Macular degenerationGold Coast & Tweed Heads

The macula is a small area at the centre of the retina, the light-sensing layer at the back of the eye. It gives you sharp, detailed central vision for reading, recognising faces and driving. Age-related macular degeneration (AMD) slowly damages the cells in the macula, so central vision is lost. Side vision is not affected.

AMD is the leading cause of permanent vision loss in Australians over 50. About 1 in 7 people over 50 have some sign of it. Finding it early and treating it on time are the best ways to protect your sight.

About 85 to 90 in every 100 people with AMD have the dry form. Small yellow deposits called drusen build up under the retina, and the macula slowly thins. Vision usually changes slowly, over years, although the loss can become significant.

In its advanced stage, dry AMD can become geographic atrophy. Patches of the macula waste away completely, leaving a permanent blind spot in the centre of your vision.

Looking after dry AMD means regular checks and slowing it down where possible:

• Regular OCT scans to look for change, or for a switch to wet AMD
• AREDS2 vitamin supplements (lutein, zeaxanthin, vitamins C and E, and zinc). These lower the risk of getting worse in people with moderate AMD, or advanced AMD in one eye.
• Stopping smoking, as smoking makes AMD worse faster
• Good-quality sunglasses
• A Mediterranean-style diet with leafy greens and oily fish
• Checking each eye every day with an Amsler grid, so any change to wet AMD is picked up quickly

Geographic atrophy (GA) is the advanced stage of dry AMD. Patches of the macula slowly waste away, and the patches grow over months and years. Early on, you may need more light to read, find that words go missing from a line, or find faces harder to make out. GA does not cause sudden bleeding like wet AMD, but vision that is lost cannot be brought back.

Until recently, there was no treatment for GA other than monitoring and low-vision support. Newer treatments, given as regular injections into the eye, can slow how fast the patches grow in some people. They do not stop GA, reverse it or bring back lost vision. They also need to be continued long term, so they are not right for everyone.

Whether treatment is worthwhile depends on the size and position of the patches, how fast they are growing, the vision in each eye and what matters most to you. Options for GA are changing quickly. A treatment being approved in Australia does not always mean it is subsidised by the PBS, so it may be expensive to pay for yourself. Costs vary. Dr Weaver can talk you through the current options, including the likely benefits, risks and costs, and any clinical trials that may suit you.

Monitoring GA: regular OCT scans and wide-field photographs measure the patches over time. People with GA can also develop wet AMD, so keep checking each eye with an Amsler grid and report any new distortion promptly.

Only about 10 to 15 in every 100 people with AMD have the wet form, but it causes most of the severe vision loss. Abnormal new blood vessels grow under the retina. These vessels are fragile. They leak fluid and can bleed, which quickly blurs and distorts central vision.

Wet AMD can change vision quickly, sometimes over weeks, so it needs prompt assessment. How fast it changes varies from person to person. If you notice new distortion, blurring or a dark patch in your central vision, call Dr Weaver's rooms urgently. Check each eye with your Amsler grid every day between appointments.

Injections into the eye are the standard treatment for wet AMD. The medicine blocks a protein called VEGF, which makes the abnormal vessels grow and leak. With treatment, the vessels shrink and the fluid dries up.

What treatment can and cannot do:

• The main aim is to keep the vision you have and stop it getting worse.
• Some people find their vision improves.
• Vision that has already been lost often does not fully come back.
• Treatment is usually ongoing, with regular injections and scans.

Several medicines are available in Australia. They work in a similar way, and some allow longer gaps between injections. Dr Weaver will talk with you about which medicine and schedule suit your eye, based on your scans and how your eye responds.

• Do not rub the eye for 24 hours
• Avoid swimming pools, spas and dusty places for 48 hours
• Use any drops you are given as directed
• Call urgently if your vision gets much worse, or the eye becomes more painful or more red, or you have many more floaters than before. These can be signs of infection inside the eye (endophthalmitis). This is rare but needs treatment the same day.
• You can drive the next day. Do not drive on the day if your vision is affected.

Treatment for wet AMD is ongoing. Most people start with an injection every month for the first few months. After that, the gap between injections is gradually stretched out, depending on what your scans show (this is called treat and extend). Dr Weaver checks your scan at each visit and adjusts the timing. Some people keep stable vision with an injection every 3 to 4 months.