Age-Related Macular Degeneration

AMD Eye Care.

What is AMD

Age-related macular degeneration (AMD) is one of the leading causes of vision loss in adults over 55, affecting approximately 2.5 million Canadians, including many in Edmonton. AMD primarily impacts central vision, making daily tasks like reading, driving, and recognizing faces more challenging.

At Helio Optometry, we understand how AMD can affect your life, and we’re here to help. AMD comes in two forms: Dry AMD and Wet AMD. An advanced form of dry AMD, known as geographic atrophy, can result in significant vision loss.

How AMD Affects the Retina

The retina is the light-sensitive tissue at the back of the eye that enables sight. When light hits the retina, photoreceptor cells create an electrical signal that travels through the optic nerve to the brain. These cells rely on a layer called the retinal pigment epithelium (RPE) for nourishment and maintenance.

In AMD, damage occurs to the macula—the central part of the retina responsible for detailed vision. This damage disrupts the communication between photoreceptor cells and the RPE, resulting in vision loss.

Sketch of dry age-related macular degeneration in the eye

Risk Factors and Causes of AMD

AMD becomes more common as people age, with the highest prevalence in individuals over 60. However, age is not the only factor. Other contributors include:

  • Smoking increases the risk of age-related macular degeneration (AMD) by damaging blood vessels in the retina, reducing oxygen and nutrient supply to retinal cells. The toxins in cigarette smoke also promote oxidative stress and inflammation, accelerating retinal cell degeneration and impairing visual function.

  • Diet lacking essential nutrients, such as antioxidants, omega-3 fatty acids, and vitamins like C and E, can weaken the retina's ability to protect itself from oxidative damage, increasing the risk of AMD. Inadequate intake of these nutrients can also impair the function of retinal cells and blood vessels, accelerating the degeneration process and impairing vision.

  • Genetics or Family History Specific gene variations, such as those in the CFH and ARMS2 genes, have been linked to a higher susceptibility to AMD, making some individuals more prone to the condition.

  • Race, with AMD being more common in Caucasians of European descent, has a higher prevalence of AMD compared to other racial groups, possibly due to genetic and environmental factors.

Though often associated with aging, other forms of macular degeneration can affect younger people, typically caused by genetic or environmental factors.

Understanding Dry AMD

Dry AMD is the most common form, accounting for the majority of AMD cases. It progresses gradually as the macula thins, sometimes accompanied by the build-up of drusen, fatty deposits that can damage the macula.

Dry AMD progresses through three stages: early, intermediate, and late. In some cases, dry AMD may progress to wet AMD, which causes more rapid vision loss. Regular monitoring is essential to detect any changes early.

Symptoms and Diagnosis

Dry AMD often has no noticeable symptoms in its early stages, making routine eye exams critical for detection. At Helio Optometry, we check for signs like drusen and changes in the macula during your comprehensive eye exams. Our optometrist will often perform a dilated retinal examination, and use specialized equipment like OCT Retinal Scans and Optomap imaging.

As dry AMD progresses, symptoms may include blurred central vision or difficulty seeing fine details. Tools like the Amsler grid can help monitor vision changes at home, and we’ll guide you on how to use it effectively.

Current Treatments for Dry AMD

While there is no cure for dry AMD, you can take steps to slow its progression:

  • Monitor your vision regularly and report changes promptly.

  • Eat a healthy diet rich in vegetables, fish, and other heart-healthy foods.

  • Stay active—what’s good for your heart is often good for your eyes.

  • Quit smoking, as it significantly increases the risk of AMD progression.

For those with intermediate or late-stage dry AMD, AREDS2 supplements may help reduce the risk of progression. Our team can discuss whether these supplements are right for you.

Understanding Geographical Atrophy (GA)

Geographic atrophy (GA) is an advanced form of dry AMD, characterized by the death of retinal cells. It often causes blind spots in the central vision, making tasks like reading and recognizing faces more difficult.

Symptoms of GA develop gradually and may include:

  • Vision distortion or blurriness

  • Difficulty adjusting to low light

  • Reduced brightness of colours

Geographical atrophy requires regular monitoring, which we provide using advanced imaging technologies like Optomap ultra-widefield imaging, and autofluorescence (FAF) scans and 3D OCT Retinal Scans. In 2023, two groundbreaking treatments for geographic atrophy (GA), received approval: Syfovre (pegcetacoplan) and Izervay (avacincaptad pegol). These therapies represent significant advancements in managing GA, offering new hope to those affected by this progressive condition. Both treatments are administered via intravitreal injections and have demonstrated efficacy in slowing disease progression. However, they do not restore vision already lost to GA. Ongoing research continues to explore additional therapeutic options and the long-term benefits of these treatments.

Understanding Wet AMD

Wet AMD is less common but more severe. It occurs when abnormal blood vessels grow beneath the macula and leak blood or fluid, causing rapid vision loss.

  • Symptoms and Diagnosis

Wet AMD symptoms often appear suddenly, including:

  • Distorted or blurred central vision

  • Dark spots in your field of vision

  • Increased sensitivity to light

If you experience any of these symptoms, seek immediate care. At Helio Optometry, we provide detailed retinal imaging to confirm a diagnosis and discuss treatment options.

  • Treatment

Several treatments can slow wet AMD progression and, in some cases, restore some lost vision:

Anti-VEGF Injections: Anti-VEGF medications are a groundbreaking treatment for managing wet age-related macular degeneration (AMD). VEGF stands for vascular endothelial growth factor, a protein in the body that stimulates the growth of new blood vessels. While VEGF plays an essential role in healing, excessive production in the eye can lead to the formation of abnormal blood vessels under the macula. These vessels are prone to leaking blood and fluid, which damages retinal cells and causes rapid vision loss. Anti-VEGF drugs work by blocking the effects of VEGF, preventing the growth of these abnormal blood vessels and reducing fluid leakage. Administered via precise injections into the eye, these treatments can slow the progression of wet AMD, preserve vision, and, in some cases, even restore some lost vision.

There are different types of anti-VEGF drugs, including:

  • Aflibercept (Eylea®)

  • Bevacizumab (Avastin®)

  • Brolucizumab (Beovu®)

  • Faricimab (Vabysmo®)

  • Ranibizumab (Lucentis®)

  • Biosimilar for ranibizumab (Byooviz®)

Photodynamic Therapy: Photodynamic therapy (PDT), using a drug like Visudyne®, is a targeted treatment for specific cases of wet age-related macular degeneration (AMD). During PDT, Visudyne is injected into the bloodstream and travels to the abnormal blood vessels in the eye. A low-energy laser is then used to activate the drug, causing it to seal the leaking vessels without damaging surrounding tissues. This treatment can slow the progression of wet AMD and reduce vision loss, particularly when combined with other therapies like anti-VEGF injections. PDT is a valuable option for patients whose condition doesn't fully respond to standard treatments.

Laser Surgery: Occasionally used to seal blood vessels in cases where other treatments are ineffective. This was once the standard of care, but is no longer used to the same extent and is now considered a late stage treatment.

Catch It Early & Protect Your Vision:

See Your Optometrist Annually for Dry AMD!

Are you At Risk of Developing AMD?

Check Out Some of Our Articles on Diabetes Eye Health

FAQ’S | Diabetes Eye Exam

  • A diabetes eye exam involves a complete medical history emphasizing your current treatment plan (medications, lifestyle modification), blood sugar control and other risk factors. In addition, our optometrists will examine the outside and inside of your eyes in detail, which requires dilating eye drops, which temporarily enlarge your pupil and make it easier for us to see all the structures of your eyes. These tests allow us to rule out or find early signs of diabetic eye disease.

  • A diabetes eye exam focuses on your eye health and does not evaluate your vision, eyeglasses or contact lens prescriptions in detail. If you wish to update your glasses or contact lens prescription, you can also schedule a routine eye exam.

  • Absolutely. We will start with a routine comprehensive eye exam, then perform the dilated diabetes eye exam and any additional testing that may be required. When combined in this fashion, the eye exam will usually take about 1 hour but saves you a trip back to our office on a separate day.

  • Yes, most people can safely drive home after dilating their eyes. But, taking some precautions or bringing someone who can drive you home is essential. Dark sunglasses are strongly recommended as your eyes will not be able to adjust to the sunlight. In addition, we recommend that people drive straight home instead of performing other errands.

  • Yes. Every Albertan, regardless of age, is covered by Alberta Health Care for an annual diabetes eye health examination with an optometrist. You do not need to see an ophthalmologist or have a referral from your Primary Care Physician or Diabetes Specialist.

  • #1 - Your Alberta Health Care (AHC) card - this allows us to bill AHC for the dilated retinal exam

    #2 - Government Issued Photo-ID - Required for all AHC visits.

    #3 - The Name of Your Family Doctor or Diabetic Specialist - We like to send them a letter after the eye exam, letting them know our findings.

    #4 - A list of your current medications

    #5 - Your last few blood sugar readings and if they're stable

    #6 - Your last HgA1C reading and if they're stable or rising

    #7 - If you've ever had any previous eye surgeries

    #8 - Your current eyeglasses so we can check your visual acuity.