Eye Disease in the Elderly With the population in Singapore growing older, age-related macular degenration should not be ignored By Eleanor Yap As Singapore becomes the second fastest ageing nation in Asia after Japan with an estimated 240,000 citizens aged 75 and older in 2030, age-related macular degeneration (AMD) should not be taken lightly.   AMD is an age-related eye disease and is the most common cause of blindness in people 55 years and older in developed countries. Sadly, it is irreversible and a person affected with the more severe forms of the condition is likely to go blind.   Serious problem Though the exact prevalence in Singapore is currently unknown, Adjunct Associate Professor Au Eong Kah Guan, head and senior consultant, Ophthalmology and Visual Sciences, Alexandra Hospital, indicates that AMD has not gotten as much attention as it deserves from eye care practitioners because of the focus on other eye problems.   Stressing on AMD, Gerrard Grace, chair of the AMD Alliance International, a global non-profit organisation based in Canada, says that it is the third leading cause of visual impairment in the world after cataracts and glaucoma. He adds that there are “huge cost implications” related to AMD, including loss of productivity. Having AMD can further result in depression as well as hip fractures resulting from accidents and falls, which could lead to death. “There is a huge number of people who have AMD and who don’t know it,” says Dr B Maheshwar, an ophthalmologist from Alexandra Hospital. “Only about 5% of people have heard of AMD in Hong Kong and Japan.”   What is it? Previously thought to be a Caucasian disease, reports now show that AMD is just as prevalent among Asians and Africans. The cause however is unknown and the effects are gradual, with most people usually dismissing it as a sign of ageing.   There are two types of AMD: Dry macular degeneration This is the more common form of macular degeneration, representing approximately 90% of all AMD cases. However, dry macular degeneration accounts for only 10% of the severe vision loss associated with macular degeneration.   Dry AMD is characterised by the development of yellow-white deposits underneath your retina, known as drusen. There is no generally accepted treatment to reverse the condition, although antioxidant vitamins and zinc supplements may slow its progression. Over time, dry macular degeneration may develop into wet macular degeneration.   Common symptoms include slightly blurred vision, and you may have difficulty recognising faces. It often affects both eyes, but vision can be lost in one eye while the other eye seems unaffected. Over time, central vision in the affected eye may gradually deteriorate.   Wet macular degeneration  This occurs when abnormal blood vessels start to grow under the centre of your retina. These new blood vessels are very fragile and often leak blood and fluid, and this can damage your macula or create a scar on your retina, causing vision problems. Damage to the macula can occur rapidly, causing a noticeable loss of central vision. This loss may be permanent because abnormal blood vessels and scar tissue are actually replacing normal retina tissue. An early symptom is distortion of vision, when straight lines appear wavy. Treatments are available that may slow and reduce vision loss associated with wet macular degeneration. This includes photodynamic laser therapy where a light-sensitive drug is used together with a “cold” laser beam to close the abnormal blood vessels.   Those at risk of AMD tend to be people aged over 55, female, smokers and those who have a family history of macular degeneration. Furthermore, high blood pressure and high cholesterol may also increase your risks.   To pick up early signs of degeneration, A/Prof Au Eong, who sits on the Scientific Advisory Panel of the AMD Alliance International, says that those aged 55 and above are advised to get regular eye exams every two years. During the exam, if it is suspected that you have AMD, your doctor will perform additional tests to determine whether it is of the dry or wet type and manage your condition accordingly.   Alexandra Hospital currently offers its SEE (Sight & Eye Evaluation) project, which is a free comprehensive screening exam for those aged 55 and above in the evening about once every fortnight for a nominal fee. So protect yourself if you want to see brightly into your future.