Macular Degeneration

Age-related macular degeneration (AMD) is a progressive condition affecting the macula, the central region of the retina responsible for sharp, detailed vision.

Dry (atrophic) AMD
The more common form, accounting for approximately 85–90% of cases. It is characterised by the gradual accumulation of drusen (yellowish lipid deposits) beneath the retina and progressive atrophy of the retinal pigment epithelium. Progression is typically slow, occurring over many years.

Wet (neovascular) AMD
The less common but more severe form, where abnormal new blood vessels grow beneath the retina (choroidal neovascularisation). These fragile vessels leak fluid and blood, causing rapid swelling, scarring, and significant vision loss. Wet AMD can develop at any stage of dry AMD and requires urgent treatment.

Symptoms may develop gradually in dry AMD or suddenly in wet AMD. Common symptoms include:

• Blurred or distorted central vision
• Metamorphopsia (straight lines appearing wavy or bent)
• A dark, blurry area in the centre of vision (scotoma)
• Difficulty recognising faces
• Difficulty reading or performing tasks requiring fine vision
• Colours appearing less vivid or faded
• Increased need for brighter light when reading
• Difficulty adapting to dim lighting

In wet AMD, symptoms may develop suddenly and progress rapidly

When you visit us at Sutherland Eye Surgeons, some of the tests that we perform may include:

• Visual acuity testing
  Assessment of your best corrected vision

• Refraction
  Evaluation of any refractive error

• Slit lamp examination with fundoscopy
  Examination of the macula, retina, and optic nerve

• Optical coherence tomography (OCT)
  Non invasive, high resolution imaging that provides cross sectional images of the macula to detect and quantify fluid, drusen, and retinal thinning, and to monitor response to treatment

• Fundus photography
  Colour photographs of the retina to document drusen and other changes, and to monitor progression over time

• Fluorescein angiography (FFA)
  A dye is injected into a vein in your arm, and sequential photographs are taken as the dye passes through the retinal circulation. This is essential for detecting choroidal neovascularisation in wet AMD

• Indocyanine green angiography (ICG)
  May be used in selected cases to visualise deeper choroidal vessels that are not visible with FFA

We recommend that patients with or at risk of AMD monitor their vision at home using an Amsler Grid.

This simple tool consists of a square grid of straight lines with a central dot. By covering one eye at a time and focusing on the central dot, you can check for any wavy, broken, or missing lines in your vision. If you notice any new distortion or changes, this may indicate progression of your AMD and you should contact our clinic promptly for review.

Regular self monitoring between appointments allows for early detection of changes and timely intervention, which is critical for preserving your vision.

Dry AMD
For dry AMD, the AREDS2 formulation of nutritional supplements: vitamins C and E, zinc, lutein, and zeaxanthin has been shown to reduce the risk of progression to advanced AMD in patients with intermediate or advanced dry AMD. If you smoke, it's important to quit as soon as possible.

Wet AMD
Anti-VEGF injections are the most effective treatment for wet AMD. These medications block the protein that causes abnormal blood vessels to grow and leak, reducing swelling and preventing further damage. Injections are given in the clinic, usually every four to sixteen weeks depending on your response to treatment.