Macular degeneration

Auckland Eye Surgery Macular Degeneration Page

COVID-19 and Macular Degeneration

New Zealand is currently at COVID-19 alert level 4. This is to reduce the impact and hopefully, eliminate Covid-19 from our country. We must all do our part.  Information about Covid-19 is available on the Government Website: https://covid19.govt.nz

We are instructed to stay home with only essential services, including health clinics, to remain open. There has been a major reprioritisation of healthcare services.

What does this mean if I have Macular Degeneration?

RANZCO (Royal Australian and New Zealand College of Ophthalmologists) have issued guidelines:

  • Most routine appointments in Eye Clinics will be deferred to a later date.
  • High urgency is given to:

Conditions with recent, severe vision loss or vision threatening conditions AND

Patients requiring injections to treat neovascular (or wet) macular degeneration as well as other sight threatening conditions, including diabetic macular oedema and retinal vein occlusion.

What about my injection treatments for Macular Degeneration?

  • If you are currently having regular eye injections, it is important that you continue with your treatments.  Your specialist will aim to safely extend the time between your treatments to limit the number of treatments and visits you require. This is called “treat-and -extend”. If your eyes are stable, you will be treated with a slightly longer interval before your next visit.
  • If your eye disease is not stabilized, the time between treatments may be reduced.
  • Travel is permitted to attend urgent health care appointments. Some public transport is still available. Refer to https://covid19.govt.nz/help-and-advice/for-travellers/public-transport/

or the NZ Transport agency link: https://www.nzta.govt.nz/about-us/coronavirus-disease-covid-19-services-update/

  • Fewer patients will be booked into clinics to ensure you remain distanced from other patients. Your driver or accompanying person, should remain out of the clinic if possible.
  • If you are unwell with a fever or new, continuous cough or other symptoms of COVID-19 or if you have been in contact with someone who has signs of or been diagnosed with COVID-19, DO NOT COME TO THE EYE CLINIC. Phone ahead to discuss your case. Talk to your GP (by phone) or the COVID-19 Healthline team on 0800 3585453.
  • Eye doctors understand that some patients may be too worried to attend their appointment. If you are concerned, phone your clinic and your doctor may be able to have a phone consultation to discuss concerns and come to a joint decision regarding further injections.
  • Macular Degeneration New Zealand has a free Macular Degeneration Help Line 0800 622 852 (0800-MACULA). During the current Covid-19 alerts, there will be access to an ophthalmologist to discuss your concerns or questions.

 

What if I have Atrophic of Dry Macular Degeneration?

  • Routine appointments to monitor atrophic or dry macular degeneration will be deferred.
  • All patients should continue to monitor their vision with an Amsler grid. 

What if I have new symptoms?

  • Check your Amsler grid with each eye individually, using your reading glasses. Check for any change.
  • If you notice a significant change, particularly with distortion of the lines, contact your Eye Clinic or optometrist. If it is suspected that you have developed wet macular degeneration, requiring treatment, you will be seen in an Eye Clinic.

Please note that this advice may change if healthcare services need to be reprioritised further because of the coronavirus outbreak. This may affect some areas of New Zealand more than others. We will endeavour to provide the most up to date information for patients.

Stay safe.

https://www.mdnz.org.nz/

 

There are many categories of macular degeneration.

Age-related macular degeneration is a common cause of visual impairment in adult New Zealanders. The symptoms relate to degenerative processes that are occurring at the macula and can affect both eyes.

Auckland Eye is an affiliated provider to Southern Cross Health Society for OCT measurements.

If you have a question or would like to book an appointment, please contact our friendly specialist team on 0800 AKL EYES or email to admin@aucklandeye.co.nz 

Please visit the Macular Degeneration New Zealand website for more information about macular degeneration. MDNZ is a charitable trust with a vision to provide awareness, education and support to those who suffer from the disease.

The macula is that part of the retina that we use for fine visual tasks. The retina is a layer inside the eye on which light is focused by the cornea and lens. It is rather like a film of a camera in that it responds to a focused light and transmits signals to the brain enabling us 'to see'.

Different parts of the retina perform different visual tasks. For example, the peripheral retina is useful for night vision and detecting movement and motion. The central part of the retina, the macula, is needed for fine visual tasks such as reading, writing, threading a needle, and tying fishing flies etc.

In macular degeneration, degenerative processes occur which impede central vision.

                          Normal Eye

There are many categories of macular degeneration and these sub-divisions can be based on appearance, age at onset, etc. One common classification includes a subdivision of wet or dry appearance to the macula.

In early forms of macular degeneration, accumulations of waste products can be seen underneath the retina. These deposits are called drusen and can be either of small discreet types or larger confluent disturbances. Progression of this stage can be heralded by abnormalities in pigmentation or thinning of the retina. If the disease process progresses, then these changes can become more marked and can be associated with complications of macular degeneration.

                Macular Degeneration

The thinning of the macula can become more widespread with time and lead to features of atrophic macular degeneration. This typically is a slow process with affected people becoming symptomatic in their eighties. Some patients with advanced macular degeneration can develop a more exudative reaction where there is leakage of fluid or development of abnormal blood vessels beneath the macula. This process tends to be faster and occurs at a younger age group than atrophic changes.

There is no proven treatment or lifestyle change that has been shown to prevent macular degeneration. However, high blood pressure and smoking are known to increase the risk of visual loss from macular degeneration. Equally, controlling high blood pressure and stopping smoking dramatically decreases that risk.

The National Eye Institute has also shown that for patients with moderate or advanced forms of macular degeneration, a combination of vitamins and anti-oxidants can be beneficial. In New Zealand this formulation is not funded by Pharmac and before starting treatment it is advisable to have a thorough eye examination, including photographs of the macula, to ensure the medication is going to be of benefit.

Historically, retinal laser surgery was the treatment of choice. However, the development of a class of drugs that can act on the abnormal leaking vessels in the eye has lead to a widespread change in practice. These drugs, such as Avastin, Lucentis and Eylea are injected into the vitreous cavity within the eye and allow for better visual outcomes. A retinal scan (OCT), and sometimes fluorescein angiography, is required to diagnose and monitor the effect of the treatment. Repeat injections are often required to reduce the leaking vessels causing the reduction in vision.

Patients who lose or have defective reading vision can be helped with low visual aids (LVA) such as magnifiers or closed circuit television. If the central vision is totally lost, talking books can replace the written word.

More sophisticated aids with computers and talking typewriters can enable patients who lose central vision to continue to lead a normal life and occupation. Auckland Eye work with specialist optometrists who are experienced in assisting people requiring LVA and can arrange referral if required.

Ask your doctor for an Amsler Grid to ensure you can regularly test yourself for any signs of distortion. 

Amsler Grid

Amsler Grid

Amsler Grid viewed with macular degeneration

Amsler Grid viewed with macular degeneration

Treatment and techniques to reduce macular degeneration (both the wet and dry form) will be increasingly important as it is a major cause of visual impairment in the developed world, including New Zealand. Auckland Eye actively participates in international clinical trials investigating new drugs for both the treatment and possible prevention of AMD in the future.

MDNZ is a charitable trust with a vision to provide awareness, education and support to those who suffer from the disease. If you would like further information then please contact Macular Degeneration New Zealand:

Web: www.mdnz.org.nz
Tel: 0800 MACULA (0800 622 852).

Auckland Eye - New Zealand Centre of Excellence for Eye Care