Age-related macular degeneration

Reviewed by Caroline MacEwen, consultant ophthamologist and Paul Klenerman, consultant physician and infection specialist

What is age-related macular degeneration?

Age-related macular degeneration (ARMD) is a very common cause of reduced vision in the UK. As the name suggests, it is a condition that tends to become more common as people get older.

Although this condition may cause significant reduction in vision it never leads to complete blindness as it affects only the central part of the vision and the side, or peripheral, vision is always left intact.

The retina, which is situated at the back of the eye, transmits the images that we see to the brain. The retina has two main parts - the macula and the peripheral retina.

The macula is the part of the retina that is responsible for seeing fine detail, such as reading, seeing facial features and interpreting different colours. It is this part of the retina that is affected by age-related macular degeneration.

How does ARMD develop?

This is an ageing change and occurs because of 'wear and tear' changes in the macular region. It is thought that waste materials from this very active part of the eye build up as the mechanisms for removing them become less able. This causes damage to the cells over a period of time.

Who is at risk of age-related retinal degeneration?

This condition tends to affect people who are over 60 years of age. Some younger people may be more susceptible, including people who are very short-sighted. Women tend to be affected more commonly than men, but that is probably because they live longer. There is a hereditary tendency, but this has not yet been fully researched.

What are the different types of macular degeneration?

There are two major types of ARMD. These are described as dry or wet.

Dry ARMD This is the more common form of ARMD and affects almost 80 per cent of those with the condition. The onset of this condition tends to be slow. Both eyes are usually affected symmetrically.

Wet ARMD

Wet macular degeneration is less common but tends to have a more severe and rapid effect on the central area of vision. In this condition, blood vessels from one layer at the back of the eye grow in an abnormal fashion into the macular area. These blood vessels may leak or bleed causing a rapid and significant reduction in central vision. This tends to affect one eye at a time but there is a risk of the same thing occurring in the other eye over the following months.

What are the symptoms of age-related retinal degeneration?

Dry ARMD causes a gradual reduction in central vision. This tends to affect the ability to read and to see fine detail more than distance vision.

The first symptoms of wet ARMD may be distortion of vision (known as metamorphopsia). This often has the effect of making straight lines appear curved or tilted. The vision deteriorates and eventually the central vision may be completely lost leaving a dark central area of poor vision (known as a central scotoma).

Which treatments are available?

There is research being carried out in this area but the treatments are far from universally successful. No tablets or drops are of any use in this condition.

Dry ARMD The vision tends to deteriorate gradually and the loss of vision is not always severe. Treatment involves wearing the best spectacles and possibly using bright lights to help you see things more clearly. The use of large print books and the prescription of a magnifying glass (low visual aid) are often necessary.

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