AMD: Diagnosis and treatment

Diagnosis

If you think you may have AMD but no sudden symptoms, you should make an appointment at the opticians or visit your GP. You will be referred to an ophthalmologist (a doctor who specialises in diagnosing and treating eye conditions) if they suspect you have macular degeneration. A series of tests can provide a formal diagnosis and indicate the stage your AMD has reached. 

In the case of the ‘dry’ form, once a diagnosis is made, a regular eye examination can help determine if, and how fast, it is progressing.

Treatment

Dry form

There is no medical treatment for this form of AMD but lifestyle changes, including giving up smoking if you are a smoker, are thought to slow the rate of progression.
 
There is also evidence that taking a special supplement of certain vitamins and minerals may help if you have reached the intermediate stage. Do not start a multi-vitamin and mineral supplement without first asking your ophthalmologist or GP if you could benefit. Remember to ask about any potential side effects of taking a particular supplement.

Wet form

There are a number of treatments that can help stop the progression of wet AMD. 

• Photodynamic therapy (PDT) involves injecting a light-sensitive drug into the bloodstream.  This drug is absorbed by the abnormal blood vessels in the macula. A cold laser beam is then shone onto the macula. This activates the drug and seals the leaking blood vessel without affecting healthy tissue. This treatment is not suitable for everyone and depends on where the blood vessels are growing and how they affect the macula area. It may be necessary to have the treatment every few months to control growth of new blood vessels.
• Anti-vascular endothelial growth factor (anti-VEGF) medications target a protein involved in the formation of new blood vessels. You are given a local anaesthetic and the medication is injected into your eye using a fine needle. This blocks the protein and prevents new blood vessels forming in the retina. In most cases this treatment prevents further sight loss and some patients may find their vision improves.

National Institute for health and Clinical Excellence (NICE) has reviewed several anti-VEGF treatments.  It approved one drug as an NHS treatment for those patients who meet specific criteria.  There are some risks and complications associated with this treatment and these should be explained to you when discussing your treatment options. 

A patient version of this guideline is available on request or can be downloaded from their website. You can find out how to contact their orderline in the Further information section.

Associated conditions

Charles Bonnet syndrome

Some people with AMD can experience this syndrome which causes hallucinations that can last from a few minutes to several hours. They are usually pleasant images but can be very unsettling.

It is thought around 10% people with AMD have this syndrome but are reluctant to raise it with their GP.  If you have such experiences, it is important to speak to your GP. They are due to problems with your vision and there are ways to help you cope when they arise. The Macular Disease Society also has information that can help you.