AMD

Age-related macular degeneration (AMD) is the first cause of vision loss for French people over 50 years old. It destroys the macula, part of the eye responsible for fine vision. It is characterized by an inexorable loss of vision, and there is no treatment today to cure the disease.

How many people are touched by the disease ?

AMD impacts about one million French people. It is rare to be affected before 50 years old, but the disease touch more than 50 % of people older than 80. Due to aging population, the disease is in constant increase. It could touch two million of French people by 2050. AMD is responsible for 3000 new cases of legal blindness every year.

How can I know if I have AMD?

Often the first lesions responsible for the disease start as young as 50 years old, even tough the diagnosis is usually not done before the age of 60-65.

Actually, the disease start with discreet symptoms that usually are not recognized as pathological, such as the need to increase the light to read, having a hard time driving at night.

Little by little, near and far vision is altered with the feeling that straight lines are becoming curves. These symptoms are slowly impairing the ability to read, to write, to work on hobbies.

The person affected by the disease has trouble recognizing familiar faces, surrounding objects seems deformed and faded, all colors are dark and dull.

Later a dark shadow appears in the central vision that make fine and central vision almost impossible. People can still orient themselves because the peripheral vision is not affected by the disease. But driving, reading, writing, any of everyday life actions such as looking at oneself in a mirror, pealing vegetables, lighting a candle become impossible to do.

What should I do if I have symptoms resembling AMD ?

First, you should quickly schedule an appointment with your healthcare provider. Diagnosis is made by an eye doctor. It is very important that once experience the first symptoms or from 50 years old, that a complete eye examination is performed to evaluate your eyesight.

Your eye doctor will perform several tests to diagnose AMD and determine if you have the dry or the wet form of the disease. The treatment is different depending on the form you have.

At first, the doctor will perform a complete ophthalmologic examination, including a retinal examination and an Amsler test. The doctor will also take some pictures of your retina to use them as a reference to follow the evolution of the disease.

The Amsler test is an easy and simple test, it could be performed by the patient to follow the evolution of the disease.

When people are suffering from the disease, lines of the grid appear blurred, wavy with some dark areas at the center.

Then the eye practitioner will perform a retinal angiography (using fluorescein and/or indocyanin green). During that exam your doctor will inject you with a fluorescent contrast medium: fluoresceine or indocyanin green. This products allows to show precisely if the patient is suffering from the dry or wet form of the disease. This test is painless but could be long since the practitioner needs to take several photographies of the retina at different times.

A new test is sometimes performed by your doctor, called Ocular tomodensitometry or OTC. It allows your doctor to see very precisely the lesions extension. Since this exam is very new, it is not yet performed on everyone.

Your doctor will repeat these tests on a regular basis to follow the evolution of the disease and to adapt the treatment to the disease.

What does dry AMD and wet AMD mean?

Dry AMD is the most frequent form of the disease (80 to 90 % of cases) and the wet form represent only 10 to 20 % of AMD.

Retinal lesions causing AMD are called drusen. These drusen are seen when your doctor perform a retinal examination, where they look like white dots more or less converging to each other.

There are two types of drusens. Miliary drusen responsible for the dry form of the disease and Serous drusen responsible for the wet form of AMD. Serous drusen being generally bigger and more convergent and more often complicated by what doctors call choroidal neovascularization. When these new blood vessels are appearing on the retina then the patient has a sudden increase of symptoms, they need to be treated quickly.

What are the treatments of the disease ?

There is no cure for AMD. However,some treatments can slow down the evolution of the disease and sometimes even improve the vision of people suffering from AMD.

Surveillance: As part of the first treatment, the doctor will give you an Amsler grid and explain how to use it. On a regular basis, every day if possible, you have to look at the grid and evaluate if what you are seeing is different from previous days. In case of changes, you should schedule an appointment with your eye doctor as soon as possible so they can perform an angiography to see if new blood vessels appeared.

Worsening prevention: It is very important to protect your eyes from the sun, which seems to have a role in the disease to get worse. Stopping smoking also could help prevent the worsening of the disease.

Drugs: Medicine is not available, in France, to treat AMD. Some drugs are being studied, even some already marketed in other country to stop new blood vessels from appearing.

However, it is common to prescribe drugs helping blood vessels dilatation, or improving blood oxygenating or vitamins and minerals. Even these drugs do not show their efficacy in clinical trial that they can help.

Laser treatments :

Regular laser: It is only effective with wet AMD. It helps with destroying the new blood vessels and stop their growth. Its main side effect is that it leaves a permanent scar that leads to a small permanent blind spot on the visual field.

Photodynamic therapy (PDT): Only used for particular forms of wet AMD. It is a laser treatment associated with a veinous injection of a product called verteporfine, this product allows the laser to be more precise in the target to be destructed. This more recent treatment seems to have very good results. However, it is very expensive (one dose of the product being about 1500 euros)

Transpupillary thermotherapy: This treatment is reserved to particular wet form of the disease. It uses the heating power of the laser to destroy the new blood vessels.

Other treatments:

Radiotherapy: Only for certain form of wet AMD. It is not often used because the results of clinical trails are discordant.

Surgery: Rarely used, solely for some particular form of the wet AMD. Its results are controversial.

Future: A lot of new treatments are currently being studied, especially some eye injection capable to stop the new blood vessels from appearing.

I am suffering from dry AMD, for which there is no treatment, what can I do to improve my vision ?

A lot of low vision devices are available, such as telescopes, magnifying lenses, bright lights to improve reading. Your optician can help you find the best devices for you. Furthermore, it is possible to reeducate your vision, especially at the beginning of the disease to use the peripheral vision, an orthoptist will help you find the best program for you.

When the vision become very bad, it is possible to adapt every day help to facilitate your life, an occupational therapist will help you change your home to prevent falls, to better organize your kitchen so you can still cook your meals…

AMD causes a progressive loss of central vision that leads to a major loss of the patient quality of life who is little by little loosing the ability to see what he is doing.

There is no treatment for the most common form of the disease. For the wet form of the disease, some treatment can slow down or even stop the evolution of AMD. Whatever form you are suffering from, frequent exams by your eye doctor are necessary. From the beginning of the disease you need to find an orthoptist to help you better using peripheral vision. Your optician can help you find vision devices.