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Most AMD patients start with the dry form. Ten per cent of these people will go on to develop the wet form of the disease. Although the wet type is much less common, it tends to be more aggressive, causing greater and more rapid visual loss.
In response to retinal degeneration, new blood vessels from the choroid (the deeper vascular layer of the eye) sometimes develop beneath the retina, like weeds growing up through the cracks in a pavement. This process is called neovascularisation. Neovascularisation does not help the retina because the vessels are very fragile and easily leak or bleed. Eventually, this process results in the formation of a disc-shaped grey scar in the middle of the visual field. The scar may take some time to form, but once established, all retinal tissue in the area is destroyed, leaving a large central blind spot. Macular degeneration cannot be reversed once this has occurred.
Frequently asked questions
How might nutrition impact AMD?
There is good evidence that AMD is becoming more common, at a rate greater than that attributable to simple ageing of our population. Of the many potential causes, nutrition appears a likely candidate. There is no consensus view, but the following points are generally agreed:
Processed vegetable seed oils have been implicated in the development of AMD. We do not yet know whether this effect is direct or related to the gradual change we have witnessed in replacing animal fats with vegetable products.
Sugar, or foods which rapidly release sugar into our bloodstream (known as high glycaemic foods), are linked to an increased risk of AMD.
Populations that consume fish, and in particular oily fish, have a lower rate of AMD.
Fish oil supplements have not yet been shown to be effective. Some authorities believe that increasing our consumption of omega- 3 polyunsaturated fats (present, for example, in fish oil) is ineffective when our diet is swamped by omega-6 polyunsaturated fats from vegetable seed oils.
The fragile cells of the macula are highly susceptible to damage from oxygen-charged molecules called free-radicals. It has been shown that people who have a low intake of antioxidants (nutrients that fight the damaging effects of free-radicals) may be at an increased risk of developing AMD. Excessive alcohol consumption may also deplete the levels of antioxidants in the body.
The Age-Related Eye Disease Study (AREDS) suggests that certain combinations of vitamins, pigments and zinc may slow the development of AMD in patients with early disease. Whilst this is undoubtedly true, the effect is not over-impressive: for every 13 people taking the supplements, only one will show significant benefit in avoiding disease progression.
How do I know if I have wet or dry AMD?
When you come into the clinic for an appointment, we will analyse your eyes carefully to determine which form of AMD you may have. The main way to do this is with a test called an OCT scan. This is really just like having a photograph taken of the retina – it is quick and completely painless. Occasionally more information is required, for which you would be asked to attend a local hospital for a fluorescein angiogram. This involves injecting an orange dye into a blood vessel in your arm and then taking a series of photographs to watch the passage of the dye through retinal blood vessels.
We now have an OCT machine, which takes such detailed pictures that the actual blood vessel layer beneath the retina can be visualised. This is called OCT angiography (or OCT-A). This has dramatically decreased the need for the dye test.