The most common type of Age-Related Macular Degeneration is what’s called dry AMD,” says Professor David Keegan, who is UCD clinical professor of ophthalmology and retina, a Mater Hospital surgeon and also a board member of the organisation Fighting Blindness.

“It is a slowly progressive form and less impactful in immediacy than wet AMD but it can lead to severe vision loss over time. Dry AMD symptoms are often similar to cataracts in that those affected complain of blurred vision and gradual progression.

“Wet AMD often presents with people seeing wavy lines and experiencing a sudden deterioration in sight. This is due to either a leak or bleeding from abnormal blood vessels.”

No effective cure for dry AMD but lifestyle changes can help

There is no effective cure for the dry type of AMD but there are lifestyle recommendations for it, he says.

“Special multivitamin supplements will reduce a person’s risk of progression. That is based on the AREDS2 study (age-related eye disease study) and other studies (many conducted in Ireland by the Macular Pigment Research Group at Waterford IT) which shows that supplements reduce the risk but don’t eliminate it. Lifestyle choices like not smoking, having a healthy diet and exercise are beneficial also.”

Wet AMD is less common

Wet AMD is less common but can have a devastating effect, he says.

“Untreated, around 55% will have severe vision loss within three months of developing the condition. With treatment, the risk of severe vision loss drops to around 5%. About 70% of those with wet AMD experience improved vision with treatment and 45% show a significant improvement in vision if they start on treatment in a timely fashion.”

Eye injections are the main treatment

Treatment today involves injections into the eye. These Anti-VEGF injections help by blocking a molecule that is responsible for driving the blood vessel development and leaking process.

“These injections have been the single biggest advancement in the management of AMD. They first became available in 2005. Prior to that, treatment involved largely ineffective hot or cold laser treatments.”

Doctors recommend that those with wet AMD should start on the injections within two to four weeks of diagnosis.

“If treatment is delayed there can be irreversible vision loss,” he says.

But are the injections still very expensive? Back in 2007, they cost around €800 per injection.

“The two licensed versions are still expensive. The unlicensed one less so and that is the most commonly used one in Ireland,” he says. “All of them work to prevent vision loss for patients with AMD vision loss, with varying degrees of success for individual patients.”

However, for the majority of patients they work very well.

“For individuals, sometimes they respond to one drug better than another. The challenge for doctors is to find the one that works best for them.”

Accessibility to this treatment is improving, he says. While all the injections are covered by private medical insurance if you have it, it is not so simple if you’re a public patient.

“The biggest issue is access but we are getting closer to getting all our patients seen in a timely fashion. One issue is our eye units being able to deliver enough injections for our patients. On average they need five to seven injections annually on an ongoing basis to maintain any vision gain or prevent further vision loss. Even with that there is a slow deterioration over a seven- to eight-year period. The best way to maintain vision is to continue to go for monitoring and have regular injections.”

Challenge for the health service

He has seen these injections make a huge difference in people’s lives.

“Many people are still driving and still reading comfortably – the injections work but we stress that treatment needs to be a in a timely fashion and injections have to be maintained. That’s the challenge for the health service – that we keep these patients in ongoing therapy.

“There is a history of underinvestment in ophthalmology in this country and we are struggling against that backdrop.”

He gives the example of how 400 new patients with AMD would have generated about 1,600 related outpatient appointments at the Mater prior to injection therapy. That number of referrals now generates a need for more than 6,000 appointments, investigations and injections following diagnosis of the condition with, on average, about nine injections per patient needed in the first year.

“To manage our existing cohort of patients with wet AMD, we need to provide space for more than 8,000 people per annum. Nationally we need provision for 40,000 injections in the public hospitals alone for AMD. You have to find space for that. We plan to work around that by introducing virtual clinics where we try and monitor a patient’s response to treatment via imaging. These clinics need to be tightly monitored to be safe. We’re training up doctors and nurses to give the injection also and providing more capacity in appropriate facilities. It’s been delayed in Ireland but we are making progress in some units now.”

AMD more common in aging society

AMD is becoming more common in Ireland because of our ageing society, he points out.

“The population of those over 80 years of age is due to increase by 50% by year 2030, so we know we’re going to have a steady increase. Some people with intermediate macular degeneration will benefit from taking multivitamin supplements, for example, AREDS2 formulation or Macushield Gold.

“There are antioxidants and macular pigment in them. They are not a cure but they can slow the progression of AMD.”

His other recommendations include a good diet.

“Eat fish and lots of antioxidant-rich vegetables. Don’t smoke and if you do then stop as smoking is one of the biggest factors for development and progression of AMD. If you have a family member with the condition then you may also be at an increased risk.

“If you are worried about having macular degeneration, have a routine eye examination. You can monitor for the severe wet form by using an Amsler grid (a grid test that detects distorted vision).”

John Leonard's story

It started with him needing reading glasses in 2012. John Leonard got them but found that he needed a stronger prescription within a year. Night driving was also becoming a problem. John had never heard of age-related macular degeneration (AMD) until he accidentally came across the term and its associated home test, the Amsler Grid.

It is a grid of horizontal and vertical lines that you look at, covering each eye alternately. It can tell you if there is something wrong with your central vision or not.

“I saw all these wavy lines when the lines of the grid should have been straight,” he says.

His GP subsequently confirmed that he has AMD and John was put on a course of special eye health supplements. After four months his sight got worse, however, and John was diagnosed with wet AMD.

He then started on a course of injections in his left eye.

“I think of the injections as being something like superglue,” he says, “stopping the sight loss. The injections are maintaining the bit of vision I have. I have 20% vision in my right eye but the vision in the left one is gone.”

John says that while he used to get very frustrated by his sight loss he still has some peripheral vision and is getting used to it now. He says that getting the first injection wasn’t easy though.

“It was a bit terrifying. You can’t move when the needle is going in but anaesthetic drops are put in your eye first and it’s all over in half a minute. When it wears off it feels like you’ve a bit of grit in your eye for a while but then it is fine. I’d certainly recommend the injections for what they are doing for me.”

John can’t see the face of a clock at all so uses a key ring aid that tells him the time when he presses it. Using a computer isn’t possible any more but he hasn’t explored the voice reactive software option just yet.

While he has had to give up hobbies like golf and snooker and holidays abroad and has to rely on radio rather than television now, he uses a strong magnifying glass for occasional reading and an inexpensive pocket magnifying glass with a light.

“I’d be lost without that,” he says.

John has had 30 eye injections to date.

He speaks highly of the support he has had from the organisation Fighting Blindness: “It is a great organisation and lets us know about the huge amount of research that’s going on in Ireland and worldwide into AMD.”

John is also a member of MIST (Macular Impairment Support and Togetherness). This is a small social and peer support group that holds informal monthly meetings and organises useful activities.

“On reflection, I am thankful I still have part vision and realise one can live a full (though different and slower) life with AMD. Those who are totally blind are the real champions. One can only marvel at their courage and adaptability living with this disability.”