Age-related Macular Degeneration (AMD) is one of the leading causes of blindness affecting those 50 years or older. 

Age-related macular degeneration (AMD) is a chronic, irreversible eye condition that affects the macula, which is the central portion of the retina, and is responsible for clear sharp central vision.

You can think of the macula as the “film/sensor” of the eye, just like in a camera. As such, damage to this area affects vision and can make it blurry, distorted or even result in a central grey/black patch that obscures your vision.

This would impair activities of daily living, such as, your ability to read, recognise faces or drive safely. 

The change in vision can be gradual or sudden depending on the type of AMD.

• In dry AMD, there is a gradual and slower loss of vision,
   
• In wet AMD, a rapid and severe loss of central vision is experienced

AMD may affect one eye first, or both eyes at the same time. 

What are the risk factors of AMD?

Ageing is the main risk factor for AMD, but genetics and family history may also play a role.

Cigarette smoke is also a major risk factor with a 2-4x higher risk of developing late/advanced AMD.

Other potential risk factors include hypertension, cardiovascular disease, obesity and possibly UV exposure.

Thus, preventive actions such smoking cessation and avoiding second hand smoke, having a healthy diet, exercising regularly, controlling your blood pressure and sunglasses in high UV exposure environments can help to reduce the risk.

Early detection is the best protection 

Early detection of AMD is very important in the management of the condition, especially for wet AMD.

There are treatments that can delay or reduce the severity of the disease and that can significantly improve vision if done in a timely manner.

Thus, those at risk are encouraged to monitor their eyesight carefully and to go for regular check-ups with their eye doctor. 

If you have questions about the causes, symptoms and treatment for this condition, Dr Christopher Sun can help to answer them. Submit your questions now!

Related articles:
AMD (Age-Related Macular Degeneration): What You Need to Know

Macular Degeneraton: What Is It

Macular Degeneration: Prevention and Treatment

Dr Christopher Sun is an Associate Consultant with the Cataract and Comprehensive Ophthalmology Department at the Singapore National Eye Centre (SNEC).

He obtained his medical degree from the University of Western Australia in 2015 and subsequently completed his Ophthalmology residency at the Singapore National Eye Centre in 2023.

He was inducted as a Fellow of the Royal College of Ophthalmologist UK in the same year. He is a sub-specialty fellow with the Medical Retina Department, under the Advanced Clinical Specialist Program. His interest in retina started early on in his residency with first author publications on different retinal diseases. 

In addition to his clinical work, he served as the Deputy Lead and Lead Resident in 2021 and 2022 respectively.

Dr Sun is also an avid Clinician Educator and has been actively involved in teaching medical students throughout his residency though didactic sessions, clinical sessions as well as authoring online e-learning modules. As recognition of his commitment, he received the NUS YLL MedACE 2022 Junior Doctor teaching award. 

His current practice includes the management of general ophthalmology conditions such as cataracts, and retinal conditions such as age-related macular degeneration and diabetic retinopathy.

1. Question by Elaine

Dear Dr Sun,

Can a person who had undergone cataract surgery for both eyes still get AMD as the years go by? What are the best prevention measures? Thank you for your advice.

Answer by Dr Christopher Sun

Hi Elaine, 

Yes AMD can still occur after cataract surgery.

AMD affects the retina (back light sensitive layer of the eye) whereas the cataract surgery only deals with the cloudy lens at the front of the eye.

While both conditions affect vision they are independent of each other.

Unfortunately, there is no fool proof way to prevent AMD but you can reduce your risk by not smoking/avoiding second hand smoke, maintaining a healthy lifestyle and diet, wearing sunglasses in high UV exposure areas.

For patient’s who already have intermediate AMD or advanced AMD in 1 eye, based on the Age-related Eye Disease Study 2 (AREDS 2), there are some vitamins/minerals which include vitamin C /E, zinc, copper, lutein and zeaxanthin that can potentially help to reduce the risk of progression to advanced AMD.

However, it has not been shown to help in patients without any AMD or early AMD. Lastly, it is important to monitor your vision and see an ophthalmologist if there is any sudden deterioration in your vision.

2. Question by Charles

Hi Dr Sun, I am 63. I see floaters and my vision is becoming more blurry after hitting 60. 

An eye specialist told me that changing spectacles may not be able to help me see sharper soon. Does that mean I have cataract? Does taking lutein and zeaxanthin supplements help prevent my condition from getting worse especially AMD? Thanks.

Answer by Dr Christopher Sun

Hi Charles, 

The onset of floaters is most commonly due a normal age-related change of the jelly like substance (vitreous) in the eye.

However, if you experience a sudden and large increase in the number of floaters, flashing lights or “curtain like” defect blocking your vision you should get an expedient eye review.

With regards to what your specialist told you, while it is possible that it could be due to cataracts, without more information it is hard to comment on whether your decreasing vision is due to cataracts alone or another pathology.

I would suggest clarifying this with your treating ophthalmologist. Lutein and zeaxanthin supplements, taken in combination with vitamin C /E, zinc, copper as part of the Age-related Eye Disease Study 2 (AREDS 2) formula, may help to reduce the risk of progression to advanced AMD in patients with existing intermediate AMD. It has not been shown to help in patients without any AMD or early AMD.

3. Question by Esther

Dear Dr Sun, My mum is an AMD patient since August 2021. She is under ophthalmology care since and had been on jab on her right eye. 

Beginning with a monthly jab, subsequently to quarterly and last jab was in October 2023, she was advised that her condition was stable and do not need jab until further findings. 

Other than AMD right eye, her right eye got water bumps (blister-like), her eye ball size are long , retina unusually spacious. 

I had briefly described her condition and here are some questions to further understand more about AMD causes, prevention and treatment. 

• What are the symptoms to look out for wet & dry AMD?
  
• Usual visit to government hospital ophthalmologist basic test are offered, what type of test shall we seek to diagnose AMD ?
• Does cataract operation improve or slow down AMD?
• What are the vitamins can be taken to prevent AMD from?e) What is the medication or treatment for AMD?
• Does any laser therapy stop or slow down AMD ?
• Does AMD leads to other eye / retina / nerve problem (eye problems I mentioned above)?
• How to approach / ask government hospital ophthalmologist to do detailed investigation on our eyes for complicated eye issues? 

I’m glad I had chanced upon HealthXchange on ask the specialists page while browsing the net so I can have my queries answered :)  

We are often laypeople when it comes to our health, and even when specialists explain things to us, we may not fully understand. We're frequently referred from one specialist to another, which often delays diagnosis and treatment — potentially worsening our condition.

I hope by having a better understanding, we can all achieve improved healthcare outcomes. Thank you so much for answering my questions!

Answer by Dr Christopher Sun

Hi Esther, 

• Both wet and dry AMD only cause visual symptoms (i.e do not cause any other symptoms such as eye redness, pain).
  
  Symptoms of wet AMD include blurring of vision, distortion of vision, greyish/black patches in your vision.
  
  Dry AMD may not have any symptoms until it is advanced. Even then if the central area of the retina is not affected, there may not be significant symptoms.
  
  
• A typical visit to an ophthalmologist in a public hospital usually consists of a vision and eye pressure check as well as a detailed examination of the eye.
  
  Depending on what is found during the examination, additional tests may be performed to further evaluate any underlying eye diseases.
  
  AMD can be seen on examination but we do additional tests such as eye scans/angiograms to determine the severity and if any intervention is necessary.
  
  
• Cataracts/cataract surgery have no effect on AMD.
  
  
• There are no vitamins that can be taken to prevent AMD but vitamins and minerals which include vitamin C /E, zinc, copper, lutein and zeaxanthin (Age-related Eye Disease Study 2 formula), may help to reduce the risk of progression to advanced AMD in patients with existing intermediate AMD. It has not been shown to help in patients without any AMD or early AMD.
  
  
• The treatment depends on the stage and type of AMD. Currently in Singapore, for wet AMD, the main stay of treatment is anti-vascular endothelial growth factor (anti-VEGF) intravitreal (eye) injections.
  
  Depending on the location and type of lesion, sometimes lasers can also be used to help manage the disease and may also lessen the need for injections.
  
  For dry AMD there is currently no treatment available in Singapore apart from the vitamins mentioned earlier for patients with intermediate AMD.
  
  
• Yes, laser can be used to help manage wet AMD in appropriate cases and is usually used in conjunction with eye injections.
  
  
• AMD only affects the retina and will not affect other parts of the eye.
  
  
• During a visit to an ophthalmologist (be it at a government hospital or elsewhere) an eye examination will be performed and depending on what is found relevant test will be performed to make a diagnosis.
  
  In very complicated cases sometimes this may involve a few visits, as sometimes not all tests can be performed on the same day, or even an admission but this would be organised in a timely manner. 

4. Question by Srivathsan

Dear Dr. Christopher Sun, 

I am a Singaporean aged 61.  I had a Retina Detachment in my right eye in 2015 and had Scleral Buckle Surgery. 

In 2019 part of the band got infected and was removed. Have been going for annual eye check-up and the Retina has been intact so far. 

I have some floaters in both my eyes for quite some years. Lately I find a slight increase in floaters in my right eye. 

I wanted to know whether this is because of the onset of AMD. I don’t have any other health condition like Hypertension or Diabetes. Thanks & regards.

Answer by Dr Christopher Sun

Hi Srivathsan, 

Floaters are most commonly due a normal age-related change of the jelly like substance (vitreous) in the eye which is unrelated to age related macular degeneration.

However, if you experience a sudden and large increase in the number of floaters, flashing lights or “curtain like” defect blocking your vision you should get an expedient eye review.

5. Question by Wan YM

Hi Dr Sun, 

I discovered I have AMD in late 2023. 

Since Jan 2024, I had a total of 7 intravitreal injections in my right eye. 

May I know what kind or brand of supplements I should take for my AMD condition or is there anything I can do to improve my condition? 

Kindly advise. Thanks.

Answer by Dr Christopher Sun

Hi Wan YM, 

Based on the Age-related Eye Disease Study 2 (AREDS 2), there are some vitamins/minerals which include vitamin C /E, zinc, copper, lutein and zeaxanthin that can potentially help to reduce the risk of progression to advanced AMD in your left eye which I presume is unaffected.

These supplements can be bought at SNEC or over the counter at any retail pharmacy.

Bear in mind that these supplements will not improve the condition of the right eye that is currently receiving injections.

6. Question by Loh

Dear Doctor, please advise if there is a cure for AMD?

Answer by Dr Christopher Sun

Hi Loh, 

Unfortunately there is no cure for AMD.

You can reduce your risk by not smoking, maintaining a healthy lifestyle and diet, wearing sunglasses if you have frequent high UV exposure.

If you develop dry AMD, depending on the stage of dry AMD, supplements may help to reduce the risk of progression.

If you do develop wet AMD there are treatments that can help to stabilise disease and slow progression.

7. Question by Amy

Dear Dr Christopher Sun,

How would  I know if I have AMD?  Also, I suspect I may have signs of cataract. Hope to hear from you.

Answer by Dr Christopher Sun

Hi Amy, 

Symptoms of AMD include blurring of vision (which may be sudden or slow in onset depending on the type of AMD), scotomas (grey/black patch in your vision) as well as distortion of vision.

Cataracts can also cause generalised blurring of vision/cloudy vision which is usually slow in onset and may be associated with other things like glare/halos.

If the cataracts are early you can usually still get good vision with glasses but as they get thicker eventually glasses will not help. If you notice any of these things I recommend a visit to an ophthalmologist for further evaluation.

8. Question by M Prakash

Dear Dr Sun, 

I am a 77-year-old male. I’m a trainer. I had my cataract removed at SNEC about 10 years ago. 

I’ve had perfect working vision until now. I don’t uses glasses, except when watching TV to be able to read the text (distance of about 12-14 ft). 

My left eye started having a dull ache and it gets moist and teary. I’ve put some eye drops but the slight dull ache is still there. 

How can I check if I have AMD? Do I need to have my condition looked at? Thank you for your advice.

Answer by Dr Christopher Sun

Hi M Prakash, 

What you are describing could be caused by a number of things, it could be something as benign as dry eyes or more sinister such as elevated eye pressure.

AMD only causes painless blurring of vision and is not associated with any pain or tearing. I would advise getting an ophthalmology evaluation to determine the cause of your symptoms.

9. Question by TW

Hi Dr, 

To cut a long story short, SNEC told me I do not have AMD then performed cataracts surgery on both eyes with lens implant and retina repair on my left eye. 

After recovering, during post-surgery consultation my left eye still has a patch of irregularly shaped blackout at lower centre right. Grid pattern still distorted. 

Doctors say it's not AMD but I couldn't catch what they say it was. Apparently, the black patch I complained about does map to something on my left retina. 

Can you help explain to me what it is? Will I go blind in left eye if that is untreated? Thank you for your advice.

Answer by Dr Christopher Sun

Hi TW, 

Unfortunately it is difficult to answer this question without further information as this would depend on what the mentioned retina repair was for.

For example, if was for a retinal detachment or a macular hole then it is possible to have residual distorted vision or a black patch in your vision as even though the surgery is successful sometimes the photoreceptors (light sensitive cells) do not fully recover.

These conditions also usually remain stable after the repair.

10. Question by Foo MY

Dear Doctor, I have the following queries on AMD.

• I have been diagnosed initial dry AMD (during my company health screening checkup). My late mother was diagnosed with wet AMD. How certain my condition will lead to wet AMD and if it does, what is the typical timeline? I am currently 57 years old.
  
  
• The doctor said I need to monitor annually but said I can proceed with my current lifestyle as normal. She did not give me any medication and said I can eat everything as usual.
  
  I read I should eat more green leafy vegetable for AMD prevention so is this aspect too late for me? Anything I can do further to slow the progression (eg take certain food, supplements, avoid sun etc) or even keep its current status where possible?
  
  
• Is there any research trial where I can participate for AMD for further tests to further slow the progression? 

Thank you very much for your advice!

Answer by Dr Christopher Sun

Hi Foo MY,

• The risk of conversion from dry to wet AMD is approximately 10-15%, however the timeline for this to happen is very varied and can be even years or decades.
  
  It is important to regularly self monitor your vision and look out for symptoms such as sudden blurring of vision, distorted vision or scotomas (black patches in your vision) as these are symptoms of wet AMD.
  
  
• In general there is no treatment available for dry AMD but you can reduce your risk or worsening by not smoking/avoiding second hand smoke, maintaining a healthy diet and lifestyle and wearing sunglasses if you have frequent high UV exposure.
  
  Yes eating dark leafy vegetables may help to reduce the risk of progression as they contain lutein and zeaxanthin. Lutein and zeaxanthin are part of the vitamins/minerals recommended in the Age-related Eye Disease Study 2 (AREDS 2), in addition to vitamin C/E, zinc, copper that can potentially help to reduce the risk of progression to advanced AMD in patients with intermediate dry AMD. It has not been shown to help in patients without any AMD or early AMD.
  
  
• Currently at SNEC we only have interventional trials for wet AMD. But we do have an ongoing observational/imaging study (i.e no treatment) that includes patients with early dry AMD if you are interested.

11. Question by Mdm Theng

Hi Dr Sun,

Regarding the above my right eye vision has central grey patch. It was sudden. May I know any treatment or to reduce patch? Thank you.

Answer by Dr Christopher Sun

Hi Mdm Theng, 

There are several things that can cause a central grey patch in the vision and I would advised to see an ophthalmologist as soon as possible to determine the cause and see if it can be treated.

12. Question by Rav

Dear Doctor, 

I did my cataract surgery in eye centre in 2019. The doctors recommended that the right eye should see far and the left eye for reading. 

2 years ago I noticed my eyesight getting blur in both eyes. I was examined n corrected for the vision on my right eye. However, the doctor felt that my cornea in my left eye was too thin for LASIK or laser. 

Over the years the right eye has become blurry again. I’ve been wearing prescription glasses to correct my vision but was wondering if there’s any new medical development to correct the vision in both eyes without needing glasses. 

I was very myopic before the surgeries. I’m looking forward to hearing from you. Thank you.

Answer by Dr Christopher Sun

Hi Rav, 

Apart from just a refractive error, there can be several reasons why your vision might be getting blurry again.

This ranges from reversible causes like posterior capsular opacification (clouding of the capsular bag that your lens is in) to non-reversible causes such as myopic macular degeneration.

I would advise seeing an ophthalmologist to determine what is the cause of the increasing blurring of vision.

13. Question by Kimberly

Dear Dr Christopher Sun,

My first visit to SNEC with red eye and pain. After consultation, Doctor prescribed only tear drop. 

Until today, I still occasionally encounter red eye and pain, what should i do now? Thanks and best regards.

Answer by Dr Christopher Sun

Hi Kimberly, 

Based on what you’ve said it sounds like you were diagnosed with dry eyes.

In some patients, regular eye lubricants are required to remain symptom free.

Other things you may need to address include: ensuring your eyelashes are kept clean as clogged meibomian glands (glands located at the base of the eye lashes which produce oil that is importantly for a healthy tear film) can make dry eyes worse; adding a humidifier to your desk if you work in an aircon environment and making sure that you take regular eye breaks especially if you do a lot of reading/computer work.

Ref: G25