Amsler Grid

The Amsler grid is a useful tool to detect vision problems resulting from damage to the macula (the central part of the retina).

Report any irregularity to your eye care professional immediately.

The grid does not replace having your macula tested by an eye care professional, particularly if you are over 50 yrs old or have any risk factors for macular degeneration.

Amsler Grid

How to do it

  1. Cover one eye, then focus on the dot in the centre.
  2. Do any of the lines look wavy, blurred or distorted?
  3. Are there any missing areas or dark areas in the grid?
  4. Don't forget to test
    both eyes.

Treatment

 

Early detection is important

Treatment options depend on the type and stage of MD.  Whilst there is presently no cure, early detection is vital to save sight. The earlier you seek treatment, the more likely you are to have a better visual outcome compared to those who wait.

MD can cause many different symptoms. Diffculty with your vision should not be dismissed as part of 'getting older'. In its early stages MD may not be obvious to you but can be detected in with eye test before any visual symptoms occur. Early detection may allow you to take steps to slow the progression of MD.

 

What tests are used to diagnose MD?


Eye examination

An eye care professional may use eye drops to dilate your pupils to give a better view of the retina at the back of the eye.

Amsler grid

The Amsler grid may be used to detect distortion in vision where straight lines appear wavy or bent and to see if there are dark spaces or empty patches in the vision.

Cells 

Optical Coherence Tomography (OCT)

OCT is a standard investigation for the diagnosis and ongoing management of wet MD. It is a non-invasive imaging technique that uses light to produce very high resolution cross sectional images of the retinal layers. Repeated tests are usually necessary to monitor disease activity.


 Eye Structure

 

Fluorescein angiography (FA)

FA is sometimes used to investigate wet MD. It involves injecting fluorescein dye into a vein in the arm to image the blood circulation at the back of the eye. As the dye circulates through the choroidal and retinal blood vessels, a camera with a special filter is used to take a series of photographs over about 10 minutes. The dye highlights any abnormalities of or damage to the blood vessels.

 

What treatments are available?

Currently there are no medical treatments for dry MD. However, a considerable amount of research is being conducted to find a treatment.

There are a number of medical treatments available for wet MD. These treatments do not cure the disease but aim to stabilise vision and maintain the best vision for as long as possible. In some people, treatment can improve vision. Treatment options for wet MD should be discussed with an eye specialist.

Anti-VEGF drugs

In wet MD, blood vessels are prompted to grow under the retina by a protein called vascular endothelial growth factor (VEGF). These vessels can bleed, leak fluid and cause scarring under the retina leading to rapid vision loss that if left untreated becomes permanent. To slow or stop this process, various drugs that block VEGF (called anti-VEGFs) can be used.

These drugs consist of an antibody directed at VEGF. They are injected into the eye where they spread to the retina and block VEGF induced blood vessel growth. Anti-VEGF drugs have been proven effective in many clinical trials and maintain vision in the vast majority of patients with wet MD.

Treatment usually begins with monthly injections for 3 months. In order to maintain control of the disease, injections are usually required indefinitely. However, the interval between ongoing injections is determined on an individualised basis by the eye specialist in consultation with the patient.

Avastin (bevacizumab)           

Avastin was primarily developed, tested and approved to decrease new blood vessel growth associated with cancer. It is highly effective and used worldwide for treating wet MD. It is funded by PHARMAC, the NZ government agency that decides which medicines are subsidised for use in the community and public hospitals. However, it is not registered for the treatment of MD as it was not designed for use in the eye. Avastin is typically used as the initial treatment of wet MD in NZ.

Lucentis (ranibizumab)

Lucentis is very similar to Avastin. It is derived from the same parent molecule but is much smaller and has been pharmacologically altered to provide stronger binding to VEGF than Avastin. Lucentis was specifically formulated and registered for use in the eye. It costs significantly more than Avastin and its availability in the NZ public health service is restricted by PHARMAC.

Eylea (aflibercept)

Eylea is similar to Avastin and Lucentis but works slightly differently to them. It binds to VEGF significantly more strongly than both Avastin and Lucentis, and also binds placental growth factor (another factor involved in the development of abnormal blood vessels). It is longer acting and only needs to be injected every 2 to 3 months rather than monthly. It is registered for use in the eye but not funded by PHARMAC.

Photodynamic therapy (PDT)

This is a 2-step process combining a light-activated drug called Visudyne (verteporfin) with light from a cold laser directed onto the abnormal area of retina. Once activated, the drug causes the abnormal vessels to close off. PDT does not cause direct damage to the surrounding retina. Therefore, it can be used to treat new vessels that are under the centre of the macula (fovea).

Several treatments are needed to keep the leaking blood vessels closed and stop the progression of wet MD. Close follow up and monitoring is needed to determine if further treatment is required.

Unlike anti-VEGF drugs with which the vision is usually maintained, patients undergoing PDT continue to lose vision in the first 6 months. Their vision then stabilises so that the eye does not progress to severe vision loss.

PDT is now rarely used to treat ordinary wet MD. It is sometimes used in conjunction an anti-VEGF drug to treat a type of MD called polypoidal choroidal vasculopathy (PCV) as some of these cases do not settle completely with anti-VEGF treatment.

Laser photocoagulation

This treatment consists of a concentrated light beam of high-energy thermal light that is directed onto the retina to destroy and seal leaking blood vessels. It is not painful. The laser not only destroys the abnormal vessels but also destroys retina adjacent to them. Therefore, it may only be used for treating new vessels that are not under the central part of the macula.

Laser photocoagulation is only used for a small percentage of patients with wet MD. Close follow up is required as there is a 50% recurrence rate.

Nutrition and supplements

The Age Related Eye Disease Studies (AREDS I and II) are 2 major clinical trials that identified a specific formula of antioxidants including high dose zinc that significantly reduced the relative risk of progression of MD and delayed vision loss. The daily amounts of these are zinc 80 mg, copper 2 mg, vitamin E 400 IU, vitamin C 500 mg, lutein 10 mg and zeaxanthin 2 mg.  More information is contained in MDNZ’s Nutrition and Supplements fact sheet. Any changes in diet or lifestyle should be undertaken in consultation with your doctor.

Learn more about Macular Degeneration

Find out how MD affects the lives of real New Zealanders. Watch the video, learn about the risks and see how MD is a growing problem in our society.

 

watch video button solid

Video  

_EK4zOrmORU

 

Map: Where is MD in NZ?

Age-related Macular Degeneration (AMD) is a growing problem in NZ. Total prevalence is predicted to be 206,908 in 2018.

View more

 map 2

Getting tested is simple

There is a quick and easy way to tell if MD affects your vision.  Click on the link below to see if you have the common warning signs.

Test Button

 MDNZ Website 3steps

What you need to know

Infomation Icon

What's the chance?

In New Zealand MD affects 1 in 7 people over the age of 50 years

info icon

Smoking

Smokers have 3 times the risk of developing MD and tend to develop MD 10 years earlier than non-smokers

info icon

Is it getting worse?

It is estimated the number of people with MD will increase by 70% by 2030

info icon

More common than you think

Age related Macular Degeneration is the most common cause of blindness

info icon

You need to know!

Of those most at risk (50+) 67% have heard of MD and only 48% understand that it is an eye disorder. *Galaxy Poll March 2014

People with a family history of MD have a 50% chance of inheriting the genetic predisposition of developing MD.

info icon

What if I don't have treatment?

Untreated, the majority of people with wet MD become functionally blind within 2 years

Stay connected with MDNZ

Sign up to receive our newsletter

sign up

 

Like us on Facebook

facebook