What is the Macula?
The macula is the small but critically important central region of the retina — the light-sensitive layer at the back of the eye. It is responsible for sharp, detailed central vision: the vision you use when reading, recognising faces, driving, and viewing fine detail. The macula contains a very high concentration of specialised photoreceptor cells called cones, which are responsible for colour and fine-detail vision.
When the macula is damaged, central vision is affected — often causing blurring, distortion, or a blank spot in the centre of the visual field. Peripheral (side) vision is generally preserved.
What is Age-Related Macular Degeneration?
Age-related macular degeneration (AMD) is a progressive condition in which the macular cells deteriorate over time. It is the leading cause of permanent vision loss in Australians over the age of 50. AMD does not cause complete blindness — peripheral vision is retained — but loss of central vision can be profoundly disabling, affecting the ability to read, drive, and recognise faces.
Dry AMD vs Wet AMD
Dry AMD is the more common form, accounting for approximately 85–90% of cases. It involves a gradual thinning and deterioration of the macular cells, often with the accumulation of small protein deposits beneath the retina called drusen. Dry AMD typically progresses slowly over years. In some patients, it can advance to geographic atrophy — a more severe form with significant areas of cell loss.
Wet AMD (neovascular AMD) accounts for approximately 10–15% of cases but causes the majority of severe vision loss. It occurs when abnormal new blood vessels grow beneath the macula (a process called choroidal neovascularisation). These vessels are fragile and prone to leaking fluid and blood into and beneath the retina, causing rapid and potentially severe distortion and loss of central vision. Wet AMD requires prompt treatment.
Risk Factors
The most significant risk factor for AMD is age — the condition is rare under 50 and becomes progressively more common thereafter. Other important risk factors include smoking (which doubles the risk of AMD and accelerates progression), a positive family history of AMD, cardiovascular disease, obesity, and a diet low in antioxidants and green leafy vegetables.
Prolonged UV exposure without adequate eye protection may also play a role. Certain genetic variants are strongly associated with AMD risk.
Symptoms to Watch For
AMD often causes no symptoms in its early stages, which is why regular eye examinations — particularly after age 50 — are so important. As the condition progresses, symptoms may include blurred or distorted central vision, difficulty reading fine print, straight lines appearing wavy or bent (metamorphopsia), colours appearing washed out or less vivid, and a grey or blank patch in the centre of vision.
The Amsler grid — a simple grid of horizontal and vertical lines with a central dot — can be used at home to monitor for early distortion. If straight lines begin to appear wavy, curved, or if a gap appears, you should seek urgent review from your ophthalmologist. This may indicate conversion from dry to wet AMD.
Diagnosis
AMD is diagnosed and monitored using several imaging technologies available at Northern Eye Consultants. Optical Coherence Tomography (OCT) provides high-resolution cross-sectional images of the retinal layers, allowing precise assessment of fluid, atrophy, and structural changes. OCT Angiography can visualise the retinal blood vessels without the need for dye injections. Fluorescein Angiography — in which a dye is injected and photographed as it flows through the retinal vessels — may be used in selected cases.
Treatment
For wet AMD, the main treatment is intravitreal anti-VEGF injections — medications such as Eylea, Lucentis, or Avastin injected directly into the vitreous cavity of the eye under topical anaesthesia. These drugs suppress the abnormal blood vessel growth and reduce fluid accumulation, stabilising or improving vision in the majority of patients. Treatment is typically required regularly (monthly or every 6–12 weeks depending on the drug and response). Early treatment gives the best outcomes.
For dry AMD, there is currently no established medical treatment that reverses the condition. However, large clinical trials (the AREDS studies) have shown that high-dose antioxidant vitamin supplements (AREDS2 formula) can slow progression in patients with intermediate or advanced dry AMD. Lifestyle modifications — quitting smoking, eating a diet rich in leafy green vegetables, managing blood pressure and cholesterol — are also recommended.
When to Seek Urgent Review
If you notice a sudden change in your central vision — new distortion, a blank spot appearing, or vision suddenly becoming worse — you should contact your ophthalmologist promptly. Wet AMD can progress rapidly, and delays in treatment can result in permanent vision loss that may have been preventable with early intervention.