Macular Degeneration: How to Prevent and Treat

So far, there are no treatments that have been proven to be highly effective in preventing AMD (age-related macular degeneration).

Studies have shown that smokers are more than four times more likely to develop "wet" or advanced Age-related Macular Degeneration (AMD) than non-smokers. Therefore, reducing or stopping smoking can reduce the risk of AMD.

A particular combination of supplements and vitamins, commonly referred to as the "AREDS2" formulation, has been shown to reduce the risk of developing the advanced form of AMD. However, the reduction in risk was only about 25% over 5 years, and this was only proven for some patients with high risk, and not all patients. It would be best to consult your eye doctor on whether these supplements will be beneficial for you.

The best way to avoid permanent vision loss is with prompt eye examination and diagnosis by an eye doctor. Early diagnosis improves the chances of treatment success.

The Amsler grid screening tool

A simple screening test that you can do yourself is to use an Amsler grid (above). It may help to detect subtle changes in your vision. You can monitor your vision daily by looking at an Amsler grid.

How to use the Amselr grid

• Hold the Amsler grid below at eye level at a comfortable reading distance. If you wear reading lenses, wear them during this test. 
• Cover one eye at a time and focus on the dot in the centre. 
• If you see wavy or fuzzy lines, or if certain squares are missing or appear blurred, you may be displaying symptoms of Age-related Macular Degeneration (AMD).

If you do not have access to the Amsler grid, you may also use items that you see daily such as bathroom tiles or window panes with straight lines, both horizontal and vertical.

Lower your risk with lifestyle measures

You can reduce your risk with preventive actions such as:

1. Wear sunglasses when outdoors and under strong sunlight

This will help protect your eyes from the sun’s ultraviolet radiation.

2. Don't smoke 

It is one of the most clearly established risk factors. About 30 per cent of AMD patients seen at the Singapore National Eye Centre are smokers.

3. Eat right

Foods rich in carotenoids (like carrots, tomatoes or pumpkins) and antioxidants (such as wolfberries) help slow down the rate of deterioration. They may even prevent the spread of AMD to the unaffected eye. A low-fat balanced diet rich in green leafy vegetables is also recommended.

4. Seek help early

Periodically close one eye to see if there’s any distortion in vision and seek help at the first sign of a problem.

5. Control blood pressure

If you already have high blood pressure, take your medication regularly to keep it under control.

For dry AMD

For dry Age-Related Macular Degeneration (AMD), there is currently no known treatment. Some patients may benefit from the "AREDS2" formulation of supplements and vitamins, in terms of reducing the risk of developing advanced AMD. Early detection of conversion to the wet type is also important for better preservation of vision. 

For wet AMD

Once you have been diagnosed with wet Age-Related Macular Degeneration (AMD), treatment is usually necessary as the condition may worsen over the next few weeks and lead to irreversible vision loss.

If treatment starts before scarring sets in, it can improve vision significantly. “The gold standard now is to inject medicines such as Bevacizumab (Avastin), ranibizumab (Lucentis) and aflibercept (Eylea) into the eye, which blocks the growth of abnormal blood vessels. The injection procedure is performed after the eye has been anaesthetised with eye drops”

At Singapore National Eye Centre (SNEC), patients are given one injection every month for three months.

“After that, we re-evaluate. If things settle down, we stop the injections and continue monitoring them every month. If there’s new bleeding, we restart the injections,” said specialists from the Surgical Retina Department at SNEC, a member of the SingHealth ​group.​

Doctors also look out for a particular variant of wet AMD known as polypoidal choroidal vasculopathy (PCV), which is more common in Asians. Patients with this subtype require treatment with laser in addition to injections.

Treatment effect depends on the exact type of AMD you have, and does vary from person to person.

In general, the effect of each injection would usually last for a few weeks to months, and in most cases, multiple injections are required over a period of time to adequately control the condition. Clinical studies have suggested that at least 12 to 14 injections may be required over a two-year period to control the disease.

“A patient may come in with being able to read only the big letters on the chart, but we can get them back to driving vision if they come early enough. Most of our patients get back good functional vision,” said the Surgical Retina Department.

​Ref. H24
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