Explainer | What is AMD? Eye condition could cause blindness – and only an eye test can detect it
Age-related macular degeneration (AMD), a leading cause of severe vision impairment, comes in dry and wet versions, with treatment for both
I scheduled a routine eye test after a reminder pinged into my inbox. I had a free morning and fancied an excuse for a new pair of prescription sunglasses.
The optometrist’s questions seemed more probing than I remembered from the last visit two years ago.
“Any blurred vision?” he asked. “If I hold this grid up and you focus on the dot at the centre with your right eye, left eye closed, are all those lines quite straight?”
On completion of the scans and tests, he said: “You have early age-related macular degeneration.” When he saw my face fall, he added: “AMD – it’s very common.”
I heard only “macular degeneration”.
My grandmother suffered. At the end of her life she was almost blind, having to feel her way around a room, tipping her head to the sound of a voice to recognise who was there.
AMD affects about 20 million people in the US and 196 million people worldwide. Optometrist Dr Andy Meau, a director at Central Eye Care in Hong Kong, says it is a leading cause of severe vision impairment – sometimes even blindness.
Studies suggest AMD affects around 1 in 10 people aged over 60. Meau says that up to 7.5 per cent of people aged 70 and older in Hong Kong have a form of AMD.
The macula is part of the retina at the back of the eye, about 5mm across, that is responsible for our central vision, most of our colour vision and the fine detail of what we see. A healthy macula is about 250 microns thick, or one-quarter of a millimetre.
Early signs of AMD, Meau says, are the appearance of “drusen” in the macular area. These small, discrete, yellowish deposits made from protein and fatty substances can be detected during an eye examination.
Most people with drusen have normal vision. But numerous small drusen, or larger ones, raise the risk of progression to AMD. This is considered the “dry” stage of the disease. Dry AMD – my diagnosis – develops slowly and gradually, and most people do not notice any change in vision for years.
In about 10 per cent of cases, it will progress to the “wet” type, in which abnormal blood vessels grow into the macular, restricting blood supply and causing rapid vision loss.
“People with wet AMD will report seeing wavy lines, distorted faces when looking at people, or a blank spot or smudge in the centre of their vision,” Meau says.
What triggers AMD?
The retina at the back of each eye is a layer of photosensitive cone and rod cells that receive and process visual information.
Rod cells, throughout the whole retina, detect movement and vision in the dark. Cone cells, which interpret colour and fine detail vision – such as when driving or reading – are tightly packed into the macula at the retina’s centre.
Macular diseases such as AMD occur when there is damage to these cells. Early changes to the macula do not produce any symptoms, Meau says, so patients may not “feel” the changes, which can only be detected through a dilated eye examination.
A common symptom of macular diseases, including AMD, is for straight lines to appear wavy. That explains the use of the grid – or Amsler chart – during my assessment.
“This may not be noticeable if the change happens in one eye only, as the unaffected eye will compensate,” Meau says. To test the affected eye, you need to close your good eye.
Because macular damage affects only central vision, peripheral vision remains intact.
How to manage AMD
Meau recommends an annual optical coherence tomography (OCT) test and eye exam in patients without symptoms who have a few drusen deposits but whose eyes are otherwise healthy. The OCT test measures and tracks drusen progression to help monitor the location, number and size of the deposits over time.
If drusen do progress, Meau recommends having the test more often, say every six months.
Lifestyle risk factors for AMD include smoking, a poor diet – one that is high in fat but low in omega 3 and 6, vitamins, carotenoids, and minerals – and a lack of exercise.
A 2024 report from the UK’s Royal College of Ophthalmologists says timely treatment is key. Its research found that, without intervention, most eyes affected by wet AMD faced a gradual decline in vision. But after the first year of regular injections, more than 90 per cent of eyes maintained stable vision, almost 20 per cent experienced a significant improvement, and more than 40 per cent had good vision.
Lifestyle changes and supplements may help
Lifestyle changes may help prevent or delay progression to AMD’s wet form and may slow progression of the dry type.
They include:
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Vitamin C (ascorbic acid) 50mg
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Vitamin E 400 international units (IU)
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Lutein 10mg
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Zeaxanthin 2mg
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Zinc (as zinc oxide) 80mg
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Copper (as cupric oxide) 2mg
Lutein and zeaxanthin are phytochemicals (micronutrients from plants) called carotenoids that protect the macula from damage caused by light.
Vitamins C, E and zinc are antioxidants. Copper is included because zinc can cause copper deficiency, since the two compete for absorption in the intestines.
Having initially felt dismayed by my diagnosis, I feel reassured that my condition does not have to lead to visual impairment.
Caught early, I know what to do, how to eat, which supplements to take – and I had a reason to get a new pair of bigger sunglasses.
Why acupuncture attracts growing numbers of people for its pain relief and other effects
Acupuncture is a popular TCM treatment. Two young practitioners describe the ways they use it and the benefits it provides
This series is based on our reporting on TCM: its history, treatments and growing acceptance around the world. This is the fifth instalment.
A slip of the foot before the start of the 2016 Standard Chartered marathon brought me to a traditional Chinese medical practitioner’s clinic days later.
About 7km (4.3 miles) into the 42km race, I realised that I had pulled a muscle in my buttocks. When the pain began to flare, so did my resolve to finish. When I got home, clenching my finisher’s medal, I could barely walk.
I had agreed to see Dr Ting Hiu Tung for relief from the deep aching pain – but could hardly believe that I was lying face down in the doctor’s clinic in North Point, on Hong Kong Island, with a handful of needles planted in my backside.
They were sending electrical impulses that helped reduce the inflammation, promote blood flow and alleviate the pain.
After that session, and a few more, I understood why acupuncture has a reputation for pain relief, and why people have been willingly subjecting themselves to its precisely placed jabs for thousands of years.
Acupuncture’s many uses
Acupuncture is the most widely recognised form of non-herbal TCM treatment.
According to TCM qi, our life energy, is believed to flow through meridians, or pathways, in the body. These meridians and energy flows can be accessed through more than 360 acupuncture points – or acupoints.
Inserting fine, sterile needles into them – or applying pressure on them – in the right combinations will bring the energy flow back into balance and relieve pain, symptoms and illness.
Two young practitioners with a passion for sharing their knowledge of TCM describe their reasons for studying the age-old medical system, and common ways to use acupuncture and other non-herbal treatments.
Growing up in Hong Kong, Elizabeth Yau saw the ways natural remedies helped her family manage and prevent illnesses, and developed an appreciation for TCM’s holistic approach to health.
She studied Chinese medicine at the University of Hong Kong, has a Master of Science in Sport & Exercise Nutrition, and certification in personal training. The qualifications allow her to combine the ancient wisdom of TCM with insights from Western medical principles, sports and nutrition.
It targets the cause of imbalance, making it effective for a range of conditions, she says. By addressing underlying issues it helps with digestive problems, fertility, anxiety, insomnia and hormonal health.
Having it with herbal remedies can enhance its function – but some patients do not like the often bitter taste or prefer not to take medicine of any kind.
Yau reassures those who are fearful of their skin being pierced by needles – especially on the face. A needle is thinner than a strand of hair, “so it’s not super painful”, she tells them.
For those new to acupuncture, she tries inserting just one needle after first massaging the acupoint. If they cannot take it, she may try a smaller needle, or use another method such as acupressure.
Facial acupuncture is done for three key reasons, including for beauty. The needles can boost blood circulation, help reduce wrinkles, clear up acne, help scars fade and improve skin texture, Yau says.
There are many acupoints on the face which may be targeted to treat conditions such as a headache or sinus blockage, she adds.
It may also be done to alleviate facial paralysis, such as in the case of Bell’s palsy.
Others include lower back pain, infertility, insomnia, hay fever and premenstrual syndrome.
Sharing TCM’s benefits
Chee Hee Seng, aged 22, graduated in October 2024 with honours and distinction from Xiamen University Malaysia’s school of traditional Chinese medicine. He had wanted to learn ways to take care of himself and his family after losing two of his grandparents to illness.
Now working as a practitioner in his home country, he is spreading word of the value of TCM – and being a good student – through social media. His original Instagram account, focused on study, mindsets and personal growth, has more than 774,000 followers; a second, focused on TCM, has more than 366,000.
Seng was exposed to Chinese medicine from a young age, and admits that he had always thought it was “a very mysterious and non-scientific treatment that doesn’t work”.
His mind changed while attending a Buddhist school, Developing Virtue Secondary School, in the US state of California for six years.
When he hurt his ankle playing basketball, he would see a Chinese acupuncturist, whose treatment quickened his recovery, he says. Before, his sprains usually took two weeks to heal, but after having acupuncture it took only three days to fully recover.
Seng’s social media posts are having an impact if the comments are anything to go by: friends, colleagues and strangers are willing to try his “hacks” – many of them using acupressure, based on the same acupoints you would use in acupuncture – which they can safely do for themselves or a loved one.
They are simple to understand and, like many of his posts, have links to journal articles that describe the research that show the treatment works.
Both Yau and Seng describe many other ways that acupuncture and other non-herbal treatments can improve your health, even if you are not “sick”. Getting better sleep and relieving stress are two of them.
People who are afraid of needles may find other TCM treatments beneficial. They include:
