Private Age-Related Macular Degeneration (AMD) Screening Service

WHAT IS AGE RELATED MACULAR DEGENERATION (AMD)?

Your Macula is the central part of the Retina and is located at the back of your eye. Though it is only about 6mm across, it has a very high concentration of Photoreceptor cells that detect light and capture images. It is responsible for fine and detailed vision tasks such as recognising faces, identifying colours and reading. The remaining of the Retina is responsible for your Peripheral (side) Vision.

Age-related macular degeneration (AMD) is common after the age of 50, though it can happen earlier. The risk of developing AMD increases with age. The prevalence goes up from 1/ 200 at 60 to 1/5 at 90.

We expect AMD to become increasingly common as people tend to live longer.

There are two forms of AMD: Dry and Wet.

In Dry AMD, there is a gradual and usually slow deterioration of the macula as the photoreceptor cells die off and are not renewed.

In Wet AMD, abnormal blood vessels grow under the macula and leaking blood or fluid which leads to scarring and rapid loss of central vision.

We can classify AMD as Early, Intermediate and Late: Dry, Wet or Disciform Scar.

As we age, it is normal to see changes in our organs, including our eyes. For example, the appearance of Drusen. Drusen are yellowish clumps of protein, lipids and pigment, amongst others, that sit under the Retina, either in the Macula or the Peripheral Retina.

There are different types of Drusen and they can vary over time in the same person and from person to person in number, size and pigmentation. Few and small Drusen are frequently seen in those 50 and older and can represent an epiphenomenon of aging and not AMD.

People with Early AMD not always develop sight loss, as the speed and extent of changes can vary from person to person.

In Intermediate AMD, Drusen increase in number and size. Therefore, these changes are more specific for AMD. Geographic Atrophy (see Late AMD) not affecting the centre of the Macula may also be present.

Late AMD includes one or more of the following in one eye:

  • Geographic atrophy (GA) is a well-defined area of loss of photoreceptor cells that expands over time and leads to loss of Central Vision.
  • Wet AMD with abnormal blood vessels called Choroidal Neovascularisation (CNV).
  • Disciform Scar (end-stage scarring of the Macula as a consequence of Wet AMD).

Find out more

WHY IS IT IMPORTANT TO BE PERIODICALLY SCREENED FOR AMD?

People with Early AMD may not experience any symptoms. It is therefore ideal for people over the age of 50 to be routinely screened for AMD.

Some examples of changes in vision that need looking into are difficulty in recovering vision when moving between dark and well illuminated environments, gaps, blurred areas or dark spots in your central vision, distortion of straight lines or images, any change in the perception of colours.

As with all medical conditions, early detection and prompt treatment are key to a better response to therapy.

Though there are currently no approved treatments for GA in Dry AMD, several studies are now available, and it may therefore be advantageous for GA to be diagnosed at the earliest stage called Nascent GA, so that you become aware of the status of your Maculas and can be offered participation in our ongoing and currently recruiting Clinical Studies or treatments as soon as they become available.

There are already various approved and very successful available treatment options for Wet AMD.

WHAT DOES OUR PRIVATE AMD SCREENING INCLUDE AND HOW DOES IT DIFFER WITH AN NHS EYE TEST?

Our Private AMD Screening Service uses the most advanced Non-invasive Functional and Multimodal Imaging Technologies to diagnose the earliest changes associated with AMD up to a cellular level using Adaptive Optics.

This is the First Private AMD Screening Service available in the UK.

We Assess, Diagnose, Stage, Monitor and offer Therapy or participation from ongoing and currently recruiting Clinical Studies.

A complete assessment of the Retina requires more than Slit-Lamp examination or Photography of only the Posterior Pole or Central Retina.

We therefore deliver this dedicated Private AMD Screening Service through Prof. Stanga & his Retina-Specialist Optometrist.

We recommend this service as from the age of 50 as we believe early diagnosis has become essential in view of new and upcoming therapies and specially when there is a positive family history for AMD.

We also have the capacity to deliver this service much sooner than the NHS and with no cancellations, at a time that is convenient for yourself. We do our utmost to ensure you are seen in a timely manner and without the need for a referral.

The Retina Clinic London performs in-house all necessary diagnostic testing and treatments, both medical and surgical.

The Retina Clinic London NHS
Most advanced Non-invasive Functional and Multimodal Imaging Technologies used to diagnose the earliest changes associated with AMD up to a cellular level using Adaptive Optics and even before the patient suffers from symptoms (vision is affected).Multiple Different Ultra Widefield and Widefield Imaging Technologies are used to image the Retina in detail and in its entirety.

See below Full List and Description.

Results are emailed within 1 week to you and/or your GP/Optician at your request.

The Macula is assessed as part or NHS Eye Tests. However, using usually only Fundus Photography and Macular OCT scans.If further investigations are required, patients are referred to an NHS Eye Unit.
No GP Referral required.
No delay in screening.
Not all Hospital Eye departments have Clinical Studies available to take part.

Appointment with Retina-Specialist Optometrist: £280

  1. Medical History Please bring your most up to date List of Medications.
  2. Best Corrected Visual Acuity. Please bring your spectacles, if prescribed.
  3. Non-Contact Tonometry Measurement of the Intra-Ocular Pressure.
  4. AdaptDx® Dark Adaptation This could be the earliest indicator of AMD. Measures recovery time from a bright flash stimulus. A healthy normal Retina would show a rapid recovery, however those with Macular Degeneration will show a Slow one. During the test, a bright flash stimulus is followed by a dim stimulus. The intensity of the stimulus is gradually extinguished to measure your Sensitivity Threshold. It has been found that a slow Dark Adaptation can indicate sub-clinical AMD at least three years before structural changes are identified on the Retina. In order to ensure there are no external factors that can skew the lighting levels, we will place your chin on the device’s chin rest, forehead against the forehead bar and cover your head with a hood.
  5. Dilation of Pupils To allow the most complete possible imaging and scanning of the Retina. Your vision may remain blurry for up to 4-6 hours and affect your capacity to drive. You may want to bring sunglasses for after the Examination.
  6. Optos® Multiwavelength Ultra-Widefield Imaging Non-invasive device that can image up to 200° (approximately 80%) of the Retina in a single image. The scanner uses different light wavelengths (colours of light) that allow a “layer by layer” visualisation of the back of the eye. It is important to image the peripheral Retina for the detection of Peripheral Drusen.
  7. Topcon® Macular Optical Coherence Tomography Angiography. DRI Triton OCT uses Swept-Source technology to allow increased visualization into the deepest layers of the Retina even through cataracts. This device provides Cross Sectional views of the Macula to identify the presence of Intra or sub-Retinal Fluid, abnormal blood vessels as well as Topographic Maps of it to identify areas of Retinal Thickening/Oedema (Swelling).
  8. Heidelberg® Macular Optical Coherence Tomography Heidelberg Spectralis® OCT uses Cross Sectional views of the Macula to identify changes to the Central Retina such as the presence of Drusen, Fluid and/or bleeding within the deeper layers of the Retina. With its excellent reference tool it is able to compare imaging results and identify changes over time.
  9. Imagine Eyes® rtx1 Adaptive Optics can map the structural changes of Macular Degeneration to a microscopic level. This new technology is able to differentiate sub-clinical AMD for the detection of different types of Drusen, clumping of pigments and Cell atrophy.
  10. Macula Integrity Assessment (MAIA®) Microperimetry This Functional Assessment provides a measure of Retinal Sensitivity and Fixation Analysis. The projection of a bright stimulus on different locations of the Central field of vision can map the function of the Macula. It is not uncommon for those with Macular degeneration to have areas of unstable results within the central region. It is able to monitor stability or progression with follow up visits.
  11. All the scans, images and results will be evaluated by our Retina-Specialist Optometrist who will devise a report to the patient and/or GP as per the patient’s preference.

**This appointment will approximately last up to 2.5 hours**

Full Vitreoretinal Consultation with Prof. Stanga £650

Treatment at TRCL is Patient-Specific. If you require treatment for your AMD, Prof. Stanga will tailor your treatment according to your specific needs.

**Additional fees: If Optos® Ultra Widefield Digital Fundus Flourescein Angiography is required to rule out Choroidal Neovascularisation (CNV) £550**

SUGGESTED READING:

https://www.macularsociety.org/macular-disease/macular-conditions/age-related-macular-degeneration

https://www.rcophth.ac.uk/patients/patient-information-booklets

https://www.aao.org/eye-health/diseases/amd-macular-degeneration

Stanga PE, Pastor-Idoate S, Duvoby S, Vatas P, Reinstein U, Reinstein D, Zahavi O. Navigated Single-Capture 3D and Cross-Sectional Wide-Field OCT of the Mid and Peripheral Retina and Vitreoretinal Interface. European Journal of Ophthalmology. Eur J Ophthalmol. 2021. In Press.

Stanga PE, Tsamis E, Siso-Fuertes I, Dorn JD, Merlini F, Fisher A, Crawford FIJ, Kasbia SS, Papayannis A, Baseler HA, Morland AB, Hanson RL, Humayun M, Greenberg RJ. Electronic Retinal Prosthesis for Severe Loss of Vision in Geographic Atrophy in Age-Related Macular Degeneration: First-in-Human Use. European Journal of Ophthalmology. Accepted 18-01-21. In Press.

Cehajic-Kapetanovic J, Xue K, Martinez-Fernandez de la Camara C, Nanda A, Davies A, Wood LJ, SalvettiAP, Fischer MD, Aytward JW, Barnard AR, Jolly JK, Luo E, Girach A, Black GCM, Gregori NZ, Davis JL, Rosa pR, Lotery A_1, lam BL, Stinga pE, Maclaren RE. Gene therapy in X-linked retinitis pigmentosa caused by mutations in RpGR: Results at 6 months in a first in human ctinicat trial. Nat Med. ZO20 Mai;26(3):354_3S9

Choudhry N, Duker JS, Freund KB, Kiss S, Querques G, Rosen R, Sarraf D, Souied EH, Stanga PE, Staurenghi G, Sadda SR. Classification and Guidelines for Widefield Imaging: Recommendations from the International Widefield Imaging Study Group. Ophthalmol Retina. 2019 Oct;3(10):843-849

Stanga PE, Tsamis E, Papayannis A, Stringa F, Cole T, Jalil A. Swept-Source Optical Coherence Tomography Angio™ (Topcon Corp, Japan): Technology Review. Dev Ophthalmol. 2016;56:13-7

Stanga PE, Sala-Puigdollers A, Caputo S, Jaberansari H, Cien M, Gray J, D’Souza Y, Charles SJ, Biswas S, Henson DB, McLeod D. In vivo imaging of cortical vitreous using 1050-nm swept-source deep range imaging optical coherence tomography. Am J Ophthalmol. 2014 Feb;157(2):397-404

Lanzetta P, Holz F, Monés J, Querques G, Stanga P, Veritti D, Barbone F, Brusaferro S, Isola M. Intravitreal injections: a healthcare failure modes and effects analysis. Ophthalmologica. 2013;230(3):151-64

Harding SP, Tomlin K, Reeves BC, Langham J, Walker J, Carpenter J, Grieve R, Patton WP, Muldrew KA, Peto T, Chakravarthy U; Verteporfin Photodynamic Therapy Cohort Study Group. Verteporfin photodynamic therapy cohort study: report 1: effectiveness and factors influencing outcomes. Ophthalmology. 2009 Dec;116(12):e1-8

Jalil A, Mercieca K, Chaudhry NL, Stanga PE. Choroidal nonperfusion with significant subretinal exudation after PDT of predominantly classic CNV: an OCT and FFA study. Eur J Ophthalmol. 2009 May-Jun;19(3):490-3

Mathews JP, Jalil A, Lavin MJ, Stanga PE. Retinal pigment epithelial tear following intravitreal injection of bevacizumab (Avastin): optical coherence tomography and fluorescein angiographic findings. Eye (Lond). 2007 Jul;21(7):1004-5

Sahni J, Stanga P, Wong D, Lenfestey P, Kent D, Harding S. Optical coherence tomography analysis of bilateral end-stage choroidal neovascularization where one eye is treated with photodynamic therapy. Clin Exp Ophthalmol. 2007 Jan-Feb;35(1):13-7

Sahni J, Stanga P, Wong D, Harding S. Optical coherence tomography in photodynamic therapy for subfoveal choroidal neovascularisation secondary to age related macular degeneration: a cross sectional study. Br J Ophthalmol. 2005 Mar;89(3):316-20

Berra A, Ferreira S, Stanga P, Llesuy S. Age-related antioxidant capacity of the vitreous and its possible relationship with simultaneous changes in photoreceptors, retinal pigment epithelium and Bruchs’ membrane in human donors’ eyes. Arch Gerontol Geriatr. 2002 May-Jun;34(3):371-7

Wong D, Stanga P, Briggs M, Lenfestey P, Lancaster E, Li KK, Lim KS, Groenewald C. Case selection in macular relocation surgery for age related macular degeneration. Br J Ophthalmol. 2004 Feb;88(2):186-90

Stanga P, Hiscott P, Li K, Wong D. Macular relocation after photodynamic therapy for recurrent choroidal neovascular membrane: visual results and histopathological findings. Br J Ophthalmol. 2003 Aug;87(8):975-6

Stappler T, Stanga P, Groenewald C, El Bably I, Wong D. Measurement of cyclotorsion in a patient following macular translocation surgery using a modified version of the Watzke-Allen test. Retina. 2003 Apr;23(2):250-2

Stanga PE, Lim JI, Hamilton P. Indocyanine green angiography in chorioretinal diseases: indications and interpretation: an evidence-based update. Ophthalmology. 2003 Jan;110(1):15-21; quiz 22-3

Stanga PE, Kychenthal A, Fitzke FW, Halfyard AS, Chan R, Bird AC, Aylward GW. Retinal pigment epithelium translocation after choroidal neovascular membrane removal in age-related macular degeneration. Ophthalmology. 2002 Aug;109(8):1492-8

Stanga PE, Kychenthal A, Fitzke FW, Halfyard AS, Chan R, Asaria RH, Bird AC, Aylward GW. Functional assessment of the native retinal pigment epithelium after the surgical excision of subfoveal choroidal neovascular membranes type II: preliminary results. Int Ophthalmol. 2001;23(4-6):309-16

Stanga PE, Kychenthal A, Fitzke FW, Halfyard AS, Chan R, Bird AC, Aylward GW. Retinal pigment epithelium translocation and central visual function in age related macular degeneration: preliminary results. Int Ophthalmol. 2001;23(4-6):297-307

Stanga PE, Bird AC. Optical coherence tomography (OCT): principles of operation, technology, indications in vitreoretinal imaging and interpretation of results. Int Ophthalmol. 2001;23(4-6):191-7

Ahuja RM, Downes SM, Stanga PE, Koh AH, Vingerling JR, Bird AC. Polypoidal choroidal vasculopathy and central serous chorioretinopathy. Ophthalmology. 2001 Jun;108(6):1009-10

Ahuja RM, Stanga PE, Vingerling JR, Reck AC, Bird AC. Polypoidal choroidal vasculopathy in exudative and haemorrhagic pigment epithelial detachments. Br J Ophthalmol. 2000 May;84(5):479-84

Lincoff H, Kreissig I, Gelisken F, Stanga P. A retained catheter for retrobulbar administration of interferon for age-related macular degeneration. Dev Ophthalmol. 1997;29:69-77

Lincoff H, Stanga P, Movshovich A, Palleroni A, Madjarov B, Rivera R, Silverman R. Choroidal concentration of interferon after retrobulbar injection. Invest Ophthalmol Vis Sci. 1996 Dec;37(13):2768-71