Age related macular degeneration - What Every Patient Needs to Know

8/11/2019 Age related macular degeneration - What Every Patient Needs to Know

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Contents

Terms of Use and Disclaimer 3

How to Contact Mr. Jaheed Khan 4

Forward 6

What Patients & Staff Say about Mr. Khan 8

What Exactly IS Age-Related Macular Degeneration? 10

What Are the Symptoms of ARMD? 12

What Causes ARMD? 16

The Two Types of ARMD 18

How is Dry ARMD Treated? 21

How is Wet ARMD Treated? 22

What Can I Expect During a Consultation for ARMD? 24

Frequently Asked Questions about ARMD 26 Afterword 29

How to Contact Mr. Jaheed Khan 30


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Terms of Use and Disclaimer

his eBook is Copyright 2014. All rights are reserved. No

part of this book may be reproduced, stored in a retrievalsystem or transmitted by any means: electronic,mechanical or photocopied, recorded or otherwise without writtenpermission from the copyright holders.

You may distribute this eBook as long as it remains in its originalform and unchanged in content.

The authors are both qualified surgeons and Mr. Jaheed Khanhas particular expertise in eye and cataract surgery.

Nevertheless this eBook is not intended to replace the need for aone-on-one consultation with and examination by a qualified andexperienced eye surgeon. All advice given is intended for generalguidance only.

If you have any disturbance in your vision or eyesight you areadvised to seek medically qualified advice without delay.

Emergency medical care can be obtained through your GP orlocal Accident and Emergency Department.

Mr. Jaheed Khan is also very happy to see patients both NHSand Privately.

His contact details for patients who wish to consult him privatelyare overleaf.

NHS patients will need to see their GP to be referred to him atMoorfields Hospital but private patients can telephone his secretarydirectly.

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How to Contact Mr. Jaheed Khan

rivately I practice at both Moorfields and at Harley Street either telephone or send my secretary an email. A GP referralis not necessary for Private Patients.

Moorfields Eye Hospital

Private Consulting RoomsJohn Saunders Suite9-11 Bath StreetLondon EC1V 9LF

Tel: (020) 7566 2803

[email protected]

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mailto:[email protected]:[email protected]://maps.google.com/maps?f=q&source=embed&hl=en&geocode=&q=EC1V+9LF&sll=51.52695,-0.090954&sspn=0.003404,0.010525&ie=UTF8&hq=&hnear=London+EC1V+9LF,+United+Kingdom&t=m&z=14&ll=51.52694,-0.090968https://maps.google.com/maps?f=q&source=embed&hl=en&geocode=&q=EC1V+9LF&sll=51.52695,-0.090954&sspn=0.003404,0.010525&ie=UTF8&hq=&hnear=London+EC1V+9LF,+United+Kingdom&t=m&z=14&ll=51.52694,-0.090968https://maps.google.com/maps?f=q&source=embed&hl=en&geocode=&q=EC1V+9LF&sll=51.52695,-0.090954&sspn=0.003404,0.010525&ie=UTF8&hq=&hnear=London+EC1V+9LF,+United+Kingdom&t=m&z=14&ll=51.52694,-0.090968mailto:[email protected]


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Clinica London140 Harley StreetLondon W1G 7LB

Tel: (020) 7935 [email protected]

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mailto:[email protected]:[email protected]://www.google.com/maps/place/Marylebone,+London+W1G+7LB/@51.522717,-0.148416,14z/data=!4m2!3m1!1s0x48761ad11f84f989:0x10abf2887be5ba06?hl=enhttps://www.google.com/maps/place/Marylebone,+London+W1G+7LB/@51.522717,-0.148416,14z/data=!4m2!3m1!1s0x48761ad11f84f989:0x10abf2887be5ba06?hl=enmailto:[email protected]


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clear explanation and advice. I also answer the questions I getmost commonly asked in my clinics and wards in the hospitalwhere I work every day, so if you have or are worried about ARMD

theres a very good chance youll find the answer to your questionhere.

If you have any feedback or want to ask any questions aboutanything in this eBook, simply drop me an email via my secretaryat:

[email protected]

I would be delighted to hear from you and will personally answerany questions you may have.

Best Wishes,

Jaheed KhanConsultant Ophthalmologist.

Moorfields Eye Hospital,London.

June 2014.
mailto:[email protected]:[email protected]:[email protected]


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What Patients & Staff Say About Mr. Jaheed Khan

Mr. Khan is not only an outstanding surgeon but more importantly agreat communicator and caring Doctor. As a GP and commissioner Ihave total faith when referring my patients to Mr. Khan, that they willreceive the best care available from a surgeon who constantly strives forexcellence and treats them as individuals. I would not hesitate torecommend him to both my private and NHS patients. He is a real assetto both Moorfields and Hinchingbrook Hospitals.

Mr. Khan is a brilliant doctor and was a pleasure to work with.

Jaheed Khan is a very competent Ophthalmologist with great patientcare skills and the unique ability to explain complex condition in amanner comprehendible to the patient.

Just keep up the good work Dr. Khan. My wife, who accompaniedme, and I were both very impressed by the care and considerationshown by the whole team when I had surgery. I just hope they haven'tlost the knack by the time I get my other eye fixed. Joking apart the careof this team has made it a wonderful experience for me.

A knowledgeable and trustworthy colleague with extensiveexperience in the diagnosis and treatment of retinal diseases. Up to datewith the latest research and best practice, he is able to integrate thisknowledge into the care of patients with ophthalmic conditions. I wouldhave no hesitation in recommending him to friends and family.

Mr. Jaheed Khan is a thorough, compassionate and conscientiousdoctor. He listens to his patients and treats them with respect and care.He provides excellent medical care, both in clinic and in the operating

theatre. I would highly recommend him.Mr. Khan is an excellent colleague to work with. He is always

approachable and willing to help. His has an outstanding level ofknowledge concerning eye disease and he is more than happy to offerhis opinion whenever needed. He is trustworthy and respects bothpatients and colleagues. I have no hesitation to state that he is one ofthe best colleagues I worked with.

I always enjoy working with Mr. Khan, he is friendly, confident andapproachable. He always maintains a high standard of professionalism


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What Exactly IS Age-Related Macular Degeneration?

guess a sensible starting point is to assume that if you arereading this eBook you either have been told you havemacular degeneration already; you know someone close to

you who has macular degeneration and want to know more; orperhaps you know a little about the condition and worry that youmay have it yourself.

But before we can talk about what Age-Related MacularDegeneration or ARMD is we need to look a little at how the eyeworks.

As you probably have heard before the eye is similar in manyways to a camera.

Light comes in the front, passes through a lens where it isfocused to a sharp image on the light sensitive layer at the back,called the retina. It is similar in this respect to a camera: in an oldercamera the retina is represented by a piece of film. In a moderndigital camera it is represented by an electronic sensor.

The retina of course, is extremely important, as this layer doesthe actual seeing of the image that is focused onto it through thelens.

A cross - section through the human eye

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The retina is not the same all over; it has a specialized areacalled the macula that is able to pick out fine detail in what we see.The image of anything you look directly at is focused onto thissmall area, which is about the size of a pinhead because this isthe area which is specialized to pick out detail. This means that any

problem affecting the macula will interfere with your central visionrather than the edges of your vision. It also means that a problemhere will make it difficult to see detail.


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What are the Symptoms of ARMD?

e have already seen how macular degeneration affects

the central area of your vision, but what does the patientactually see? How does a problem at the maculaactually affect your eyesight?

Above is an image showing what a patient with early ARMDmight see. The central area of this patients vision is distorted anddarker than the area around it. This is because of damage to themacula. You can see how difficult it can be to read or to recognizeordinary objects when you have this condition.

You can see the clock but cant see the hands!

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Difficulty telling the time

The picture above shows what a patient with macular

degeneration might see if they look directly at a clock. Becausethey have problems with their central vision they can see the clockand they know what they are looking at but they cant tell the timebecause they cant clearly see the hands.

In fact, a famous artist called Lee Allen had maculardegeneration and wrote a book about his experiences called AHole in my Vision. This is an excellent description of what patientswith ARMD actually see.

So patients with macular degeneration often complain of:

Tunnel vision Difficulty seeing straight in front of them they often

have to turn their head to one side to see something straightin front of them

Distorted vision. For example they may complain that

the edge of a tall building, which they know to be straightlooks distorted, wobbly, or blurred.

In advanced macular degeneration they may get ablurred or even blank spot in the centre of their vision.

Words and letters of text can look indistinct or blurry Colours look less bright It takes longer for your eyesight to adapt when moving

from bright sunlight to a dimly-lit room

The Amsler Grid

This is a test for problems with the macula which might indicatemacular degeneration:


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The Amsler grid in someone with normal vision

The appearance of the Amsler grid in macular degeneration

As you can see from the pictures above, the straight lines of thegrid appear distorted to patients with problems of the macula suchas ARMD.

To use the Amsler grid test put on your normal reading glassesand cover up one eye. Keep the picture of the grid 12-15 inchesaway from your face and focus on the black dot. As you do this askyourself if the other lines of the grid look straight or wavy.

You then cover up the other eye and repeat the test. If the linesof the grid look wavy you could have macular degeneration.

But remember, you could have ARMD and still see the grid fairlyclearly

that is why if you are at all concerned about your vision youneed to see an expert even if there is nothing wrong thereassurance you will get will be very well worthwhile.


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A word of caution

It is important to remember that not all people with macular

degeneration have all or even any of these symptoms. And not allpeople with these symptoms have macular degeneration, as otherconditions of the eye can cause similar symptoms. Some of theseother conditions can be serious, which is why it is so important tosee a specialist if you have noticed any problems with your eyes,

One other important thing to note is that there are two types ofmacular degeneration. The first, dry macular degenerationdevelops slowly so people may not really notice the symptoms untillater on.

The second is called wet macular degeneration and candevelop very rapidly. People with wet macular degeneration oftennotice a rapid change in their vision, over weeks or even days. Asyou might imagine it is a much more serious condition and requiresurgent assessment and treatment by a specialist in eye problems.Luckily we now have some good treatments for it if it is picked up

early enough.


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What Causes Macular Degeneration?

acular degeneration is commonly called Age-Related

Macular Degeneration or ARMD because it tends toaffect older people. In fact it is the commonest cause of

blindness and loss of central vision in the over-65s.

Cause of Macular Degeneration?

Nobody really knows what causes ARMD. However, there arecertain risk factors aspects that can increase the likelihood ofdeveloping the condition. These include:

Age As you might expect, ARMD is commoner in older people,particularly in the over-65s. However, it can still develop inpeople in their 40s and 50s so once again, no matter howold (or young!) you are a change in your vision needs to betaken seriously.

Gender

More women than men tend to get ARMD, but that maysimply be because women live longer than men do.

Family History ARMD can run in families, which indicates that some peopleare born with certain genes that make the condition morelikely. Nothing can (as yet) be done about that but it doesmean that if you have other family members with thecondition you should be perhaps more vigilant about yourvision yourself.

SmokingSmoking seriously increases your risk of developing ARMD,as it does with many other conditions. Stopping smokingwhatever your age is a very good idea and may reduce yourrisk of developing ARMD

Ultraviolet LightSunlight is composed of visible light which we can see butalso invisible light which we cant infra-red and ultra-violet

light. Ultraviolet light causes tanning of the skin and appearsto be a risk factor for developing ARMD too.

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Diet

There does appear to be a link to diet and ARMD but thecase is not clear-cut. There is some evidence that a diet rich

in the vitamins A,C and E as well as zinc may be beneficial. Race

ARMD is commoner in Caucasians (white people) comparedto other races

It is important to remember though that these are merely riskfactors very large numbers of people without any identifiable riskfactor go on to develop the condition every year.


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The Two Types of Macular Degeneration

acular degeneration occurs in two different forms, Dry

and Wet. They are called Dry and Wet because ofwhat is actually happening in the eye, and what the eye

specialist sees when he examines you, not because of how the eyefeels or because it is watery or dry.

Dry (non-exudative) Macular Degeneration

This is the commonest type of ARMD. It usually develops veryslowly, which means that the symptoms you get the changes inyour vision are also very slow to develop. For this reason peopleoften learn how to cope with the symptoms and may not seekadvice until it is quite advanced. Dry ARMD can develop into wet

ARMD at any stage. It is also perfectly possible to have dry ARMDin one eye and wet ARMD in the other (Dame Judi Dench hasexactly this problem)

Dry Macular Degeneration the white spots are called Drusen

Wet (Exudative) Macular Degeneration

Up to perhaps 15% of people with ARMD have wet maculardegeneration. This is different to dry macular degeneration as it is

caused by new blood vessels growing underneath the retina.These vessels are very fine and delicate and leak fluid and blood

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and it is this that causes the problems with the patients eyesight.

The appearance of the back of the eye in wet ARMD

How do you know if you have ARMD?

The simple answer is that you cannot diagnose the condition inyourself.

Only a doctor with special expertise in conditions affecting theeye an ophthalmologist can accurately diagnose ARMD.Neither can your GP or optician make the diagnosis, although theymay suspect ARMD is the cause of your symptoms.

The other thing is that the symptoms can often creep up on youas they may take a long time to develop. And of course, by the timeyou notice the symptoms the damage has already occurred.

With both types of macular degeneration people progressivelylose their central vision and that can be very disabling anddistressing. Although they never go completely blind they can stillsee in the periphery - poor vision can mean people lose confidencein getting out and about in unfamiliar places and stay indoors. Poorvision can mean people socialise less and become withdrawn. Andpoor vision makes us more likely to fall or injure ourselves in other

ways.


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That is why I find treating eye problems so rewarding: becausehelping to improve patients eyesight can give people a whole newlease of life and return some of their independence and self-

confidence.


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How is Dry Macular Degeneration Treated?

eople with any type of ARMD must be carefully assessed

and monitored over a period of years by an expert,because many people with dry ARMD will go on to develop

the more aggressive and severe wet form of the disease.

There is no specific treatment for dry AMD although somestudies (The Age-Related Eye Disease Study, AREDS) haveshown that taking high-doses of certain vitamins and zinc sloweddown vision loss in people with intermediate or advanced AMD.

Another study ('AREDS II') is looking at the effects of othervitamins (including Lutein and Zeaxanthin which are found in themacula) on people with ARMD.

The supplements that are thought to help are:

Vitamin C Vitamin E Beta-Carotene Zinc oxide Cupric oxide

Certain foods contain higher levels of these compounds, foodssuch as:

Oranges Kiwi fruit

Tomatoes Carrots (Yes they really are good for your eyes!) Leafy green vegetables Mangoes Peas Sweetcorn

Supplementing your diet with these foods may help your visionand will certainly give you other general health benefits, but pleaseconsult your doctor/eye specialist before taking them.

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How is Wet Macular Degeneration Treated?

eople with wet macular degeneration until recently were in

considerable trouble, because there was no really effectivetreatment available. Laser had been used (and

occasionally is still used) but was not particularly effective intreating the condition.

Thankfully, over the last few years there has been something ofa revolution in treating wet ARMD as new treatments have becomeavailable. The most exciting of these are the anti-VEGF drugsLucentis and Eyelea.

How do anti-VEGF Medicines Work?

VEGF or Vascular Endothelial Growth Factor is a naturallyproduced 'signaling' substance in the body that is thought to bepartly responsible for the growth of the abnormal blood vessels inthe eye that are responsible for Wet AMD.

Lucentis and Eyelea work by blocking the action of the VEGF inthe eye and so reduce the growth of these blood vessels.

Unfortunately, the only way we can get these medicines wherethey need to be is with an injection in to the eye.

Now although this sounds very unpleasant and dramatic, thegood news is that it is nowhere near as awful as it sounds. Let mereassure you that it is nowhere near as bad as you might think -most people aren't even aware of the injection happening!

This is because I always give drops into the eye to make it gonumb first of all. These local anaesthetic drops prevent theinjection from hurting you.

Next, I always use a very fine needle to give the injection - it ismuch finer than the ones used to take blood tests from your arm.

The needle is almost as thin as a human hair.

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And finally I always give the injection just into the very corner ofyour eye - you won't see any nasty needles or feel anyone veryclose to your face.

After this you will be able to go home you do not need to beadmitted to hospital for treatment and I will arrange a follow-upappointment to see how you are getting on.


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What Can I Expect During a Consultation for ARMD?

fter booking your appointment you will be greeted at the

clinic by one of my nurses and reception staff. You willthen be brought in to the clinical room where I will see you

personally you will not be seen by a junior doctors or specialisttrainee as often happens in the NHS.

We will go through details of your medical history as well asdiscuss the problems you have been having with your eyesight. Iwill then examine your eyes thoroughly.

Your vision will be checked and your pupils dilated to allow theback of the eye to be examined. Your pupils are dilated with dropsthat take about 30 minutes to work. They will make you sensitive tolight and cause your vision to be blurry. The drops allow me to seethe inside of your eye more easily. The effect of the drops usuallywears off in about six hours though sometimes it can happenovernight. It is not safe to drive until the effects have worn off.

I will look at the inside of your eye using a special microscopecalled a slit lamp. You place your chin on a rest and I will ask youto look in various directions while shining a light into your eye. Thisallows me to see your retina and any changes that ARMD mayhave caused. Although very bright, the light cannot damage youreye.

Often I can tell you whether you are likely to have ARMD or notfrom this examination. However, you may need a test called aFluorescein angiogram to find out for certain if you have ARMD andif so to determine which type, wet or dry.

The fluorescein angiogram

The fluorescein angiogram looks at the network of blood vesselsunderneath your retina can't be seen by examining your eyes witha slit lamp. You are given an injection in the arm of Fluorescein, a

yellow dye that shows up the blood vessels at the back of the eye.The injection isnt painful but does make some people feel a bit

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sick sometimes.

Once the dye has been injected pictures of the back of your eye

are taken as the dye is travelling through the blood vessels. Thistakes about 10 minutes.

It is a very common test and very few people have any seriousside effects. The injection may give your skin a slight yellow tingefrom the dye and it soon passes into your urine, which may alsoappear a darker yellow than normal (possibly for up to two to threedays) but often it fades quicker than that. Some people are dazzledfor a while after the flashing lights but most people find the teststraightforward.

These tests help the ophthalmologist decide which type of ARMDyou have and so guides him to the correct treatment.


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Frequently Asked Questions

Can you have ARMD in only one eye?

Yes, you can. However it is much commoner to have ARMD inboth eyes. The reason you only notice symptoms in one eyethough is because it is worse in that eye.

Can you have dry ARMD in one eye and wet ARMD in the other?

Yes, you can. In fact, it is possible to have both wet AND dry

ARMD in the same eye! This shows just how important it is to haveyour eyes looked after by an expert.

Dame Judi Dench, the actress in fact has dry ARMD in one eyeand wet ARMD in the other.

Dame Judi Dench - M in the Bond films

Does ARMD ever get better?

No. Dry ARMD usually gets worse only very slowly though, whichis obviously good news. Wet AMD however can progress veryquickly, causing serious problems with your vision. However, ifpicked up early you can see a dramatic improvement withtreatment.


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Does dry ARMD always go on to wet ARMD?

No. You can have dry AMD for many years and still not get wet

AMD. The big 'but' though is you need to keep a very close watchon people with dry ARMD because quite a few go on to developwet ARMD - and Wet ARMD is a serious (but treatable) condition.

Will vitamins prevent dry ARMD getting worse?

We're still not sure. There is some evidence that it slows thecondition down at least - but this is not yet proven.

Does dry ARMD require injections?

No.

Do injections into the eye hurt?

Most people only feel slight discomfort only, because I alwaysgive local anaesthetic drops first. I also always use a very fineneedle - almost as thin as a human hair - and I always inject just into the corner of the eye.

If you have Wet ARMD you will need several injections over time,and I have never had a patient cancel an appointment because theinjections hurt her - not even once.

Will I see the needle?

Only if you want to! The injection is given into the corner of theeye so no, you won't normally see the needle at all.

Do you give any anaesthetic before giving the injections?

Always. I always give eye drops into the eye to make it nice andnumb before giving the injection.


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Can you have cataracts and ARMD?

Yes you can. And because both conditions affect older people

there are many people with both conditions. This is another reasonto see an expert early if you have any trouble with your vision at all.Your vision is too precious to risk anything else.

Are you more likely to get ARMD if you have cataracts?

No. But both are common conditions and both affect the samesorts of people, so many people do have both.

Can you treat ARMD with stem cells?

Not yet. One day perhaps, but any treatment with stem cells ismany years away yet.

Will taking high doses of vitamins prevent me getting ARMD?

No. We do not believe that taking high doses of vitamins willprevent ARMD.

What will happen if I have ARMD and dont get treated?

ARMD is a serious, progressive condition affecting your vision. Ifit is left untreated your vision will continue to deteriorate. If you goon to develop wet ARMD then your eyesight can deteriorate veryquickly indeed over a matter of days or weeks, even. Its just not

worth risking your eyesight at all.

How long do the injections take?

A few moments only then its all done. There really is nothing tobe afraid of.


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Afterword

s you will probably have realized this has been a whistle-stopsummary about age-related macular degeneration - what it is,what causes it and how it is treated. I have also summarized

what you can expect if you should need treatment for wet ARMD andthe common questions I get asked by patients. I hope it has beenuseful.

As a consultant ophthalmologist I am fully trained in themanagement of all conditions affecting the eye, and my specialexpertise is in treating ARMD and cataracts.

If you have problems with your eyes and would like to see me viathe NHS then have a word with your GP and ask to be referred.

If you wish to be seen privately then you do not need a GP referraland can simply contact my secretary directly.

I look forward to seeing you.

Best wishes,

Mr. Jaheed Khan FRCOphth

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How to Contact Mr. Jaheed Khan

rivately I practice at both Moorfields and at Harley Street

either telephone or send my secretary an email. A GP referralis not necessary for Private Patients.

Moorfields Eye Hospital

Private Consulting RoomsJohn Saunders Suite9-11 Bath StreetLondon EC1V 9LF

Tel: (020) 7566 2803

[email protected]

View Larger Map

P
mailto:[email protected]:[email protected]://maps.google.com/maps?f=q&source=embed&hl=en&geocode=&q=EC1V+9LF&sll=51.52695,-0.090954&sspn=0.003404,0.010525&ie=UTF8&hq=&hnear=London+EC1V+9LF,+United+Kingdom&t=m&z=14&ll=51.52694,-0.090968https://maps.google.com/maps?f=q&source=embed&hl=en&geocode=&q=EC1V+9LF&sll=51.52695,-0.090954&sspn=0.003404,0.010525&ie=UTF8&hq=&hnear=London+EC1V+9LF,+United+Kingdom&t=m&z=14&ll=51.52694,-0.090968https://maps.google.com/maps?f=q&source=embed&hl=en&geocode=&q=EC1V+9LF&sll=51.52695,-0.090954&sspn=0.003404,0.010525&ie=UTF8&hq=&hnear=London+EC1V+9LF,+United+Kingdom&t=m&z=14&ll=51.52694,-0.090968mailto:[email protected]


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Clinica London140 Harley StreetLondon W1G 7LB

Tel: (020) 7935 [email protected]

View Larger Map
mailto:[email protected]:[email protected]://www.google.com/maps/place/Marylebone,+London+W1G+7LB/@51.522717,-0.148416,14z/data=!4m2!3m1!1s0x48761ad11f84f989:0x10abf2887be5ba06?hl=enhttps://www.google.com/maps/place/Marylebone,+London+W1G+7LB/@51.522717,-0.148416,14z/data=!4m2!3m1!1s0x48761ad11f84f989:0x10abf2887be5ba06?hl=enhttps://www.google.com/maps/place/Marylebone,+London+W1G+7LB/@51.522717,-0.148416,14z/data=!4m2!3m1!1s0x48761ad11f84f989:0x10abf2887be5ba06?hl=enmailto:[email protected]

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Age related macular degeneration - What Every Patient Needs to Know

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