They are converted to nerve signals and sent to the brain to be viewed as pictures. The centre of this retina is called the macula. It enables us to see fine detail and differentiate colour. It also enables us in our daily detailed activities like reading, writing and driving.

There are 2 forms of Age-related macular degeneration - Dry and Wet form.

Dry or Non-Exudative AMD is the more common form, affecting majority of patients with AMD. As a person gets older, these photoreceptors slowly fail to function properly. This results in any abnormal deposits or debris, called drusen to accumulate under the retina. Fortunately, these deposits rarely cause visual loss or blindness. However, in some patients, the photoreceptors slowly degenerate with time, resulting in an advanced form of dry AMD called geographical atrophy. In a small group of patients, patients with drusen can progress to develop wet AMD. Both advanced form of dry AMD and wet AMD can cause visual loss.

Wet or Exudative AMD accounts for 10 to 15% of cases but is responsible for majority of vision loss. This is due to growth of abnormal blood vessels under the retina called Choroidal Neovascularization (CNV). These new blood vessels are very fragile and may leak fluid or blood. This results in scarring that causes rapid and severe visual loss. Another variant that is commonly seen in this part of the world is called Polypoidal Choroidal Vasculopathy (PCV). This condition frequently results in large amount of bleeding and leakage under the retina.

• Blur vision
• Central loss of vision (scotoma) or areas of black patches/ shadows
• Distortion of vision or metamorphopsia where a straight line appear wavy

The Amsler Grid Test is used to monitor the macula. This consists of a large square with multiple small, regular squares. The centre of the large square is a black dot for the patient to focus on. A patient with normal vision focusing on the centre black dot should notice that the surrounding lines and squares are regularly spaced. If there are any abnormalities (ie. missing black dot or squares and waxy lines), a consult with an ophthalmologist is necessary.



What can I do to reduce my risk of developing AMD?
Targeting the modifiable risk factors by changing our lifestyle. This includes:
• Healthy diet of fish, green, leafy vegetables and reduced fats
• Take medications to control high blood pressure and elevated cholesterol
• Stop smoking
• Exercise to reduce weight
• Wear sunglasses to decrease sunlight exposure

How can I treat dry AMD?
There is currently no proven effective treatment for dry AMD.

How can I treat wet AMD?
As for wet AMD, there are a few options but none of these are a cure.

Laser
This involves applying a focused beam of high energy laser to the leaky blood vessels. However, this will also destroy surrounding health tissues and cannot be used for blood vessels directly under the centre of the macula.

Photodynamic Therapy (PDT)
This is a 2 step procedure. The first involve injection of a drug called verteprofin (Visudyne) into the blood stream. The drug is pooled in the abnormal leaky blood vessels but not on normal vessels. The second step involves applying a 'cold' laser to activate the drug on these abnormal blood vessels. This way, the abnormal vessels will be closed and the normal tissue will not be affected as they do not collect the drug.

Anti-VEGFs
This is a recently discovered new group of drugs, called anti-VEGF (anti-Vascular Endothelial Growth Factor). By injecting the drug directly into the eye using a small, fine needle, it has been shown to be effective in wet AMD by causing regression of the CNV. This is the only treatment that may result in improvement of vision but results vary between individuals. However, injections may have to be repeated on a monthly basis for optimal results. An example of this agent is Lucentis. Due to the high cost of Lucentis, a close chemical alternative of Lucentis, Avastin can be used. Avastin is a drug used for patients with colorectal cancer. It is used 'off-label' for patients who cannot afford Lucentis. Both of these drugs are injected directly into the eye known as an intravitreal injection.

What be done when I already have poor vision from advanced AMD?
Fortunately, macular degeneration does not lead to total blindness and usually, only the central vision is damage. Even in advanced cases, the peripheral vision is still very well preserved, allowing for 'navigational' vision.

There are many low vision aids that can help. These consist mainly of magnifiers, both for near and distances. They range from simple desktop glass magnifiers or telescopes to more sophisticated ones like computer screen readers.

At Eagle Eye Centre, we will first perform a comprehensive ocular examination which includes a visual acuity test, observations through the slit lamp and a dilated fundal examination. Based on your assessment, we can then offer a proper diagnosis and will devise a personalised treatment for your condition.

With the latest imaging techniques including FFA, ICG and state of the art spectral domain OCT, we are highly equipped to offer an accurate diagnosis of various possible conditions. We are also able to perform laser from the latest PASCAL laser and have various intravitreal injection options between Avastin and Lucentis.

As part of our quality care we pride in, we also offer counseling with regards to diet and lifestyle modifications to help reduce your risk of AMD. EEC also provides a wide range of low vision aids help overcome various visual inconveniences.