Age-Related Macular Degeneration

This week’s blog on Age-Related Macular Degeneration has been contributed by Dr Paola Salvetti, Consultant Ophthalmologist and Specialist in Medical Retina.

Age-Related Macular Degeneration

Age-Related Macular Degeneration (AMD) is one of the most common causes of the loss of vision in people aged 50 and older. Worldwide, the number of people with age-related macular degeneration is projected to reach 196 million by 2020, increasing to 288 million by 2040. (1)
The vision loss occurs due to damage to the central part of the retina, or macula, which is the most sensitive part of the retina and enables us to have sharp and detailed vision when we look straight ahead. When the macula is damaged, the centre of our field of vision may appear blurred, distorted, or dark. This loss of central vision, even without leading to complete blindness, can still however interfere with everyday tasks such as reading, writing, driving or recognising faces.
The progression rate of the disease varies and when it is in the initial stages, any vision-related symptoms may develop slowly. However, there are cases in which the progression of the disease is rapid and loss of vision may be sudden.
The most significant risk factor for AMD is age but research has shown that smoking doubles the risk of AMD. Furthermore, AMD is more common among certain groups within the community and genetics are relevant because people with a family history of AMD are at higher risk, and more than 20 genes have now been identified as affecting the risk of developing AMD (source nei.nih.gov).
In the early and intermediate stages, AMD can typically be detected only with a comprehensive examination of the retina, often using dilating drops to provide a better view of the back of the eye. The examination normally includes the measurement of visual acuity, visualisation of the retina with a slit lamp and ancillary tests such as OCT and Fluorescein & Indocyanine Green Angiography (FFA & ICGA).

Early AMD;

the disease is characterised by the presence of medium-sized drusen (yellow deposits beneath the retina). People with early AMD typically do not have vision loss.
Initially there may be no symptoms but over time the quality of the vision deteriorates. The sharpness of vision may be lost and colours may appear washed out and lack definition. Glare is another symptom that may be experienced.

Intermediate AMD; 

in these cases, drusen are larger and often joined together and may be associated with pigment changes in the retina. At this stage there may be some vision loss, but most people will not experience any symptoms.

Late AMD;

in addition to drusen, people with late AMD have vision loss caused by damage to the macula. There are two types of late AMD:
1: Geographic Atrophy (also called dry AMD) in which the progressive damage from drusen ultimately leads to cell death and loss of vision
2: Neovascular AMD (also called wet AMD) in which abnormal blood vessels grow underneath or through the retina.  These vessels can leak fluid and blood, which accumulates in the retina leading to swelling and damage of the macula. The damage may be very quick and severe.
It is possible to have both geographic atrophy and neovascular AMD in the same eye, and either type can appear first.
Whilst there is no specific treatment for early AMD, research has found that daily intake of certain high-dose vitamins and minerals can slow progression of the disease in people who have intermediate AMD, and in those who have late AMD in one eye only. The first AREDS trial showed that a combination of vitamin C, vitamin E, beta-carotene, zinc, and copper can reduce the risk of late AMD by 25 percent.
With neovascular AMD, abnormally high levels of vascular endothelial growth factor (VEGF) are secreted in the eyes – VEGF is a protein that promotes the growth of new abnormal blood vessels. Anti-VEGF injection therapy blocks this growth and therefore slows the progression of the disease.
Today, most neovascular AMD is treated with intravitreal injections, with laser being reserved for a selected minority of cases. Typically, multiple monthly injections are required and the earlier treatment starts, the higher the chances of better vision results.
AMD has few symptoms in the early stages, so it is important to have your eyes examined regularly. If you are at risk of AMD because of age, family history, lifestyle, or some combination of these factors, you should not wait for changes in your vision before being checked for AMD.
If you have late AMD in one eye only, you may not notice any changes in your overall vision. With the other eye seeing clearly, you may still be able to drive, read, and see fine details. However, having late AMD in one eye means you are at increased risk of late AMD in your other eye.
1 Wong, WL Lancet Glob Health. 2014 Feb;2(2):e106-16
2  nei.nih.gov

Moorfields Eye Hospital Dubai appoints new Medical Director

Dr. Ammar Safar, Consultant Ophthalmologist and Vitreoretinal Surgeon, GCAA Approved Specialist Aeromedical Medical Examiner, brings wealth of experience to the continuously growing 21-member permanent and visiting consultant team in the UAE
15 April 2018 (Dubai – United Arab Emirates): Moorfields Eye Hospital Dubai has announced the appointment of Dr. Ammar Safar, Consultant Ophthalmologist and Vitreoretinal Surgeon, and GCAA Approved Specialist Aeromedical Medical Examiner as Medical Director of Moorfields Eye Hospitals in the UAE. Dr. Ammar is American Board Certified in Ophthalmology and is a highly experienced surgeon in vitreoretinal diseases. In his capacity as Medical Director, he will be leading the 20 permanent and visiting consultant ophthalmologist team in the UAE, driving further growth of Moorfields’ reputation as a “Centre of Excellence” in the Middle East and Africa regions.
Dr. Ammar undertook his medical training in Syria before moving to the US where he specialised in ophthalmology, holding a number of positions including Fellow, Vitreoretinal Diseases and Surgery at the Parkland Memorial Hospital at the University of Texas, Southwestern Medical Center in Dallas, Texas USA. He then relocated to the UAE where he was Vitreoretinal Surgeon and President of Medical Staff at a private general hospital in Dubai.
In addition to his work in private practice, Dr. Ammar has undertaken research and clinical trials in areas such as diabetic retinopathy and age-related eye disease, and published and presented extensively. His research work has also resulted in advances in Retinal Vascular diseases (discovering new management options for diabetic retinopathy and vascular occlusive disorders) and in Macular Degeneration (new approaches for treatment of exudative macular degeneration).
Among his many honorary awards, Dr.  Ammar was the inaugural recipient of The Martha Bentley Wood Chair of Ophthalmology at the University of Arkansas. He is a member of a number of professional associations including the American Academy Of Ophthalmology; American Society of Retina Specialists; American Society of Cataract and Refractive Surgery; The Association for Research In Vision and Ophthalmology ARVO; Arab-American Medical Association; Research to Prevent Blindness – Ophthalmologic Associate; and the American College of Surgeons.
Commenting on the new appointment, David Probert, Chief Executive, Moorfields Eye Hospital NHS Foundation Trust, said: “Moorfields is delighted to announce this new appointment in an important clinical area and in the management of the hospital’s clinical team. Dr. Ammar brings a tremendous range of expertise and will add considerable additional experience to our consultant-led team and approach to patient treatment and care.”

Dr. Ammar Safar

Medical Director
Consultant Ophthalmologist & Vitreoretinal Surgeon
GCAA Approved Specialist Aviation Medical Examiner
Professor of Ophthalmology (Adjunct)
Dr. Ammar Safar is American Board Certified in Ophthalmology and is a highly experienced consultant in vitreoretinal diseases and surgery. Dr. Ammar is the Medical Director of Moorfields Eye Hospitals in the UAE. He is based in Moorfields Eye Hospital Dubai.
Dr. Ammar undertook his medical training in Syria before moving to the United States for post-graduate training. He specialised in Ophthalmology at Georgetown University in Washington, DC where he also served as a Chief Resident. He then acquired an additional 2-year fellowship training in Vitreoretinal Diseases & Surgery at the University of Texas, Southwestern Medical Center in Dallas, Texas, USA. Dr. Ammar then went on to hold the position of Assistant and later Associate Professor and Director of Vitreoretinal Surgery at the Department of Ophthalmology, Jones Eye Institute, University of Arkansas for Medical Sciences, in the United States. He then relocated to the UAE where he was a Consultant Vitreoretinal Surgeon and President of Medical Staff at a private general hospital in Dubai.
In addition to his work in private practice, Dr. Ammar has undertaken research and clinical trials in areas such as diabetic retinopathy and age-related eye diseases, and published and presented extensively. His research work has also resulted in advances in retinal vascular diseases (discovering new management options for diabetic retinopathy and vascular occlusive disorders) and in macular degeneration (new approaches for treatment of exudative macular degeneration).
Among his many honorary awards, Dr. Ammar was the inaugural recipient of The Martha Wood Bentley endowed Chair of Ophthalmology at the University of Arkansas. He is a member of a number of professional associations including the American Academy of Ophthalmology, American Society of Retina Specialists, European Society of Retina Specialists, American Society of Cataract and Refractive Surgery, The Association for Research In Vision and Ophthalmology (ARVO), Arab-American Medical Association, Research to Prevent Blindness, and a fellow of the American College of Surgeons.
Click here to read more about Retinal Detachment.
Click here to read more about Vitrectomy.
Click here to read more about Diabetic Retinopathy.
Click here to read more about Cataract Surgery Treatment.
Click here to read more about Intravitreal Injections.

Cataract

This week’s blog on Cataract has been contributed by Dr. Avinash Gurbaxani, Consultant Ophthalmic Surgeon in Uveitis and Medical Retinal Diseases and Cataract Surgery.

What is cataract?

Cataract is the clouding of the natural lens of the eye. This is generally a slow process related to age, in which the transparent lens gradually loses its transparency, making the vision cloudy or dull. Other factors such as Diabetes or eye surgery, or medications like corticosteroids, can also cause cataract.

What are the symptoms?

Initially there may be no symptoms but over time the quality of the vision deteriorates. The sharpness of vision may be lost and colours may appear washed out and lack definition. Glare is another symptom that may be experienced.

Does cataract threaten vision?

Having a cataract does not damage your eye and vision loss due to cataract is reversible. Patients with visual symptoms should be examined for cataract by an ophthalmologist.

What is the treatment?

Cataract is treated by surgery. This is one of the most frequently performed operations in the world and also one of the most successful. Modern day cataract surgery is very safe and effective. The cloudy lens is removed and an artificial lens is implanted. It takes 15-20 minutes and is painless, and is most often done under local anesthesia. The surgery is performed on a day patient basis.

Will I need glasses?

The eye is examined and an appropriate lens is implanted. Monofocal lenses usually correct distance vision and you may only need reading glasses. Multifocal lenses correct for distance and near vision and may eliminate the need for glasses. Based on the eye examination, the ophthalmologist can advise on which lens is most suitable for you.

How long does recovery take?

Recovery depends on the overall health of the eye and patients can return to regular activities the very next day. Full vision recovery may take a few days up to a month. There are no major lifestyle restrictions after the operation.