Macular Degeneration

Advanced retinal scanning using the Heidelberg OCT

Intraocular injections are a necessary component of wet macular degeneration treatment. The advanced retinal scanning technology from Heidelberg used at Toowoomba Ophthalmic Consultants and Dr Holcombe’s advanced training in treating macular diseases allows us to manage your macular degeneration with the least number of injections possible.

What is macular degeneration?

The macula is the central region of the retina (the camera film layer lining the inside of the back of the eyeball). It is responsible for your central vision and diseases that affect this area affect your ability to see objects that you look towards.

Macular degeneration, or age-related macular degeneration, is a condition that affects the central retina, and hence the central vision. It never causes complete blindness as the surrounding peripheral (side) vision remains normal. However the disease impairs a person’s ability to read, recognise faces, drive, and makes it difficult to recognise colours and contrasts.

Macular degeneration commonly occurs in people over the age of 50 years, and the Macula Disease Foundation Australia states that 1 in 7 Australians over age 50 have some evidence of macula degeneration. If there is a direct family history of macular degeneration then your chance of the disease jumps to 50%. It is however, not a normal or inevitable consequence of ageing. You can have the early signs of the disease without symptoms, so having your macula examined is an important part of an eye health check.

Wet vs dry macular degeneration

Simplistically there are two major “types” of macula degeneration: dry and wet. These terms refer to the presence or absence of fluid and bleeding within and beneath the macula.

Wet vs dry macular degeneration

The two types of Age-related Macular Degeneration (AMD): Dry and Wet

Dry macula degeneration is the most common form, accounting for 85-90% of all cases of macula degeneration. It develops gradually and doesn’t cause sudden vision loss or distortion (unless it converts to the wet form of the disease). Over time, areas of the macula can die, leading to corresponding areas of vision that cannot be seen.

Enhanced scanning laser OCT imaging is used to precisely examine retinal layers in dry macular degeneration


Drusen - a feature of early and intermediate macular degeneration


Geographic atropy - a feature of late stage macular degeneration

Wet macula degeneration accounts for approximately 10-15% of cases. For reasons that are not yet completely understood, blood vessels grow from deep behind the retina into the space immediately beneath the retina. These vessels may leak fluid or bleed, causing scaring of the macula and a corresponding loss of vision. This process can be relatively rapid.

Symptoms of macular degeneration

It is possible to have early macular degeneration and have no symptoms – hence the importance of an eye check.

Symptoms of macular degeneration include:

  • difficulty in reading or any other activity which requires fine vision
  • distortion of straight lines such that they appear wavy or bent
  • difficulty with central vision, such as distinguishing faces, or dark patches or empty spaces

At home you can use an Amsler grid to monitor your central vision. Simply download the chart and follow the instructions.

Assessing macular degeneration

In the clinic a careful dilated fundus examination and investigations using optical coherence tomography (OCT) are used to assess for the presence of disease. OCT is a non-invasive imaging technique which shows the macula in cross-section in exquisite detail and allows detection of fluid or bleeding within or deep to the retina. At Toowoomba Ophthalmic Consultants we use the Heidelberg Spectralis OCT, which combines scanning laser fundus imaging with simultaneously acquired OCT which provides unmatched precision in the detection of early disease and monitoring during treatment.

Macular degeneration treatment

For the dry form of the disease there is currently no treatment. Diet and lifestyle, including the use of an appropriate supplement, can help slow disease progression and vision loss. Adopting the following simple dietary recommendations can assist with your macula health:

  • eat a healthy well-balanced diet
  • eat dark green leafy vegetables and fresh fruit daily
  • eat fish two to three times a week
  • choose low GI carbohydrates
  • eat a handful of nuts a week

There is considerable interest in the use of supplements to boost macular health and assist in macular degeneration. A large medical trial called AREDS, and a follow-up trial called AREDS2 demonstrated that for people with intermediate stage macular degeneration in one or both eyes, or late stage macular degeneration in one eye, taking supplements with the AREDS(2) formula reduced the progression of the disease by approximately 20-25%.

At Toowoomba Ophthalmic Consultants, Dr Holcombe can advise you on your stage of disease and the potential benefit of supplements. Remember though:

  • supplements do not cure the disease
  • supplements do not stop or reverse damage caused by the disease
  • supplements are not beneficial for those with no macular degeneration or the early stages of the disease
Omega-3 supplementation
  • there is a substantial body of evidence supporting the consumption of actual fish 2 – 3 times per week
  • if you eat adequate amounts of fish, current evidence shows that fish oil supplements provide no additional benefit
  • if you don’t eat enough fish they may be of some benefit but there is lack of evidence from large randomised control trials to confirm this
Lutein supplementation
  • lutein is found in dark green leafy vegetables
  • if you are over 50, have a family history of macular degeneration, and are not eating sufficient dark green leafy vegetables as part of your normal diet, then there is evidence that lutein supplementation may be worthwhile

The mainstay of treatment for wet macular degeneration is injection of medication directly into the back of the eyeball.

Initially this occurs monthly, but depending on the response of the disease to the injections, the injection interval may be progressively increased resulting in fewer injections to maintain your vision. Whilst these injections cannot cure the disease, they aim to stabilise and maintain the best vision for as long as possible. In some people, treatment can improve vision.

Dr Holcombe’s goal for his macula degeneration patients is to control the disease with the least number of injections possible. The use of the Heidelberg Spectralis OCT makes this possible.

All surgical procedures carry some risk. The information provided here is for general educational purposes only. Please contact Dr David Holcombe of Toowoomba Ophthalmic Consultants to discuss the options that are appropriate for your individual situation.



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