In some cases early age-related macular degeneration (AMD) may be detected before it begins to cause any symptoms, during a routine eye test.

If you are experiencing symptoms of macular degeneration, visit your GP or make an appointment with an optometrist (a healthcare professional trained to recognise signs of eye problems). Find your nearest optician.

If there is a sudden change in your vision, visit your nearest accident and emergency (A&E) department.

Referral

If your GP or optometrist suspects macular degeneration, you will be referred to an ophthalmologist (a medical doctor who specialises in diagnosing and treating eye conditions).

Your appointment will usually be at an eye department in a hospital. If travelling by car, ask someone else to drive you because you may be given eye drops during the appointment that make your vision blurry.

Eye examination

Your ophthalmologist will first carry out a routine check of your eyes. You will be given eye drops to enlarge your pupils. These take around half an hour to start working, and may make your vision blurry or your eyes sensitive to light. The effect will wear off after a few hours.

Your ophthalmologist will look at the back of your eyes where your retina and macula are located, using a magnifying device with a light attached to it. They will look for any abnormalities around your retina.

The ophthalmologist will then carry out a series of tests to confirm a diagnosis of macular degeneration.

Amsler grid

One of the first tests involves asking you to look at a special grid, known as an Amsler grid. The grid is made up of vertical and horizontal lines, with a dot in the middle.

If you have macular degeneration, it is likely some of the lines will appear faded, broken or distorted. Telling your ophthalmologist which lines are distorted or broken will give them a better idea of the extent of the damage to your macula.

As the macula controls your central field of vision, it is usually the lines nearest to the centre of the grid that appear distorted.

The College of Optometrists produces a leaflet on macular degeneration that includes an Amsler grid you can print off and use at home to help you check for possible signs of AMD.

Retinal imaging

As part of your diagnosis, your ophthalmologist will need to photograph your retinas to see what damage, if any, macular degeneration has caused. This will confirm the diagnosis and prove useful in planning your treatment. There are several different ways of taking pictures of the retinas.

Fundus photography

A fundus camera is a special camera used to take photographs of the inside of your eye. The camera can capture colour stereoscopic (three-dimensional) images of your macula. Your ophthalmologist can then look at the different layers of your retina to see what damage, if any, has occurred. 

Fluorescein angiography

An angiography is an examination that creates detailed images of your blood vessels and the blood flow inside them. A special dye is injected into your blood vessels and pictures are taken that show any abnormalities inside them.

The angiography can confirm which type of AMD you have and may be done if your ophthalmologist suspects wet AMD.

During a fluorescein angiography, the ophthalmologist will inject a special dye, called fluorescein, into a vein in your arm.

Over the next 10 minutes they will use a magnifying device to look into your eyes, and take a series of pictures using a special camera.

These images will allow your ophthalmologist to see if any of the dye is leaking from the blood vessels behind your macula. If it is, this may confirm you have wet AMD.

Indocyanine green (ICG) angiography

The technique used for an ICG angiography is the same as for fluorescein angiography, but the dye is different. ICG is used as an alternative dye to fluorescein and may be used as it can highlight slightly different problems in your eyes.

Optical coherence tomography

Optical coherence tomography (OCT) uses special rays of light to scan your retina and produce an image of it. This can provide your ophthalmologist with detailed information about your macula. For example, it will tell them whether your macula is thickened or abnormal in any way, and whether any fluid has leaked into the retina.

Staging of AMD

Once these tests have been completed the ophthalmologist should be able to tell you how far your AMD has progressed.

Dry AMD has three main stages:

• Early AMD – in this stage there may be many small collections of waste products (drusen) inside the eye, or fewer medium-sized drusen, or some minor damage to your retina. Early AMD may not cause any noticeable symptoms.
• Intermediate AMD – there may be some larger drusen inside the eye or some tissue damage to the outer section of the macula. People with intermediate AMD will have a blurred spot in the centre of their vision.
• Advanced AMD – the centre of the macula is now damaged. People with advanced AMD will have a much larger blurred spot and have difficulties reading and recognising faces.

Wet AMD is always regarded as an advanced form of AMD.

Macula

The macula is a small spot at the centre of the retina. It is the part of your eye where incoming rays of light are focused.

Retina

The retina is the nerve tissue lining the back of the eye. It senses light and colour and sends it to the brain as electrical impulses.

X-ray

An X-ray is an imaging technique that uses high-energy radiation to show up abnormalities in bones and certain body tissue, such as breast tissue.