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Anthea Rowan

I scheduled a routine eye test after a reminder pinged into my inbox. I had a free morning and fancied an excuse for a new pair of prescription sunglasses.
The optometrist’s questions seemed more probing than I remembered from the last visit two years ago.
“Any blurred vision?” he asked. “If I hold this grid up and you focus on the dot at the centre with your right eye, left eye closed, are all those lines quite straight?”
On completion of the scans and tests, he said: “You have early age-related macular degeneration.” When he saw my face fall, he added: “AMD – it’s very common.”
I heard only “macular degeneration”.

My grandmother suffered. At the end of her life she was almost blind, having to feel her way around a room, tipping her head to the sound of a voice to recognise who was there.
She could not watch television, nor read. She listened to cassette tapes with recordings of books read. She ate from a plate with curved sides so she could feel the edges of it with her fork.
AMD affects about 20 million people in the US and 196 million people worldwide. Optometrist Dr Andy Meau, a director at Central Eye Care in Hong Kong, says it is a leading cause of severe vision impairment – sometimes even blindness.
Studies suggest AMD affects around 1 in 10 people aged over 60. Meau says that up to 7.5 per cent of people aged 70 and older in Hong Kong have a form of AMD.
The macula is part of the retina at the back of the eye, about 5mm across, that is responsible for our central vision, most of our colour vision and the fine detail of what we see. A healthy macula is about 250 microns thick, or one-quarter of a millimetre.

Early signs of AMD, Meau says, are the appearance of “drusen” in the macular area. These small, discrete, yellowish deposits made from protein and fatty substances can be detected during an eye examination.
Most people with drusen have normal vision. But numerous small drusen, or larger ones, raise the risk of progression to AMD. This is considered the “dry” stage of the disease. Dry AMD – my diagnosis – develops slowly and gradually, and most people do not notice any change in vision for years.
In about 10 per cent of cases, it will progress to the “wet” type, in which abnormal blood vessels grow into the macular, restricting blood supply and causing rapid vision loss.
“People with wet AMD will report seeing wavy lines, distorted faces when looking at people, or a blank spot or smudge in the centre of their vision,” Meau says.

What triggers AMD?
The retina at the back of each eye is a layer of photosensitive cone and rod cells that receive and process visual information.
Rod cells, throughout the whole retina, detect movement and vision in the dark. Cone cells, which interpret colour and fine detail vision – such as when driving or reading – are tightly packed into the macula at the retina’s centre.
Macular diseases such as AMD occur when there is damage to these cells. Early changes to the macula do not produce any symptoms, Meau says, so patients may not “feel” the changes, which can only be detected through a dilated eye examination.
“The earlier the detection, the better the ultimate visual outcome,” he adds.

A common symptom of macular diseases, including AMD, is for straight lines to appear wavy. That explains the use of the grid – or Amsler chart – during my assessment.
“This may not be noticeable if the change happens in one eye only, as the unaffected eye will compensate,” Meau says. To test the affected eye, you need to close your good eye.
Because macular damage affects only central vision, peripheral vision remains intact.
How to manage AMD
Meau recommends an annual optical coherence tomography (OCT) test and eye exam in patients without symptoms who have a few drusen deposits but whose eyes are otherwise healthy. The OCT test measures and tracks drusen progression to help monitor the location, number and size of the deposits over time.
If drusen do progress, Meau recommends having the test more often, say every six months.
Both genetic and environmental factors play a role in AMD. Research shows about 20 per cent of AMD patients have a family history of it. People of European descent have a higher prevalence of it: people with lighter skin have less melanin, a protective pigment, in the retina.
Lifestyle risk factors for AMD include smoking, a poor diet – one that is high in fat but low in omega 3 and 6, vitamins, carotenoids, and minerals – and a lack of exercise.
There is no cure for AMD. Wet macular degeneration is treated by laser, to seal leaking blood vessels and help stop them growing, or intravitreal – into the eye – injections.


A 2024 report from the UK’s Royal College of Ophthalmologists says timely treatment is key. Its research found that, without intervention, most eyes affected by wet AMD faced a gradual decline in vision. But after the first year of regular injections, more than 90 per cent of eyes maintained stable vision, almost 20 per cent experienced a significant improvement, and more than 40 per cent had good vision.
Lifestyle changes and supplements may help
Lifestyle changes may help prevent or delay progression to AMD’s wet form and may slow progression of the dry type.
The changes are those that support good health in general. If you smoke, quit. Get plenty of exercise. Eat a Mediterranean-style diet, with lots of colourful fruit and vegetables – think spinach, coloured peppers and berries.
My eye doctor urged me to take supplements based on the AREDS 2 (Age-Related Eye Disease Study 2). The study examined the value of daily vitamins and minerals for AMD and found that some could help slow the progression of drusen, and of dry AMD to wet.
They include:

Vitamin C (ascorbic acid) 50mg


Vitamin E 400 international units (IU)


Lutein 10mg


Zeaxanthin 2mg


Zinc (as zinc oxide) 80mg


Copper (as cupric oxide) 2mg

Lutein and zeaxanthin are phytochemicals (micronutrients from plants) called carotenoids that protect the macula from damage caused by light.
Vitamins C, E and zinc are antioxidants. Copper is included because zinc can cause copper deficiency, since the two compete for absorption in the intestines.


Having initially felt dismayed by my diagnosis, I feel reassured that my condition does not have to lead to visual impairment.
Caught early, I know what to do, how to eat, which supplements to take – and I had a reason to get a new pair of bigger sunglasses.
Like what you read? Follow SCMP Lifestyle on Facebook, X and Instagram. You can also sign up for our eNewsletter here.


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What is AMD? Eye condition could cause blindness – and only an eye test can detect it

Scheduling routine eye exams can help ensure you catch problems such as age-related macular degeneration early - and save your eyesight into old age. Photo: Shutterstock

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The macula is part of the retina at the back of the eye. Illustration: Shutterstock

Adoption of lifestyle changes is important to prevent or delay progression to AMD’s wet form. Illustration: Shutterstock

Optometrist Dr Andy Meau is a director at Central Eye Care in Hong Kong.

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Health & Wellness

Health

Age-related macular degeneration (AMD), a leading cause of severe vision impairment, comes in dry and wet versions, with treatment for both


Age-related macular degeneration (AMD), a leading cause of severe vision impairment, comes in dry and wet versions, with treatment for both.


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.css-1c6uqr6{color:inherit;font-weight:inherit;font-size:inherit;font-family:inherit;line-height:inherit;overflow-wrap:break-word;}Age-related macular degeneration (AMD), a leading cause of severe vision impairment, comes in dry and wet versions, with treatment for both

Age-related macular degeneration (AMD), a leading cause of severe vision impairment, comes in dry and wet versions, with treatment for both