When Dame Judi Dench announced she was no longer able to read scripts because of an eye condition, some 500,000 people in Britain understood what she was going through.
The James Bond actress, who turns 80 this year, first revealed her eyesight was deteriorating in 2012. Since then, she’s said her loss of vision means she has to learn scripts on a tape recorder, or ask someone to read them to her.
‘I can’t read anymore,’ she said. ‘I can’t paint like I used to. I try to watch movies but it’s quite difficult.’
Dench suffers from age-related macular degeneration (AMD), a painless condition that generally leads to the loss of central vision (directly in front of you). It doesn’t affect your peripheral vision so doesn’t cause complete blindness. Although there is no cure, it can be controlled and pioneering treatments might help some people.
The Royal National Institute for the Blind (RNIB) says AMD is the leading cause of sight loss in Britain and the NHS estimates one in every ten people over 65 has the condition to some degree. It tends to be more common in women than men and in those over 50.
‘In 2009, economic analysis consultancy Access Economics projected that by 2050 the number of people in Britain with AMD would rise to 890,000,’ says a RNIB spokesperson. ‘This translates to more than 71,000 new cases a year.’
AMD comes on with advancing age but can develop in those as young as 40, says Andy Luff, ophthalmic surgeon at Optegra Eye Hospitals.
‘It is progressive damage that affects a tiny part of the retina at the back of your eye called the macula,’ he says. ‘This is responsible for fine- detailed vision used for reading, watching TV and recognising people’s faces. It usually affects both eyes but the speed at which it affects each can vary.’
There are two types of the condition: wet and dry. According to Luff, almost all patients start with dry. ‘This is simply wear and tear of the cells of the eye wall upon which the macula sits,’ he says.
‘This usually develops slowly over a number of years. The main symptom is blurring of central vision, usually first experienced as difficulty with reading in poor light.’
Luff says one in ten of those who suffer from dry AMD will go on to develop the wet version. If untreated, this can cause more damage.
‘This is when new blood vessels start growing in the wrong place, causing swelling and bleeding,’ he says. ‘This causes the macula to stop working. No one knows exactly what triggers these vessels to grow but we understand that in AMD the eye produces an excess of the chemical VEGF, which controls blood vessel growth.
‘This chemical causes abnormal vessels to grow, which then leak water. You central vision is damaged by the presence of this excess fluid.’
Luff says the effects can be limited by monthly injections of anti-VEGF drugs. If this doesn’t work, there is a relatively new and not widely known therapy called Oraya X-Ray. This is a low-energy X-ray designed to stop the abnormal blood vessels growing, and reduce inflammation and scarring.
‘Only a few patients in Britain have had this treatment commercially and it is not yet common medical practice,’ says Luff. ‘However, extensive studies have shown a real benefit in reducing the number of anti-VEGF injections required. And in a small percentage of patients it offers a cure from further leakage.’
Until about ten years ago, there was no treatment for the dry condition but Luff has been involved in a pioneering new surgery for those with a less severe form. This involves replacing the lens of the eye with two implants that work like a lower power telescope, a gadget known as an intraocular lens for visually impaired people.
He now advises on this as well as the latest treatment for severe dry AMD, which involves having a higher-powered, single telescopic implant lens inserted into the eye – known as an implantable miniature telescope (see below).
‘Opticians can provide patients with magnifiers for near and telescopic glasses for distance,’ he says, ‘but these are bulky and difficult to use. However, these telescopic systems improve a patient’s ability to recognise faces, read large print and see something on the TV.’
Pioneering surgical options to mitigate against AMD
This option is for those with early stages of the dry version of age-related macular degeneration. The procedure is similar to cataract extraction, in which a lens (like a little Smartie sitting behind the iris) is replaced with a plastic version. Here, two plastic lenses are inserted to give a telescopic effect.
Ophthalmic surgeon Andy Luff says: ‘This spares the peripheral vision in both eyes so a patient could have both eyes done and still have enough peripheral vision to drive. It’s been around for about five years and costs about £6,000 per eye.’
Implantable miniature telescope
This is an option for those with a severe case of either dry or wet AMD. The process sees a powerful telescopic implant, about the size of a pea, inserted into one eye.
The implant magnifies images and projects them on to the healthy area of the retina unaffected by AMD. During surgery, the surgeon will remove the cataract (the eye’s natural lens) in one eye and replace it with the implant.
After surgery, patients must retrain their eyes because the implanted eye provides central vision while the other provides peripheral vision.
Luff says: ‘There have been recent refinements making this treatment more successful but it has only been around a couple of years so only a small number of patients have had this surgery. At around £20,000, it’s a more expensive option but it could offer life-changing improvements in visual function.’
How to minimise the onset of AMD
As with all things, prevention is better than cure. In the case of age-related macular degeneration, treatment is neither cheap nor well-established so the adage rings particularly true.
Although the NHS says it’s not possible to completely prevent the condition, there are ways to reduce the process. It advises stopping smoking, controlling your blood pressure, eating a healthy diet with plenty of fruit and vegetables, moderating your alcohol intake and wearing UV-absorbing glasses when outside for long periods.
In 2001, researchers with the Age-Related Eye Disease Study said a nutritional supplement could reduce the risk of developing the condition.
‘We should be taking a combination of vitamins,’ says ophthalmic surgeon Andy Luff. ‘Vitamins C and E, zinc, and the vegetable pigments lutein and zeaxanthin (found in dark green leafy vegetables such as spinach) might help slow the rate of visual loss.’