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Age-related Macular

Degeneration (AMD)

The center of the retina (macula) contains millions of cells in a confined space, which enable good vision. Activities such as reading, recognizing faces or handwork rely on good macular function. AMD may initially lead to the need for more light for reading. Blurred or distorted vision may follow. Straight lines appear crooked or bent, colors become weaker. Sometimes the disease is not noticed by the patient before  the second eye is affected. In advanced disease it is difficult to identify details, reading, driving and recognizing faces may be impossible. Peripheral vision, which is very important for orientation is never lost.

Ophthalmologists distinguish two forms of AMD:

"Dry" AMD is more frequent (85%) and usually less aggressive. This form results in the loss of light-sensitive cells in the retina leading to slow vision impairment. Many pharmaceutical companies are involved in the development of effective treatment options, but they are not yet available.

In the more aggressive "wet" form of macular degeneration, which affects approximately 25% of AMD patients, leakage of retinal vessels leads to accumulation of fluid in the retina.

As a result progressive scarring occurs with destruction of the sensitive nerve layer of the retina. Without therapy significant visual loss can occur within a short time. Wet AMD is the most common cause of blindness beyond the age of 60.

As one in four  > 65-years is affected by different stages of AMD early detection and precaution are particularly important.

Avoidable risk factors (smoking, UV-light) should be avoided.

Patients at risk (family history of AMD, smokers, high UV-light exposure, women, blue eyes, persons > 55) should be examined by an ophthalmologist who will give advice about preventive steps  (dietary supplements ) or therapy.

Diagnostic steps
  • visual acuity test
  • contrast sensitivity
  • qualitative (Amsler chart) or quantitative tests for distortions (AMD - A Metamorphopsia Detector)
  • slit lamp examination
  • examination of the retina with dilated pupil or photograph
  • fluorescein angiography (FAG): after dilating the pupils with eyedrops, the inflow and distribution of an intravenously applied dye (fluorescein or indocyanine green) is documented
  • optical coherence tomogaphy (OCT): OCT is a noncontact method in which light is used to  scan eye structures, for example the retina and the optic nerve. High-resolution spectral domain OCT technology can make subtle changes visible
Therapy of wet AMD

The most common therapy of wet age related macular degeneration consists of intravitreal injections: VEGF- antagonists or corticosteroids are injected into the vitreous during a short operation, the eye is anesthesized by drops. These injections usually have to be applied several times. In selected cases alternative therapy may be applicable like Argon laser photocoagulation, photodynamic therapy, radiation (brachytherapy), surgical procedures (membrane extraction, macular rotation).




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