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How do I know if I have age-related macular degeneration (AMD)?

If you notice distortion or a blur patch in your central vision, you could have Age-related Macular Degeneration (AMD). It is the leading cause of central vision loss in people over the age of 50 in developed countries, including Singapore. With an average life expectancy of close to 80 years in the country, more than 1 in 5 elderly Singaporeans can expect to develop AMD. Recent studies have also shown that 7% of Singaporean adults who are 40 years and older have AMD.

About 1 in 10 Singaporeans are diabetics. As the risk of developing diabetes increases with age, the prevalence of diabetes in Singapore expected to rise further along with the increased life expectancy in the country.  Diabetes can affect the eye in many ways:

There are 3 types of diabetic retinopathy:

Non-proliferative diabetic retinopathyProliferative diabetic retinopathyDiabetic macular edema
Non-proliferative diabetic retinopathy is the earliest stage of diabetic retinopathy. In this stage, the damaged tiny blood vessels in the retina may begin to leak fluid and small amounts of blood hence causing the retina to swell or forming yellowish deposits at the back of your eye.
This is the most severe type of diabetic retinopathy. It occurs when new blood vessels begin to grow in the inner part of the retina. As these vessels are mostly abnormal and fragile, they may eventually lead to bleeding in the eye and in severe cases, form scar tissue that may cause the retina to wrinkle or detach.
This condition occurs when the damaged blood vessels allow fluid to leak into the most visually important part of the retina called the macula that is responsible for sharp central vision. Dr Cheryl Lee’s analogy is that if the retina is Singapore, the macula is Orchard road.

All individuals with diabetes are at risk. The longer you have diabetes, the more likely it is for you to develop diabetic retinopathy. Studies have shown that 60% of diabetics on tablets and 100% of diabetics on injection have some form of diabetic eye disease over time. Diabetic retinopathy may be a problem for women with diabetes during pregnancy. Pregnant woman with diabetes should have a comprehensive eye examination even before family planning.

Diabetic eye disease can be detected through a comprehensive eye examination that includes visual acuity test, dilated retinal examination with colour retinal photography, and a high-definition scan of the retina if necessary.

Diabetic retinopathy is treated with laser treatment that can be performed in the clinic with no hospitalization stay. Focal laser is usually done in non-proliferative cases to slow down the leakage of fluid and reduce the amount of fluid in the retina while scatter laser shrinks the abnormal blood vessels in proliferative cases. Multiple sessions may be required to complete the treatment. This treatment has been shown to reduce risk of severe vision loss by 50%. In addition, patients with proliferative retinopathy have less than 5% chance of losing their vision within the next 5 years if they receive timely and appropriate treatment.

Surgery is only needed if there is a retinal detachment or if bleeding does not resolve spontaneously.

Are you seeing little ‘cobwebs’ or specks?

These little objects that float about in your field in vision are called ‘floaters’. They move with your eye and are most noticeable when you are looking at a blue sky or a white background like a wall or piece of paper.

I feel some parts of my vision are blocked. Oh no, is it retinal detachment?

Sudden onset or increase in the number of floaters, flashes and appearance of a curtain over the field of vision may be the warning signs of a retinal problem such as retinal tear or detachment. A retinal detachment is a medical emergency. Anyone experiencing its symptoms should see an eye doctor immediately.

Droopy upper eyelids may block your vision when you look upward or even straight ahead.

Droopy eyelids

With age, the upper eyelids have the tendency to droop and obstruct one’s vision. The eyes will then "look older" as these aging processes leave the eyes appearing tired, wrinkled or puffy. To compensate for the drooping of these eyelids, patients either wrinkle their forehead and use the forehead muscles to lift the eyebrow to help raise the upper eyelids or put their chin up with the nose up in the air to see better. This, in turn, may cause forehead tension headaches and neckache.

Physical or chemical injuries of the eye can be a serious threat and may lead to vision loss if treatment is delayed.

Although most patients with eye trauma present symptoms such as redness, pain or blurring of vision upon their arrival in the clinic, certain types of trauma do not give rise to any symptoms. This occurs either when the trauma is caused by a small foreign body or when the foreign bodies go into the ‘inner part’ of the eye where the vitreous gel or the retina is. Eye trauma involving the posterior segment of the eye or intraocular foreign bodies is considered as an ocular emergency hence should be evaluated by an ophthalmologist immediately.

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