Age-related Macular Degeneration

The macula is a tiny area in the centre of the retina, the light-sensitive layer at the back of the eye. It gives you sharp, detailed central vision for reading, driving and seeing faces.

In age-related macular degeneration (AMD), the macula is slowly damaged with age [1][2]. Side (peripheral) vision is not affected, so AMD does not cause complete blindness.

Image to add

A street scene as seen by someone with AMD, with a dark blurred patch in the centre and clear edges. Alt text: "A picture of a street where the centre is blurred and dark but the edges are clear, showing how AMD affects central vision."

There are two main types [1][2][3]:

• Dry AMD: the most common type. It gets worse slowly, over many years. Yellow deposits (drusen) build up under the retina and the macula slowly thins.
• Wet AMD: less common but more serious. Abnormal blood vessels grow under the macula and leak fluid or blood. Vision can get worse over days or weeks. Dry AMD can turn into wet AMD.

Your risk is higher if you [1][2][3]:

• are over 50, and the risk rises with age
• smoke. Smoking can double the risk or more, and it is never too late to stop.
• have a family history of AMD
• have high blood pressure, heart disease or are overweight
• eat a diet low in green leafy vegetables and fruit

Early AMD often has no symptoms. Later you may notice [1][2]:

• Blurred or dark patch in the centre of your vision
• Straight lines look wavy or bent, such as door frames or tiles
• Difficulty reading, or needing brighter light
• Difficulty recognising faces
• Colours look less bright

Check each eye at home with an Amsler grid. This is a square of straight lines with a dot in the centre. Cover one eye and look at the dot. If lines look wavy, broken or missing, or this is new, see an eye doctor [2][3].

At the clinic, the eye doctor will examine the back of your eye and may do an OCT scan, a quick, painless scan of the layers of the retina.

Wet AMD needs treatment quickly. Every week of delay can mean more vision lost for good [1].

Wet AMD [1][2][3]:

• Anti-VEGF injections into the eye stop the leaking blood vessels. They are given with numbing drops, so they are usually not painful.
• Most people need injections regularly, often every 1 to 3 months, for a long time. Keep your appointments, as missing them can lead to vision loss.
• Treatment works best when started early. It often keeps vision stable, and sometimes improves it.

Dry AMD [2][3][4]:

• There is no cure yet. Most people keep useful vision for many years.
• For intermediate or advanced AMD, a special vitamin formula (AREDS2: vitamins C and E, zinc, copper, lutein and zeaxanthin) can lower the risk of it getting worse [4]. Ask your eye doctor if it is right for you. It does not help early AMD or prevent AMD.

For everyone with AMD:

• Stop smoking. This is the most important thing you can do.
• Eat plenty of green leafy vegetables, fruit and fish.
• Check your Amsler grid regularly.
• Low-vision support: magnifiers, brighter lighting, large print and phone accessibility settings can help you keep reading and stay independent [1].

Where to get help in Brunei

If you are over 50 and notice changes in your central vision, you can walk in to any Community Eye Clinic at your health centre. No referral is needed.