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Enhancing awareness of AMD

Age-related macular degeneration is the leading cause of sight loss in the over-50s in Ireland, according to the Irish College of Ophthalmologists (ICO).

Without treatment, it is also the commonest cause of legal blindness, affecting over 60,000 Irish people.

AMD awareness week 2018 ‘SightSee with me’ will take place from the 10-14 September. It aims to generate greater public awareness and understanding of AMD and encourage those aged 50 and over to get their eyes tested regularly.

This year marks the beginning of a new decade for the awareness campaign, representing the 11th anniversary of the multi eye-care stakeholder group initiative, supported by the ICO.

Consultant Ophthalmic Surgeon and ICO spokesperson Mr Mark Cahill believed the campaign had been “very effective”. He added, however, that the importance of the symptom of distortion may require better awareness.

Macula

Macular degeneration occurs when the macula is unable to function as effectively as it used to.

Dry macular degeneration (non-neovascular), which constituted around 90 per cent of cases, affects the eyes gradually, while wet macular degeneration (neovascular) can develop very quickly and is more serious.

Before the mid-2000s, the treatment possibilities for wet AMD were limited to photodynamic therapy and laser therapy and these were only applicable in a small number of patients. However, wet AMD is now usually treated with intravitreal injections.

According to the ICO, intravitreal injection therapy has proven to be a major advance for patients with wet AMD.

It is known that when wet AMD develops, abnormal blood vessels grow under the macula due to a chemical stimulant called vascular endothelial growth factor (VEGF). Intravitreal injections of anti-VEGF drugs, which block vascular endothelial growth factor, can break the cycle of leakage, bleeding and scar tissue growth. Anti-VEGF treatment offers stabilisation and very often improvement in vision.

Anti-VEGF treatment will be around for “many years to come”, predicted Mr Cahill. He also pointed out that a phase 2 trial had recently finished, which centred on a six-month implant of ranibizumab. Three different concentrations were used and the data showed that “the higher concentration was very effective for up to six months in 80 per cent of people and that is a big step forward”.

He added: “Now, that is only a phase 2 trial so it’s got to go through a third phase and then it has to go through a real world period to see if it will get approval.” It would be a game-changer according to Mr Cahill, who also acknowledges that it would entail a surgical procedure, which is not without risk.

Mr Cahill said there is huge demand for AMD treatment and it may be one of the reasons why the cataract surgery waiting list has not been addressed, as available resources have to be targeted towards patients at risk of rapidly losing their vision. Staff in eye care services have worked incredibly hard to ensure greater volumes of patients are seen, he added.

Eye exam

The ICO advises that “regular eye examination with the eye doctor are recommended especially if there is a family history of the condition. This should be done every two years for the over-55s and annually if there is any hint of AMD. It is important that patients self-monitor using an AmSler grid between visits.

“Looking after general health, being a non-smoker, eating a healthy diet rich in leafy greens (Lutein) and sensible use of sunglasses can all help to slow the progression of AMD. Often your eye doctor will recommend taking a Lutein-based vitamin supplement. Monitoring the vision in each eye separately using an AmSler grid can lead to early detection of AMD and an improved visual outcome.”

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