Macular Degeneration

What is Age-related Macular Degeneration (AMD)?
AMD is the leading cause of permanent vision loss in people over the age of 50.  It is a group of diseases usually characterized by a painless, gradual loss and increased distortion of central vision which is responsible for tasks such as reading, driving, watching TV and recognising faces. Eventually little or no central vision can remain with additional loss of colours which in combination can reduce a person’s quality of life; one third of all we perceive in our daily lives is information gained from our eyes. There are two types of AMD, dry and wet, although in rare occasions a patient can have both types. Dry is much more common affecting 90% of patients and has no medical cure. Wet can result in sudden loss in vision and may be treated by eye injections to stabilise the vision. As the UK population ages the number of people affected by AMD is expected to double within 20 years. At present it affects 30 Scots every week.

What are the risk factors for AMD?
These are a combination of genetic, lifestyle and environmental factors which include:

  • Family History
  • Smoking (more than 5 years)
  • Increasing Age
  • Low Degree of Macular Pigment
  • Macular Drusen (one or both eyes)
  • Female Gender
  • Caucasian Ethnicity
  • Cardiovascular Disease (Systemic Hypertension, Diabetes and Cholesterol)
  • Exposure to UV light (Pale Eye Colour, Fair Skin, Sunbathing, High Altitude Sports)
  • Poor Diet (High % saturated Fats/Processed Foods, Overweight).

Screening for AMD
Mackie Eyecare and Mackie Specstore are the first Scottish optician to offer screening for AMD using the MPOD.  This test requires the patient to determine when lights flicker and measures macular pigment density, a controllable risk factor. Screening also includes a digital photo of the back of the eye and a risk analysis based on risk factors revealed and their combined significance. Patients will then receive an expert opinion on how to reduce their risk.  This may include macular pigment vitamin supplementation, increased consumption of specific food groups and lifestyle changes.

What Vitamin Supplements are best for AMD?
New research has identified that Nutrof total, a combination of vitamins from a large multi centre study AREDS 1, antioxidants in the eye (lutein and xeathananin) an omega 3 can reduce or halt any macular degeneration with some patients getting improved vision. In addition, this formulation is made in a liquid format for those patients who have trouble swallowing tablets.

What Costs are Involved?
All eye examinations are FREE, within specific time intervals, as funded by NHS Scotland. MPOD Screening Costs £35 for an initial visit and no charge for reviews if supplements are purchased using bulk buy or direct debit ; For vitamin supplements we have introduced a three price structure:

  • a) Bulk Buy. Buy 6 packets of tablets get 1 packet FREE ((i.e. £19×6 = £114, SAVE £19)
  • b) Set up a direct debit. This costs £17 per month (Ie normal price £18 per month, SAVE £24 per year). Six months supply of tablets will be given at one time to avoid running out of date and just before your next 6 months batch is due we will contact you.
  • c) Purchase individual boxes. This is the most expensive option and costs £19 per box.
    Note: Vitamin Supplement can be collected at Mackie Opticians or sent in the post.

What is Macular Pigment?
Macular pigment is a yellow substance located in the middle of the light sensitive retina at the back of the eye.  It acts as “natures own sunglasses” filtering out harmful blue light radiation.  If its density is reduced below age-norm, radiation damage occurs starting AMD. However, the density of the macular pigment can be improved to age-norm by taking specific vitamin supplements.

Low Vision Clinics
Mackie Opticians in partnership with NHS Lanarkshire can provide AMD patients with access to FREE low vision aids, as funded by the Scottish Government.
These can be either special spectacles, magnifiers, lighting and electronic devices to provide vision for tasks patients cannot achieve with conventional spectacles such as watching TV, reading, viewing outside signs, seeing price labels, etc.

What do I do Next?
Contact your nearest practice to arrange an appointment to discuss AMD with Dr Mackie.  This may result in an eye examination and/or digital photography of the back of the eye and/or a MPOD measurement and risk evaluation and/or provision of magnifiers.

Frequently Asked Questions
Q. Who should be screened for AMD?
A. Any patients over 40 years of age with any risk factors as previously outlined

Q. How long does the MPOD test take and are there any restrictions?
A. The test takes about 5 mins per eye and there are no restrictions except very poor vision preventing the patient viewing the flickering lights.

Q. Will taking Nutrof Total affect any other medication taken?
A. No. However we advise discussion with your GP before beginning treatment  if you have any liver disease.

Q.Can I get Nutrof Total on prescription?
A. No these are not available from the NHS.

Q. IsNutrof Total safe to use if I am a smoker?
A. Yes,  Nutrof Total is safe as it does not contain vitamin A or beta-caroten.

Q. How long do I need to take  Nutrof Total?
A. MPOD measurements will be repeated every 6 months until Macular Pigment Density level is normal for your age.  However, maintenance of this level is usually lifelong, similar to cholesterol or blood pressure medication.  Dr Mackie will advise you.

Q. Is there anything else I can do?
A. Eat a diet rich in fruit and green vegetables (eg broccoli, spinach) and oily fish (eg mackeral, tuna) Stop smoking as this is a significant risk factor, but can be drastically reduced after 5 years of non-smoking. Get a yearly eye examination.

Amsler Grid Test
This test should be performed using your reading spectacles or bifocals/varifocals held up so you are looking through the reading portion. Cover one eye, at a time and focus on  the central spot with the opened eye.  The surrounding pattern should NOT have wavy, broken or distorted lines or areas missing.  If this happens please make an appointment.

Useful references include:
www.macularsociety.org/