Age Related Macular Degeneration

( AMD/ARMD)

What is Age Related Macular Degeneration?

Age-related macular degeneration (AMD) is a common disease of the central part of the retina (called the macula) which can cause loss of central vision. Degradation of vision is usually progessive - often gradually over time, sometimes rapidly .

AMD is traditionally classified into two distinct types: dry and wet. However, there is a third group which Mr Kheterpal has termed the ‘damp’ group where fluid can exist in the retina in a relatively stable state for some time,

Dry AMD, or nonexudative/atrophic AMD, accounts for approximately 85% of all cases. Dry AMD is often more gradual in its progression than wet AMD and, although considered generally milder than wet AMD, in its later stages, dry AMD may progress into geographic atrophy, with more severe and permanent vision impairment.

Wet AMD, or exudative/neovascular AMD, represents around 15% of cases and is characterised by the growth of abnormal blood vessels under the retina. These vessels leak fluid and blood, leading to more rapid central vision loss.

‘Damp’ AMD can occur in two main forms: Firstly, pigment epithelial detachments (PED) which are often seen in association with dry AMD and, secondly, cystic degeneration which can occur in wet AMD after treatment. Both of these require careful assessment to determine the likelihood of stability or progression.

  • Investigations

    Key investigations for macular degeneration include visual acuity screening and Amsler grid tests combined with retinal imaging modalities. Optical coherence tomography (OCT) and OCT angiography (OCT-A) provide detailed cross-sectional images; fluorescein and indocyanine green angiography assess blood flow and leakage; fundus autofluorescence evaluates retinal pigment changes. These complement comprehensive retinal examinations in clinical practice.

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  • Treatment for Dry AMD

    Treatment for dry macular degeneration primarily focuses on slowing disease progression via lifestyle changes and nutritional supplementation, including AREDS formulations rich in antioxidants. Options like intravitreal injections of Pegcetacoplan and Avacincaptad Pegol, photobiomodulation, stem cell, and gene therapies are under investigation. Although no cure exists, these measures aim to reduce oxidative stress, inflammation, and retinal damage.

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  • Treatment for Wet AMD

    Current wet macular degeneration treatments primarily focus on anti-VEGF injections—including ranibizumab (Lucentis), aflibercept ( Eylea) , faricizumab (Vabysmo) and bevacizumab (Avastin) —to halt abnormal blood vessel growth and leakage. Additional options include photodynamic and laser therapies. Emerging agents offer longer durability, reducing injection frequency while preserving visual function. Treatment with intravitreal corticosteroids and lasr modalities such a photodynamic therapy remain viable options in specific cases.

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