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Am I going blind?

The leading cause of blindness among the elderly is age-related macular degeneration (ARMD).

Sadly, there is no cure for the condition.

People in their 50s have about a 2 per cent chance of getting ARMD; at 70, this rises to nearly 30 per cent; at 75, it is almost 50 per cent.

So what hope is there for sufferers? We investigate.

WHAT IS IT?

At the front of your eye there is a lens and an aperture (an opening), which both adjust to bring objects into focus on the retina at the back of your eye.

The retina is made up of a delicate tissue that is sensitive to light, rather like the film in a camera.

The macula is found at the centre of the retina where the incoming rays of light are focused. It is responsible for frontal vision, close up vision and colour.

ARMD occurs when the delicate cells of the macula become damaged and stop working. It is, generally, an age-related condition - however, people who are much younger, and even children, can develop macular degeneration, a condition known as macular dystrophy.

WHAT ARE THE SYMPTOMS?

There are two types of ARMD - Wet and Dry. Dry ARMD affects about 90 per cent of those with the disease and its cause is unknown.

The macula simply begins to deteriorate and central vision slowly breaks down. It often occurs in just one eye at first but will eventually spread to both eyes. In the early stages, central vision may become blurred or distorted, with things looking an unusual size or shape.

Dry ARMD tends to develop over a period of several months. Sufferers may become very sensitive to light or actually see lights that are not there.

As it gets worse, a blurred dark spot may appear in the centre of the sufferer's vision. This spot occurs because a group of cells in the macula have stopped working properly. Over time, the blurred spot may get bigger and darker, taking away more of the central vision.

Wet ARMD is the most severe form. It occurs when new blood vessels behind the retina start to grow toward the macula.

Because these new blood vessels tend to be very fragile, they will often leak blood and fluid under the macula.

This causes rapid damage to the macula that can lead to the loss of central vision in a short period of time, often weeks. An early symptom of Wet ARMD is straight lines appearing wavy. Another is rapid loss of central vision - this is different from Dry ARMD in which loss of central vision occurs slowly. As with Dry ARMD, a blind spot may also develop.

HOW IS IT DIAGNOSED?

If you suspect that you may have macular degeneration but there are no acute symptoms, you should see your doctor or optometrist ( optician) who will refer you to an eye specialist.

If you have acute symptoms, then you should consult your doctor or local casualty department immediately.

In some cases, especially with Wet ARMD, loss of vision can happen suddenly and progress quickly, so even leaving diagnosis and treatment for a matter of weeks while you wait to see a specialist can reduce the chance of successful treatment to save your sight.

WHAT TREATMENTS ARE AVAILABLE FOR ARMD?

In many cases, especially if you have developed it at a young age, you should be able to have some sort of treatment.

Certain cases of Wet ARMD can be treated with laser surgery. Known as photo dynamic therapy, this is currently the most common treatment in the UK and is available privately at around £1,500 per treatment (some people may need several treatments).

The National Institute of Clinical Excellence (NICE) does not officially recognise photo dynamic therapy and so in theory it is not available on the NHS.

But some local health authorities have agreed to fund individual cases - your GP can advise on your area's policy. The treatment involves aiming a high-energy beam of light directly on to the leaking blood vessels.

But, this is not a cure for ARMD - it is only a treatment to help stop further vision loss and occasionally restore some vision.

However, the risk of new blood vessels growing back after laser treatment is relatively high.

WHAT FUTURE TREATMENTS ARE THERE FOR ARMD?

There are several treatments under investigation which could revolutionise cures for the condition in the future.

• Scientists in the U.S. are studying the possibility of transplanting healthy cells into a diseased retina. Although this work is still experimental, in the future it may help people keep their vision or even restore some lost vision.

• A new drug called Macugen is being developed for use on Wet ARMD.

  Macugen, being tested in the U.S., binds to and neutralises a protein called Vascular Endothelial Growth Factor - which is held largely responsible for damage to the macula.

  It can be used by itself or in conjunction with laser therapy to help prevent leaky blood vessels re-forming.

• One of the first treatments for Dry ARMD is under development in America.

  The treatment, called Rheopheresis, uses a filter to siphon out certain proteins and lipoproteins in the eye that are believed to contribute to the development of Dry ARMD.

• Under development are a new breed of steroids that can be injected into the eye to help prevent leakage from the faulty blood vessels.

• An experimental study is under way using a new treatment called transpupillary thermotherapy for the treatment of Wet ARMD.

  This uses a low dose of infra-red laser light to seal the blood vessels at the back of the eye without the accompaniment of therapeutic drugs and with no damage to surrounding tissue.

• Macular Translocation surgery is a controversial and highly experimental new treatment for ARMD currently under investigation by German eye specialists. The procedure involves detaching the retina by puncturing it with a needle and literally working it loose. The loosened retina is rotated up to 40 degrees, with the optic nerve as a central axis.

  The macula is then relocated over healthy tissue, which is not affected by leaky blood vessels. Laser surgery and injected silicone gel are then used to re-fasten the retina.

  The upside is that the operation can restore sight to those with advanced ARMD, but it is a highly risky, highly complicated operation that takes a long time to carry out.

  WHAT CAN BE DONE TO PREVENT ARMD?

  Although most cases of Wet ARMD are due to genetics, there are a number of lifestyle and diet factors that can affect the risk of getting Dry forms of the disease.

  A study carried out by the National Eye Institute in the U.S. found that high levels of antioxidants, such as pycnogenol or grape seed extract, taken in combination with zinc as a daily supplement reduce the risk of advanced ARMD by about 25 per cent.

  Other studies into ARMD have noted beneficial changes from a diet rich in dark green leafy vegetables, such as spinach and kale.

  In addition, The Journal Of The American Geriatric Society reported a correlation between the consumption of red wine in moderate amounts (one glass daily) and a delayed onset of ARMD.

  Tobacco appears to interfere with the absorption of lutein, an important antioxidant that protects the retina from damage caused by ultraviolet light. Smokers are likely to have low levels of lutein and so are at greater risk of developing macular degeneration.

  Also, ultraviolet light can damage your retina and may increase your chances of developing macular degeneration.

  It can also speed up its development. Therefore, it is extremely important to protect your eyes when you are outside. Look for sunglasses that screen 99-100 per cent of ultraviolet A and B rays.

  There are sunglasses designed specifically for macular degeneration that include side-panels and a ridge at the top of the glasses so that all light is filtered.

• For more information on both forms of ARMD contact The Macular Disease Society Helpline on 0800 328 2849 or write to: The Macular Disease Society PO Box 16, Denbigh LL16 5ZA.