Age-Related Macular Degeneration (AMD)
By Dr. Nejmi Öztürk, ophthalmologist and eye surgeon working in the diagnosis and treatment of retinal diseases, at HG Hospital in Kahramanmaraş, Türkiye — OCT monitoring and anti-VEGF intravitreal injections
- Age-related macular degeneration (AMD) is the wearing out, with age, of the macula, the part of the retina responsible for sharp central vision; peripheral (side) vision is preserved.
- The dry type progresses slowly and is managed with follow-up and vitamin supplements; the wet type causes rapid vision loss and is treated with series of anti-VEGF injections.
- Straight lines looking bent is an early warning sign; you can check yourself at home with an Amsler grid.
- At HG Hospital in Kahramanmaraş, diagnosis, follow-up and injections are carried out by Dr. Nejmi Öztürk; insurance coverage is clarified at the consultation.
What is macular degeneration?
Macular degeneration, in full age-related macular degeneration (AMD), is the wearing out with age of the macula, the area at the center of the retina (the light-sensing layer at the back of the eye) that provides sharp vision. It affects tasks that need central vision, such as reading, recognizing faces, driving and fine work. Peripheral vision is usually preserved; the disease does not lead to total blindness. It usually appears after the age of 50.
What is the difference between the dry type and the wet type?
The dry type is seen in roughly nine out of ten patients and progresses slowly; the wet type is less common but causes rapid vision loss. The dry type can turn into the wet type over time, which is why the dry type also needs regular follow-up.
| Feature | Dry (atrophic) type | Wet (neovascular) type |
|---|---|---|
| What happens in the eye? | Yellow waste deposits (drusen) build up under the macula and the light-sensing cells thin out. In the advanced stage, areas of cell loss called “geographic atrophy” develop. | Abnormal new vessels grow under the macula; they leak and bleed, the macula swells and scar tissue is left behind. |
| Course | Slow, over years | Fast, over weeks to months |
| Symptoms | Difficulty reading in dim light, mild blurring, a faded patch in the center | Lines looking bent, a dark patch in the center, sudden blurring |
| Treatment | Follow-up, control of risk factors, vitamin supplements on your doctor’s advice | Series of anti-VEGF intravitreal injections |
What are the symptoms of macular degeneration, and who is at risk?
The symptoms of macular degeneration begin in central vision; they are often noticed in one eye before the other, and can go unnoticed for a while because the other eye still sees well.
- Straight lines (a door frame, tile grout, a line of text) looking bent or wavy
- A blurred, faded or dark patch in the center of vision; difficulty recognizing faces
- Letters disappearing while reading, needing more light
- Colors fading, a long adjustment time when moving from dark to bright surroundings
- In the wet type, sudden blurring that becomes obvious within days
Who needs follow-up and treatment?
- Everyone over 50 is advised to have regular dilated retinal examinations; over 65, the interval between examinations becomes shorter.
- Smokers: Smoking is the most important modifiable risk factor; it increases the risk 2–3 times.
- People with a family history of macular degeneration: The inherited tendency is marked.
- People with light-colored eyes, high blood pressure, cardiovascular disease or obesity, and those whose diet is low in green leafy vegetables and fish.
- People who have developed the wet type in one eye: The risk in the other eye is high.
Who is it not suitable for?
- There is no evidence that vitamin supplements slow progression in the early stage of the dry type; at this stage vitamins are not started and the eye is monitored.
- In smokers and people who have recently stopped smoking, formulas containing beta-carotene are not used because of the risk of lung cancer; a beta-carotene-free formula is chosen.
- Injections are postponed while there is an active infection in the eye; in people who have recently had a stroke or heart attack, the decision on anti-VEGF is made together with the relevant department.
- In advanced-stage eyes with established scar tissue in the macula, injections do not bring vision back; in these patients low-vision rehabilitation takes priority.
How are the examination and tests done?
The diagnosis is made with a dilated retinal examination, in which the pupil is widened with drops, and with OCT; if the wet type is suspected, angiography is added.
- Visual acuity and Amsler test: Each eye is checked separately on a grid card to see whether the lines look bent.
- Dilated retinal examination: Drusen, pigment changes, bleeding and fluid build-up are examined. The effect of the drops lasts 4–6 hours; you should not drive.
- OCT (optical coherence tomography): Takes a cross-sectional image of the macula; it shows fluid, bleeding and thinning. In the wet type it is the main measure for timing the injections. It is completed in a few minutes without touching the eye.
- Fundus fluorescein angiography: With a dye injected into a vein in the arm, the location and leakage of the abnormal vessels are imaged. Kidney disease and a history of allergy must be reported beforehand.
- OCT angiography and autofluorescence imaging: Show the vessel network and the areas of cell loss without dye.
What happens in macular degeneration?
A close-up section of the macula: the normal structure and the difference between the dry and wet types.
- Normal maculaThe macula is a small area at the center of the retina that provides the sharpest vision. The pit in its middle (the fovea) is used for reading and recognizing faces.
- Dry typeDeposits called drusen build up beneath the retina. Progression is slow; vision may decline over the years.
- Wet typeNew vessels grow from beneath the retina and leak fluid; the macula swells. Because vision may worsen within weeks, a prompt assessment is needed.
How is macular degeneration treated?
Treatment of macular degeneration depends on the type: in the dry type the aim is to slow progression and catch a change to the wet type early; in the wet type the leakage from the abnormal vessels is stopped with anti-VEGF intravitreal injections.
Follow-up and vitamin supplements in the dry type
There is no medicine that stops the progression of the dry type. In patients at the intermediate stage, the formula defined in the AREDS2 study (vitamins C and E, zinc, copper, lutein and zeaxanthin) reduced the risk of progression to the advanced stage by about a quarter. This supplement is started after your doctor has determined the stage; it does not bring vision back and is not recommended as a preventive measure for healthy people. For the advanced dry type (geographic atrophy), new injectable medicines have been approved in some countries; their effects are limited and their use depends on your doctor’s assessment.
How is the injection for wet macular degeneration given?
- Leakage is confirmed with OCT and the examination; the procedure and risks are explained and your consent is obtained.
- The eye is numbed with anesthetic drops; the eyelids and the surface of the eye are cleaned with an antiseptic (povidone-iodine), and a sterile drape and an eyelid holder are placed.
- The anti-VEGF medicine is delivered through the white of the eye with a very fine needle into the gel-filled space inside the eye (the vitreous). The injection takes a few seconds; including preparation it is over in 10–15 minutes.
- What you will feel: Most patients feel pressure and a brief sting at the moment of injection. After the procedure, a burning and gritty feeling caused by the antiseptic may last a few hours.
- Your light perception and eye pressure are checked; you go home the same day without driving.
Frequency and the “treat-and-extend” approach: Treatment usually starts with monthly injections for the first 3 months in a row. Once the macula is dry, the interval is extended by 2 weeks each time (to 6, 8, 10, 12 weeks, for example); if leakage reappears, the interval is shortened. Injections can continue for years; stopping treatment can allow the leakage to return and lead to permanent loss.
A sign you can notice at home
If straight lines on the Amsler grid look wavy or broken, it is an early warning.
- Amsler gridEach eye is tested separately, with reading glasses if you use them. While you look at the dot in the center, the squares should look straight. If lines look bent or broken, or a spot appears in the middle, an examination is needed without delay.
What is recovery like?
- Day 1: Stinging, burning and watering may occur; a red patch may be visible on the white of the eye at the injection site and disappears in 1–2 weeks. Do not rub the eye; use the drops you have been given.
- Week 1: Increasing pain, increasing redness, a drop in vision or light sensitivity can be signs of an infection inside the eye; go to the hospital without waiting.
- Month 1: The response is measured with OCT and the next injection interval is decided. Continue the Amsler test at home; check your other eye as well.
For patients coming from Elbistan, Afşin, Göksun and the other districts, the OCT check and the injection are scheduled for the same day; the number of trips falls as the intervals get longer.
What to expect: With injection treatment in the wet type, vision is preserved in the large majority of patients, and some gain a degree of improvement. Treatment does not eliminate the disease; it keeps it under control. How much vision improves depends on the degree of cell loss in the macula.
What are the risks and limitations?
- Injection risks: Infection inside the eye (endophthalmitis; rare, roughly one in every 1,000–3,000 injections; needs urgent treatment), retinal tear or detachment, a temporary rise in eye pressure, a patch of blood on the surface of the eye (common and harmless), faster development of cataract, allergy to the medicine. In patients with cardiovascular risk, the choice of medicine is made together with the relevant department.
- Vitamin supplements: High-dose zinc can cause stomach upset; beta-carotene is not used in smokers.
- Limitations: In the dry type there is no treatment that brings vision back. In the wet type, the earlier treatment starts, the more vision is preserved; established scar tissue in the macula cannot be reversed. Regular injections and check-ups are needed; results vary from person to person.
How do the treatment options compare?
| Option | For whom? | Aim | Frequency | SGK coverage (insured patients) |
|---|---|---|---|---|
| Regular follow-up and Amsler test | Early and intermediate dry type | To catch a change to the wet type early | Examination every 6–12 months; weekly home test | Examination covered |
| AREDS2-type vitamin supplement | Intermediate dry type (on your doctor’s advice) | To slow progression to the advanced stage | Continuous, daily | Generally not covered |
| Anti-VEGF injection | Wet type | To stop the leakage and preserve vision | Monthly at the start, then treat-and-extend | Covered under certain conditions |
| Low-vision rehabilitation | Advanced stage of either type | To make the most of the remaining vision | Assessment and training with aids | Partly; clarified at the consultation |
Low-vision rehabilitation: Magnifiers, telescopic glasses, strong and well-positioned lighting, large-print text and screen magnification apps help you make the most of the vision that remains. For other diseases that cause similar symptoms, see the retinal diseases page. Macular edema caused by diabetes is a separate disease: diabetic retinopathy.
Macular degeneration treatment in Kahramanmaraş
At HG Hospital in Kahramanmaraş, Türkiye, the diagnosis of macular degeneration, its follow-up with OCT and anti-VEGF intravitreal injections are carried out by Dr. Nejmi Öztürk. The decision on vitamin supplements and referral for low-vision rehabilitation are made at the examination.
HG Hospital is a private hospital contracted with the Turkish social security institution (SGK); patients with valid SGK coverage may use it, although a private-hospital co-payment may apply. For the wet type, anti-VEGF injections are within SGK coverage under certain conditions. Patients without SGK coverage, such as international patients and visitors from abroad, pay privately or through their private or travel health insurance; the hospital checks coverage before treatment. Fee information is given by the hospital after the examination, and insurance coverage is clarified at the consultation.
Dr. Öztürk sees patients only at HG Hospital in Kahramanmaraş. For patients coming from Elbistan, Afşin, Göksun, Ekinözü and Nurhak, the examination, OCT and injection are grouped into the same day; the injection schedule is planned together, taking the travel time into account. For details, see the patients from Elbistan and the surrounding area page.
Dr. Nejmi Öztürk sees patients at HG Hospital in Kahramanmaraş, Türkiye. For patients travelling from other districts or from abroad, examination, tests and treatment planning can be arranged for the same day.
Hospital switchboard (within Türkiye): 444 46 46 · E-mail: info@nejmiozturk.com · HG Hospital, Üngüt Mevkii, Prof. Dr. Necmettin Erbakan Blv. No:209, Onikişubat / Kahramanmaraş, Türkiye
Frequently asked questions
Lines look bent to me; is this macular degeneration?
Straight lines looking bent or wavy (metamorphopsia) is an important sign of macular degeneration, particularly of the wet type. Other causes, such as macular edema, a macular hole and an epiretinal membrane, can produce the same symptom. When this symptom appears, an examination within a few days is advised.
Does macular degeneration cause blindness?
Macular degeneration impairs central vision and spares peripheral vision, so it does not lead to total blindness. In the untreated wet type, reading and recognizing faces can become difficult. With early diagnosis and regular treatment, vision can largely be preserved.
How many injections are needed for macular degeneration, and is it for life?
Treatment starts with monthly injections for the first 3 months; the interval is then extended step by step with the treat-and-extend method. In some patients the interval reaches 3–4 months; others continue to need frequent injections. In many patients follow-up continues for years.
Who is given vitamins for macular degeneration?
AREDS2-type vitamin supplements are given, on the doctor’s advice, to patients in whom the intermediate stage of the dry type is found at the retinal examination. No benefit has been shown in the early stage or in people without the disease. In smokers a beta-carotene-free formula is chosen. You are advised to have an examination before starting a supplement on your own.
Does the dry type turn into the wet type?
Yes, the dry type can turn into the wet type over time; the risk depends on the number and size of the drusen. For this reason, patients with the dry type are examined regularly and asked to do the weekly Amsler test at home. If you notice lines bending, seek care without waiting.
What is the Amsler test, and how is it done?
The Amsler grid is a sheet of squared paper with a dot in the middle. Each eye is tested separately, wearing reading glasses, at a distance of 30 cm. If there is an area where the lines bend or disappear, arrange an examination within the same week.
Does the injection for macular degeneration hurt?
The eye is numbed with anesthetic drops; most patients describe pressure and a brief sting at the moment of injection. Afterwards, a burning and gritty feeling caused by the antiseptic may last a few hours. The discomfort usually settles the same day.
Is macular degeneration hereditary?
The risk is higher in people with a family history of macular degeneration. Heredity is just one of the factors that determine the risk; age and smoking have a major influence. People with the disease in their family are advised to have regular dilated retinal examinations from the age of 50.
How much does macular degeneration treatment cost?
Fee information is given by the hospital after the examination; insurance coverage is clarified at the consultation. For insured patients, anti-VEGF injections are within SGK coverage under certain conditions, although a private-hospital co-payment may apply; patients without SGK coverage pay privately or through their private or travel health insurance.
I am coming from Elbistan; how will my macular degeneration follow-up work?
The drive between Elbistan and Kahramanmaraş takes about 2 hours. The OCT and the injection are booked for the same day; after the loading phase, the number of trips falls as the intervals get longer. You are asked to continue the Amsler test at home and to call without waiting if there is a sudden change.
Sources
- Turkish Ophthalmological Society — todnet.org
- American Academy of Ophthalmology (AAO) — aao.org
- National Eye Institute (NEI) — nei.nih.gov
Related pages
This page is for information only; diagnosis and treatment decisions are made after an examination. The results of any surgical or interventional procedure may vary from person to person. You are advised to obtain detailed advice from your physician before any procedure.
Ophthalmologist and eye surgeon. Graduate of Erciyes University Faculty of Medicine; completed his residency at Ankara Atatürk Training and Research Hospital. With 21 years of experience in cataract and refractive surgery, strabismus, glaucoma, retina and oculoplastic surgery, he sees patients at HG Hospital in Kahramanmaraş, Türkiye. Biography and training
Dr. Nejmi Öztürk
Ophthalmologist and eye surgeon
HG Hospital, Üngüt Mevkii, Prof. Dr. Necmettin Erbakan Blv. No:209, Onikişubat / Kahramanmaraş
+90 506 377 47 68WhatsAppAppointment formHospital switchboard (within Türkiye): 444 46 46 · info@nejmiozturk.com
- Private patients and private health insurance are welcome; patients with SGK coverage may use it (conditions are confirmed by the hospital)
- Same-day examination and test planning for patients travelling from other districts or from abroad
- Getting here and patient information
- Patients from Elbistan and the region