Age-related Macular Degeneration (AMD)
Age-related macular degeneration (AMD) is a disease that affects the macula — the small, central part of the retina responsible for fine, detailed vision — and is a common cause of vision loss in people over 60. Because AMD typically affects only central vision, it rarely causes complete blindness, but it can make it difficult to read, drive, or recognise faces, since side (peripheral) vision usually stays normal. Dr Zoran Aleksic diagnoses, monitors, and treats AMD at his rooms in Sea Point, Cape Town, and Vredenburg on the West Coast.
What Is the Macula?
The macula sits at the centre of the retina, the light-sensitive layer of tissue lining the back of the eye. As you read, light focuses onto the macula, where cells convert it into nerve signals sent to the brain — this is your central vision, which allows sharp, detailed sight for tasks like reading, driving, and recognising faces.
Dry AMD and Wet AMD
AMD occurs in two forms:
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Dry AMD affects around 90% of people with the disease. Its exact cause isn't known, but it involves a gradual build-up of waste deposits under the macula, and the light-sensitive cells there slowly breaking down over time. Dry AMD often starts in one eye, with the other potentially affected later — there's no way to predict if or when this will happen. Most people with dry AMD retain normal or near-normal vision, and it doesn't usually get worse quickly.
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Wet AMD affects around 10% of people with AMD but accounts for the large majority of severe vision loss from the disease. It develops when abnormal, fragile blood vessels grow underneath the retina and leak blood or fluid, which can prevent the macula from working properly and cause more rapid central vision loss.
There's also a rarer form of advanced AMD called geographic atrophy, where the macula tissue gradually wears out without any leaking blood vessels — because there's no leakage involved, this form doesn't respond to anti-VEGF treatment.
Risk Factors
You're more likely to develop AMD if you're over 50, have a family history of the condition, smoke, are overweight, eat a diet high in saturated fat, or have hypertension, heart disease, or high cholesterol. Certain ethnic groups also carry a higher epidemiological risk. Many of these factors — smoking, diet, blood pressure, and cholesterol — are within your control, and managing them may help reduce your risk or slow progression.
How AMD Is Diagnosed
During an eye examination, an Amsler grid is often used to check for blurry, wavy, or missing areas in your central vision. Dilating eye drops widen the pupil so the retina and macula can be examined directly through a special lens, and an ultra-wide field camera can also capture detailed images without dilation. Further tests may include optical coherence tomography (OCT), which scans the retina in detail to check for fluid or structural changes, and fluorescein angiography, where a dye is injected into a vein in your arm and photographed as it passes through the blood vessels in your retina, to check for abnormal or leaking vessels.
Monitoring Your Vision at Home: The Amsler Grid
If you've been diagnosed with AMD, you may be given an Amsler grid to check your own vision between visits. Cover one eye, focus on the centre dot, and check whether any of the surrounding lines appear wavy, blurred, or missing, then repeat with the other eye. Let us know promptly if you notice any new distortion, since this can be an early sign that wet AMD is developing or progressing.
Treatment
Dry AMD currently has no direct treatment, but for people with intermediate dry AMD or significant vision loss, a specific combination of nutritional supplements — vitamin C, vitamin E, lutein, zeaxanthin, zinc, and copper, in doses established by large clinical trials — has been shown to help slow progression in some patients. Your surgeon can advise whether this is relevant for you.
Wet AMD is treated with anti-VEGF injections, given directly into the eye to reduce abnormal blood vessel growth and leakage.
Understanding anti-VEGF treatment
Vascular endothelial growth factor (VEGF) is a protein the body uses to help form new blood vessels. In conditions like wet AMD, too much VEGF causes fragile, abnormal vessels to grow and leak under the retina. Anti-VEGF medications block this process, helping to stop the leaking and further growth, which can prevent further central vision loss in many patients — though the medication generally can't restore vision that's already been lost, and not everyone responds to treatment.
Several anti-VEGF medications are used in eye care: ranibizumab (Lucentis), aflibercept (Eylea), and bevacizumab (Avastin). Lucentis and Eylea are the medications registered in South Africa specifically for treating AMD. Avastin is registered for treating certain cancers, and its use in the eye for AMD is considered "off-label" — a common and well-established practice in medicine generally, where a registered medication is used for another purpose based on sound clinical evidence, even though it isn't specifically labelled for that use. Avastin is substantially cheaper than Lucentis, and there's good evidence that it's not inferior to Lucentis for improving or stabilising vision in wet AMD, though it carries a slightly different risk and monitoring profile — your surgeon can talk you through the differences and which option best suits your situation.
How the injection is given
The injection is performed by an ophthalmologist. Your eye is numbed with local anaesthetic drops, cleaned, and covered with a sterile drape, and a small clip keeps the eye open comfortably. The injection itself takes less than 20 seconds, with the whole visit typically taking five to seven minutes — most patients describe it as similar to having blood drawn from the arm. Your vision is briefly checked afterwards before you leave.
Most patients need a loading course of three injections spaced four to six weeks apart. After that, most people need ongoing injections at a similar interval, depending on how active the leaking blood vessels remain — regular review appointments are an important part of maintaining the benefit of treatment over time.
Who shouldn't have anti-VEGF treatment
Anti-VEGF injections aren't given to patients with an allergy to the medication, an active eye or serious systemic infection, or those who are pregnant, breastfeeding, or trying to conceive. Extra caution is needed if you've had a heart attack or stroke in the past six months, or have uncontrolled angina or high blood pressure — let your surgeon know if any of these apply to you.
Risks and Side Effects
Most complications relate to the injection itself rather than the medication, and serious vision loss from treatment is uncommon. Rare risks include serious eye infection (endophthalmitis), retinal detachment, raised or lowered eye pressure, bleeding inside the eye, inflammation, and cataract formation. More common, milder effects include a red eye at the injection site (usually clearing within one to two weeks), a sore or gritty feeling for a day or two, and temporary floaters or flashes of light in the days after injection.
After Your Injection
Mild discomfort, watering, or blurred vision after injection is common and usually settles within hours to days — lubricating drops can help. Avoid rubbing or pressing on the eye, bending, straining, or heavy lifting for 2 days, swimming or exposing the eye to untreated water for 3–5 days, and eye makeup for 24–48 hours. Avoid aspirin-based pain medication unless it's already prescribed for you.
Contact us promptly if you experience increasing eye pain, redness, or light sensitivity, a worsening or sudden decrease in vision, persistent discharge, new flashes of light, a sudden increase in floaters, a curtain or shadow across your vision, or severe headache, nausea, or vomiting.
Please also let your surgeon know before your injection if you have any infection in or around your eyes, and inform any other doctor or dentist that you're receiving anti-VEGF treatment before any planned surgery, since some blood-thinning or other medications may need to be managed around your injections.
Other Uses and When Surgery Is Needed
Anti-VEGF injections are also used to treat other retinal conditions that cause similar leaking, including diabetic retinopathy and myopic choroidal neovascularisation (leaking blood vessels associated with high short-sightedness). Dr Aleksic is an anterior segment and refractive surgeon who diagnoses, monitors, and treats AMD and related conditions with injections and monitoring; he does not perform vitreoretinal surgery himself. In advanced cases involving complications such as retinal detachment that can't be managed with injections alone, he works closely with, and refers to, specialist vitreoretinal surgeons.
Medical Aid and Cost
AMD is recognised as a Prescribed Minimum Benefit (PMB) condition (ICD-10 H35.3) under South African medical aid regulations, so most schemes provide some level of cover, though the extent varies by scheme and by treatment. We recommend confirming your specific benefits with your scheme, and our rooms can provide the relevant clinical information for your enquiry.
Frequently Asked Questions
What's the difference between dry and wet AMD?
Dry AMD, the more common form, involves a gradual build-up of deposits and breakdown of macula cells, usually progressing slowly. Wet AMD involves abnormal blood vessels leaking under the retina, and though less common, is responsible for most severe vision loss from AMD — it's treated with anti-VEGF injections.
Will anti-VEGF injections cure my AMD?
No. The goal is to prevent further vision loss by stopping abnormal blood vessels from leaking and growing. Some patients regain a degree of vision, but the treatment generally can't restore vision that's already been lost, and ongoing injections are usually needed to maintain the benefit.
How soon will I notice a difference after treatment starts?
You shouldn't expect immediate improvement. The initial loading course of three injections, given over about three months, is often needed before any change in the disease becomes apparent, and regular monitoring continues after that.
Is AMD treatment covered by medical aid?
AMD is a Prescribed Minimum Benefit (PMB) condition, so most medical aid schemes provide some cover, though this varies by scheme and treatment. We recommend confirming your specific benefits with your scheme before treatment.
Does Dr Aleksic perform retinal surgery for AMD complications?
No. Dr Aleksic is an anterior segment and refractive surgeon who treats AMD with anti-VEGF injections and ongoing monitoring. When vitreoretinal surgery is needed for a related complication, he works closely with, and refers to, specialist vitreoretinal surgeons.
If you've noticed changes in your central vision, are over 50, or have a family history of AMD, book a consultation with Dr Zoran Aleksic at The Eye Surgery in Sea Point or Vredenburg. You can also read our blog post on AMD or patient reviews online.