Macular + Retinal Disease

Question 1

What is macular degeneration (AMD)?

Answer 1

• degenerative disease of central part of retina (macula)
• commonest cause of sight loss in developed world
• usually over 60
• smoking = risk factor

Question 2

How does macular degeneration present?

Answer 2

Affects reading, recognising faces, reading text at a distance (eg. subtitles, bus numbers). Peripheral vision is never affected.

Question 3

There are two types of macular degeneration - dry and wet (nothing to do with dry eyes!)

What is dry macular degeneration?

Answer 3

• gradual loss of retinal cells over many years → slow vision loss
• treatment is supportive (lighting, low vision aids)
• nutritional advice → increase lutein and zeaxanthins in diet (eg. spinach and kale or tablets)

Question 4

What is wet macular degeneration + its treatment?

Answer 4

• leakage of oedema/blood capillaries from under retina → sudden vision change
• disruption of layers of retina by fluid in wet AMD gives distortion of straight lines
• distortion makes window frames look wavy
• test using a home testing grid (Amsler grid)
• needs urgent referral to eye clinic as can be treated
• Rx → intravitreal anti-VEGF injections eg. avastin, lucentis, eyelea
• course of repeated injections required
• financial burden on NHS (costly drug, old population)