Macular Degeneration

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On icon of an eye in royal blue and the text 'Macular Degeneration'

What is Macular Degeneration?

Macular Degeneration can also be referred to as Age Related Macular Degeneration because it often first affects people in their 50s / 60s. A common eye condition which affects the middle part of the eye causing various types / levels of central vision loss. The cause is presently not definitively known although a number of factors have been linked to the condition (see ‘prevention and risk factors’). It can be sub-categorised as the rarer Wet Macular Degeneration and the more commonly diagnosed Dry Macular Degeneration. While not causing total blindness, it can create difficulty with daily activities such as recognising faces and reading. Symptoms can worsen in the absence of treatment over several years (for Dry Macular Degeneration) or just a few weeks / months (for Wet Macular Degeneration).

 Symptoms of Macular Degeneration:

  • Central vision loss in one or both eyes
  • Blurry / distorted area of vision
  • Patients may experience a dark patch at the centre of the visual field
  • Impacts activities like driving, watching TV, reading print and recognising faces
  • May see straight lines as wavy or crooked
  • Objects may appear smaller than normal
  • Colours could seem less bright than they used to
  • Visual hallucinations

Note that eye pain or altered eye appearance is NOT a symptom of Macular Degeneration

Two boys are smiling at the camera, they are both holding footballs, behind them is a fence. One boy is white with blond hair and the other boy is of colour.

Scene as someone fully sighted would see it.

 

The two boys faces are blurred out with a grey blob, the rest of the image is blurry and not as sharp in focus

Scene as someone with Age Related Macular Degeneration would see it.

 

How is Macular Degeneration diagnosed:

Optometrists use a magnifier and light along with eye drops that dilute the pupils to examine the back of the eye. A person may be referred to an Ophthalmologist / Macular Degeneration specialist who will carry out further tests including eye scans. Dry Macular Degeneration can be identified If the various examinations / tests find gradual prolonged sight loss with a build up of Drusen (a fatty substance) at the back of the eye. The presence of Wet Macular Degeneration can be ascertained if sight loss occurs over a shorter period of time with the growth of abnormal blood vessels at the back of the eye.

Treatments for / management of Macular Degeneration:

Wet Macular Degeneration may be treated via eye injections (this may be regularly required) and sometimes through receiving photodynamic therapy / PDT (a potent light is shone at the back of the eye to destroy the abnormal blood vessels). The NHS reports that direct eye injections stop further visual deterioration in 9 out of 10 people and improve vision in 3 out of 10 cases. Injections are usually administered once every 1-3 months for as long as necessary. People report minimal discomfort from the procedure, likely because eye numbing drops are administered before treatment. Side effects may include bleeding in the eye, redness in the eye, and the sensation of something being in the eye.

PDT may be recommended every few months as s supplementary procedure if injections alone do not suffice. Side effects include, temporary visual problems and the eyes / skin experiencing increased light sensitivity for a few weeks.

Dry Macular Degeneration There is currently no known treatment for Dry Macular Degeneration however practical difficulties with daily activities can be reduced via the use of visual aids (among other management methods) for either version of the condition. The NHS and Macular Degeneration Society recommend people to discuss management methods with their local eye specialists who can advise / allocate training on useful devices (i.e. magnifying glasses), changes that can be made to the home / learning / work environment (e.g. brighter lighting), software and mobile apps that can improve accessibility for computers and phones, etc. If both eyes are significantly affected, the person may need to receive eccentric viewing training (EVT). A specialist training programme by which people can learn techniques to make optimal use of their remaining vision.

Due to the reported correlations between Macular Degeneration and general health, people are recommended to stop smoking, eat a balanced diet, and to increase routine exercise. Some inconclusive evidence suggests that certain health supplements can stop symptoms from getting worse. However it is strongly advised to consult a specialist before taking such supplements as they are not suitable for everyone. General research into treating Macular Degeneration is ongoing.

Depending on the level of vision loss caused by the condition, it may not be possible / appropriate to drive. A local specialist should be consulted and the condition and level of eye sight (determined via visual tests) may need to be reported to DVLA. The gov.uk website provides more specific guidance regarding this.

It is paramount for people to receive regular check ups for monitoring and managing purposes. You must report any further sight loss or other symptoms immediately. If a person experiences continued sight loss then it is useful to get officially registered as ‘Sight Impaired’ (further advice can be attained from your specialist or one of our Sight Loss Advisors). Getting registered can help a person receive financial / practical support and other relevant public services. It may also be practically and emotionally beneficial to make contact with various support groups / services like those established by the Macular Degeneration Society and the RNIB, our Sight Loss Advisors can help point you in the right direction.

Prevention / Risk factors:

Sometimes Macular Degeneration can be found in routine eye tests before symptoms are experienced. While a direct cause has not been decisively found, the NHS has reported Macular Degeneration as being linked to smoking, high blood pressure, being overweight and family history. On 8 Nov 2022, The Macular Degeneration Society reported a recent study carried out by the University Hospital Bonn (Germany) and published in the British Journal of Ophthalmology which showed evidence that drugs to control diabetes and lower cholesterol could reduce the risk of developing Macular Degeneration . The research involved 14 studies across the UK and Europe, totalling 40000 participants (around 9332 with Macular Degeneration) aged above 50 and found that those participants who took drugs to manage cholesterol levels had a 15% reduced risk of developing Macular Degeneration. While those who were taking drugs to control diabetes had a 22% reduced risk. Research in this field is still scarce and most studies so far have been small scale, but research into prevention is still ongoing.

Further information and Support:

Macular society main page:

https://www.macularsociety.org/

Macular society support services:

https://www.macularsociety.org/support/

RNIB sight loss support service:

https://www.rnib.org.uk/living-with-sight-loss/

Driving eyesight rules:

https://www.gov.uk/driving-eyesight-rules

How to tell DVLA about a medical condition:

https://www.gov.uk/report-driving-medical-condition

RNIB registering as sight impaired:

https://www.rnib.org.uk/eye-health/registering-your-sight-loss