarely used treatment option in PCV for abnormal leaks away from the centre of the eye

Frequently Asked Questions

1. When should you be concerned about AMD? 
   AMD can affect anyone and it is silent in the early stages. Regular eye screening from the age of 50 is strongly recommended to look for signs of AMD, amongst other eye diseases. 

2. What will your doctor do if AMD is suspected? 
   
   • Comprehensive history to evaluate your risk factors and symptoms 
     
   • Thorough eye examination to look for signs of AMD 
   • Specialised ophthalmic imaging which at times might require an angiography study 

3. What happens if there is significant visual loss in dry AMD or wet AMD despite treatment? 
   In addition to controlling the disease, we would encourage individuals with significant visual loss to undergo low vision therapy.

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Are there ways to reduce the development of AMD?

The best way to reduce the chances of developing AMD or to slow its progression would be to reduce risk factors. 

• Quit smoking. This is one of the easiest risk factors to avoid.
• Eat a healthy diet. Focus on fatty fish, dark green leafy vegetables, and lutein-rich foods.
• Use eye protection. Avoid exposing your eyes to UV rays and wear sunglasses when outside.
• Manage health conditions. Keep blood pressure, cholesterol, and blood sugar levels under control.
• Get regular eye screening. Especially from age 50 onwards, this can help you detect issues as early as possible.

Get Screened or Treated for AMD

If you fear you may have AMD yourself or already have it and want help with its management, reach out to us.

Our eye doctors can provide screenings, treatment plans, and consultations as necessary. Book an appointment with us today.

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