Age-Related Macular Degeneration

The Macula and Central Vision

The macula is the small central area of the retina at the back of the eye. It provides the detailed central vision you use for reading, recognising faces, driving and seeing fine detail. Age-related macular degeneration (AMD) damages the macula and can gradually or suddenly affect the centre of your vision.

What Is Age-Related Macular Degeneration (AMD)?

Age-related macular degeneration is a chronic condition that affects the macula, usually in people over the age of 50. AMD can make central vision blurred, distorted or less detailed. It does not usually affect peripheral (side) vision in the same way, although advanced AMD can still cause severe visual impairment and significantly affect everyday activities.

AMD may affect one or both eyes, and the severity can be different between the eyes. In the early stages, some people have no noticeable symptoms, which is why regular eye examinations are important.

Dry and Wet Macular Degeneration

Dry AMD

Dry AMD is the more common form. It develops as the macula undergoes age-related changes, including the formation of deposits called drusen and changes to the retinal tissues. Vision loss is usually gradual, although the rate of progression varies from person to person.

An advanced form of dry AMD is called geographic atrophy (GA). In geographic atrophy, areas of retinal cells gradually deteriorate, which can create increasing gaps or blurred areas in central vision.

Wet AMD

Wet AMD develops when abnormal blood vessels grow underneath or within the retina and leak fluid or blood. These changes can damage the macula and cause a faster decline in central vision. Wet AMD needs prompt assessment because early treatment can help reduce the risk of further vision loss.

Seek prompt eye care: If straight lines suddenly look wavy, your central vision becomes noticeably blurred, or you develop a new dark or blank patch in the centre of your vision, arrange an urgent eye assessment. These changes can occur with wet AMD and should not wait for a routine appointment.

Macular Degeneration Symptoms

AMD can cause no symptoms in its early stages. When symptoms develop, they may include:

• blurred or reduced central vision
• straight lines appearing bent or wavy
• difficulty reading, even with updated glasses
• difficulty recognising faces
• a dark, blurred or blank patch in the centre of vision
• needing brighter light for reading or close work
• reduced contrast or colours appearing less vivid
• difficulty adapting between bright and dim lighting

AMD is usually painless. A change in vision can therefore occur without discomfort.

What Causes Macular Degeneration?

AMD develops when cells in the macula become damaged as part of a complex interaction between ageing, genetics and environmental or health factors. Age is the strongest risk factor, but it is not the only factor involved.

Risk Factors for AMD

• Age - the risk increases as you get older.
• Smoking - smoking substantially increases the risk of AMD and is one of the most important modifiable risk factors.
• Family history and genetics - having a parent or sibling with AMD can significantly increase your risk.
• General cardiovascular and metabolic health - factors such as blood pressure, weight and overall health may influence risk and progression.
• Diet and lifestyle - a balanced diet and regular physical activity support general and eye health.

If you have a strong family history of AMD or other risk factors, ask your optometrist or ophthalmologist how often your macula should be checked.

Can Macular Degeneration Be Prevented?

There is no guaranteed way to prevent AMD. However, reducing modifiable risks and having regular eye examinations may help lower your risk or identify AMD before significant vision loss develops.

Helpful steps include:

• do not smoke, and seek help to quit if needed
• eat a balanced diet rich in vegetables, fruit and other nutrient-dense foods
• exercise regularly and maintain a healthy weight
• manage blood pressure, cholesterol and other medical conditions with your healthcare team
• attend regular eye examinations, especially if AMD runs in your family

How Is Macular Degeneration Diagnosed?

AMD is diagnosed through an eye examination and retinal imaging. Your assessment may include:

• a vision test and discussion of any changes you have noticed
• a dilated examination of the retina and macula
• optical coherence tomography (OCT), which provides detailed cross-sectional images of the retina
• retinal photography to document and monitor changes over time
• additional imaging, such as OCT angiography or fluorescein angiography, when your ophthalmologist needs more information about abnormal blood vessels or leakage

These tests help determine the type and stage of AMD and whether treatment or closer monitoring is required.

Macular Degeneration Treatment

Treatment depends on whether you have dry AMD, geographic atrophy or wet AMD, as well as the location and severity of the changes in your macula.

Treatment for Dry AMD

For early and intermediate dry AMD, management usually focuses on regular monitoring, reducing modifiable risk factors and supporting overall eye health. A specific AREDS2 vitamin and mineral formulation may be recommended for some patients with particular stages of AMD, but supplements are not suitable or necessary for everyone. Ask your eye-care professional whether they are appropriate for you.

For selected adults with geographic atrophy secondary to AMD, newer intravitreal treatments are now TGA-registered in Australia. These include pegcetacoplan (Syfovre) and avacincaptad pegol (Izervay) for specific patients where the fovea remains intact and central vision is threatened by lesion growth. These treatments aim to slow the growth of geographic atrophy; they do not restore retinal cells or vision already lost. Suitability, treatment burden, risks, availability and costs should be discussed with a retinal specialist.

Treatment for Wet AMD

The main treatment for wet AMD is a course of injections into the eye using medicines that block vascular endothelial growth factor (anti-VEGF). These medicines reduce leakage and abnormal blood-vessel activity. Treatment often requires repeated injections, with the frequency adjusted according to your response and retinal scans.

The aim is to stabilise the macula, reduce the risk of further vision loss and, in some patients, improve vision. Results vary between individuals, and treatment works best when wet AMD is identified and managed promptly. Laser or other treatments may still be considered in selected situations, but they are not the usual first-line treatment for most wet AMD.

Vision Aids and Low-Vision Support

If AMD has already reduced vision, brighter task lighting, updated glasses, magnification, electronic reading aids and low-vision rehabilitation can help make everyday activities easier. Your eye-care team can advise which services and devices may be useful for you.

Check Your Central Vision with an Amsler Grid

An Amsler grid is a simple tool that can help some people with AMD notice new distortion in their central vision. If your eye-care professional recommends home monitoring:

• wear your usual reading glasses if you use them
• hold the grid at your normal reading distance in good light
• cover one eye and look directly at the central dot
• check whether any lines appear newly wavy, broken, blurred or missing
• repeat with the other eye

If you notice a new or sudden change, contact your eye-care provider promptly. An Amsler grid does not replace regular professional eye examinations or OCT monitoring.

Living with AMD

AMD primarily affects detailed central vision. Peripheral vision is usually retained, so AMD does not typically remove all vision. However, advanced disease can have a major impact on reading, driving, recognising faces and other daily activities. Early diagnosis, appropriate treatment and vision-rehabilitation support can help people make the best use of their remaining vision.

Book a Macular Assessment

If you have noticed distortion, blurred central vision, difficulty reading or a new dark patch in your vision, arrange an eye assessment. People with a family history of AMD or known macular changes should also attend regular reviews even if their vision feels unchanged.

The retinal specialists at personalEYES can assess your macula, perform retinal imaging and discuss monitoring or treatment options based on your individual findings.

Book an appointment online or call personalEYES on 1300 68 3937.