Contents

Terms of Use and Disclaimer 3

How to Contact Mr. J aheed Khan 4
Forward 6
What Patients & Staff Say about Mr. Khan 8
What Exactly IS Age-Related Macular Degeneration? 10
What Are the Symptoms of ARMD? 12
What Causes ARMD? 16
The Two Types of ARMD 18
How is Dry ARMD Treated? 21
How is Wet ARMD Treated? 22
What Can I Expect During a Consultation for ARMD? 24
Frequently Asked Questions about ARMD 26
Afterword 29
How to Contact Mr. J aheed Khan 30




Terms of Use and Disclaimer
his eBook is Copyright 2014. All rights are reserved. No
part of this book may be reproduced, stored in a retrieval
system or transmitted by any means: electronic,
mechanical or photocopied, recorded or otherwise without written
permission from the copyright holders.

You may distribute this eBook as long as it remains in its original
form and unchanged in content.

The authors are both qualified surgeons and Mr. J aheed Khan
has particular expertise in eye and cataract surgery.

Nevertheless this eBook is not intended to replace the need for a
one-on-one consultation with and examination by a qualified and
experienced eye surgeon. All advice given is intended for general
guidance only.

If you have any disturbance in your vision or eyesight you are
advised to seek medically qualified advice without delay.

Emergency medical care can be obtained through your GP or
local Accident and Emergency Department.

Mr. J aheed Khan is also very happy to see patients both NHS
and Privately.

His contact details for patients who wish to consult him privately
are overleaf.

NHS patients will need to see their GP to be referred to him at
Moorfields Hospital but private patients can telephone his secretary
directly.

T


How to Contact Mr. J aheed Khan
rivately I practice at both Moorfields and at Harley Street
either telephone or send my secretary an email. A GP referral
is not necessary for Private Patients.

Moorfields Eye Hospital



Private Consulting Rooms
J ohn Saunders Suite
9-11 Bath Street
London EC1V 9LF

Tel: (020) 7566 2803

enquiries@moorfields-private.co.uk











View Larger Map

P




Clinica London
140 Harley Street
London W1G 7LB

Tel: (020) 7935 7990
secretary@clinicalondon.co.uk


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Forward

Mr. J aheed Kahn,
Consultant Eye Surgeon.

y name is J aheed Khan, and I am an eye surgeon at the
world-famous Moorfields Eye Hospital in London.

I have almost twenty years experience as a doctor and fifteen
years experience as an eye surgeon. In that time if theres one
thing Ive learned its how vulnerable we all feel when we are
unwell.

And we feel no more vulnerable when the problem we have is
with our eyes.

Hospitals can be frightening places, and talking to doctors is not
always easy.

Which is why Ive written this eBook. It is the culmination of all
those years of experience in looking after patients and their eye
problems.

In it I cover all the basics: what age-related macular
degeneration is, how it causes problems with your vision, and how
it can be treated. Theres no jargon, only straightforward, simple,
M


clear explanation and advice. I also answer the questions I get
most commonly asked in my clinics and wards in the hospital
where I work every day, so if you have or are worried about ARMD
theres a very good chance youll find the answer to your question
here.

If you have any feedback or want to ask any questions about
anything in this eBook, simply drop me an email via my secretary
at:

secretary@clinicalondon.co.uk

I would be delighted to hear from you and will personally answer
any questions you may have.

Best Wishes,


J aheed Khan
Consultant Ophthalmologist.

Moorfields Eye Hospital,
London.
J une 2014.



What Patients & Staff Say About Mr. J aheed Khan
Mr. Khan is not only an outstanding surgeon but more importantly a
great communicator and caring Doctor. As a GP and commissioner I
have total faith when referring my patients to Mr. Khan, that they will
receive the best care available from a surgeon who constantly strives for
excellence and treats them as individuals. I would not hesitate to
recommend him to both my private and NHS patients. He is a real asset
to both Moorfields and Hinchingbrook Hospitals.
Mr. Khan is a brilliant doctor and was a pleasure to work with.
J aheed Khan is a very competent Ophthalmologist with great patient
care skills and the unique ability to explain complex condition in a
manner comprehendible to the patient.
J ust keep up the good work Dr. Khan. My wife, who accompanied
me, and I were both very impressed by the care and consideration
shown by the whole team when I had surgery. I just hope they haven't
lost the knack by the time I get my other eye fixed. J oking apart the care
of this team has made it a wonderful experience for me.
A knowledgeable and trustworthy colleague with extensive
experience in the diagnosis and treatment of retinal diseases. Up to date
with the latest research and best practice, he is able to integrate this
knowledge into the care of patients with ophthalmic conditions. I would
have no hesitation in recommending him to friends and family.
Mr. J aheed Khan is a thorough, compassionate and conscientious
doctor. He listens to his patients and treats them with respect and care.
He provides excellent medical care, both in clinic and in the operating
theatre. I would highly recommend him.
Mr. Khan is an excellent colleague to work with. He is always
approachable and willing to help. His has an outstanding level of
knowledge concerning eye disease and he is more than happy to offer
his opinion whenever needed. He is trustworthy and respects both
patients and colleagues. I have no hesitation to state that he is one of
the best colleagues I worked with.
I always enjoy working with Mr. Khan, he is friendly, confident and
approachable. He always maintains a high standard of professionalism


in sometimes testing situations. Mr Khan is always willing to answer
questions related to Ophthalmology that I may have and explains things
in a manner in which myself and other colleagues understand. He is a
team player within our department, many of his patients comment on his
fantastic abilities.



What Exactly IS Age-Related Macular Degeneration?
guess a sensible starting point is to assume that if you are
reading this eBook you either have been told you have
macular degeneration already; you know someone close to
you who has macular degeneration and want to know more; or
perhaps you know a little about the condition and worry that you
may have it yourself.

But before we can talk about what Age-Related Macular
Degeneration or ARMD is we need to look a little at how the eye
works.

As you probably have heard before the eye is similar in many
ways to a camera.

Light comes in the front, passes through a lens where it is
focused to a sharp image on the light sensitive layer at the back,
called the retina. It is similar in this respect to a camera: in an older
camera the retina is represented by a piece of film. In a modern
digital camera it is represented by an electronic sensor.

The retina of course, is extremely important, as this layer does
the actual seeing of the image that is focused onto it through the
lens.



A cross - section through the human eye

I


The retina is not the same all over; it has a specialized area
called the macula that is able to pick out fine detail in what we see.
The image of anything you look directly at is focused onto this
small area, which is about the size of a pinhead because this is
the area which is specialized to pick out detail. This means that any
problem affecting the macula will interfere with your central vision
rather than the edges of your vision. It also means that a problem
here will make it difficult to see detail.



What are the Symptoms of ARMD?
e have already seen how macular degeneration affects
the central area of your vision, but what does the patient
actually see? How does a problem at the macula
actually affect your eyesight?


Above is an image showing what a patient with early ARMD
might see. The central area of this patients vision is distorted and
darker than the area around it. This is because of damage to the
macula. You can see how difficult it can be to read or to recognize
ordinary objects when you have this condition.


You can see the clock but cant see the hands!
W


Difficulty telling the time

The picture above shows what a patient with macular
degeneration might see if they look directly at a clock. Because
they have problems with their central vision they can see the clock
and they know what they are looking at but they cant tell the time
because they cant clearly see the hands.

In fact, a famous artist called Lee Allen had macular
degeneration and wrote a book about his experiences called A
Hole in my Vision. This is an excellent description of what patients
with ARMD actually see.

So patients with macular degeneration often complain of:

Tunnel vision
Difficulty seeing straight in front of them they often
have to turn their head to one side to see something straight
in front of them
Distorted vision. For example they may complain that
the edge of a tall building, which they know to be straight
looks distorted, wobbly, or blurred.
In advanced macular degeneration they may get a
blurred or even blank spot in the centre of their vision.
Words and letters of text can look indistinct or blurry
Colours look less bright
It takes longer for your eyesight to adapt when moving
from bright sunlight to a dimly-lit room

The Amsler Grid

This is a test for problems with the macula which might indicate
macular degeneration:




The Amsler grid in someone with normal vision


The appearance of the Amsler grid in macular degeneration

As you can see from the pictures above, the straight lines of the
grid appear distorted to patients with problems of the macula such
as ARMD.
To use the Amsler grid test put on your normal reading glasses
and cover up one eye. Keep the picture of the grid 12-15 inches
away from your face and focus on the black dot. As you do this ask
yourself if the other lines of the grid look straight or wavy.

You then cover up the other eye and repeat the test. If the lines
of the grid look wavy you could have macular degeneration.

But remember, you could have ARMD and still see the grid fairly
clearly
that is why if you are at all concerned about your vision you
need to see an expert even if there is nothing wrong the
reassurance you will get will be very well worthwhile.



A word of caution

It is important to remember that not all people with macular
degeneration have all or even any of these symptoms. And not all
people with these symptoms have macular degeneration, as other
conditions of the eye can cause similar symptoms. Some of these
other conditions can be serious, which is why it is so important to
see a specialist if you have noticed any problems with your eyes,

One other important thing to note is that there are two types of
macular degeneration. The first, dry macular degeneration
develops slowly so people may not really notice the symptoms until
later on.

The second is called wet macular degeneration and can
develop very rapidly. People with wet macular degeneration often
notice a rapid change in their vision, over weeks or even days. As
you might imagine it is a much more serious condition and requires
urgent assessment and treatment by a specialist in eye problems.
Luckily we now have some good treatments for it if it is picked up
early enough.




What Causes Macular Degeneration?

acular degeneration is commonly called Age-Related
Macular Degeneration or ARMD because it tends to
affect older people. In fact it is the commonest cause of
blindness and loss of central vision in the over-65s.

Cause of Macular Degeneration?

Nobody really knows what causes ARMD. However, there are
certain risk factors aspects that can increase the likelihood of
developing the condition. These include:

Age
As you might expect, ARMD is commoner in older people,
particularly in the over-65s. However, it can still develop in
people in their 40s and 50s so once again, no matter how
old (or young!) you are a change in your vision needs to be
taken seriously.
Gender
More women than men tend to get ARMD, but that may
simply be because women live longer than men do.
Family History
ARMD can run in families, which indicates that some people
are born with certain genes that make the condition more
likely. Nothing can (as yet) be done about that but it does
mean that if you have other family members with the
condition you should be perhaps more vigilant about your
vision yourself.
Smoking
Smoking seriously increases your risk of developing ARMD,
as it does with many other conditions. Stopping smoking
whatever your age is a very good idea and may reduce your
risk of developing ARMD
Ultraviolet Light
Sunlight is composed of visible light which we can see but
also invisible light which we cant infra-red and ultra-violet
light. Ultraviolet light causes tanning of the skin and appears
to be a risk factor for developing ARMD too.
M


Diet
There does appear to be a link to diet and ARMD but the
case is not clear-cut. There is some evidence that a diet rich
in the vitamins A,C and E as well as zinc may be beneficial.
Race
ARMD is commoner in Caucasians (white people) compared
to other races

It is important to remember though that these are merely risk
factors very large numbers of people without any identifiable risk
factor go on to develop the condition every year.





The Two Types of Macular Degeneration

acular degeneration occurs in two different forms, Dry
and Wet. They are called Dry and Wet because of
what is actually happening in the eye, and what the eye
specialist sees when he examines you, not because of how the eye
feels or because it is watery or dry.

Dry (non-exudative) Macular Degeneration

This is the commonest type of ARMD. It usually develops very
slowly, which means that the symptoms you get the changes in
your vision are also very slow to develop. For this reason people
often learn how to cope with the symptoms and may not seek
advice until it is quite advanced. Dry ARMD can develop into wet
ARMD at any stage. It is also perfectly possible to have dry ARMD
in one eye and wet ARMD in the other (Dame J udi Dench has
exactly this problem)



Dry Macular Degeneration the white spots are called Drusen

Wet (Exudative) Macular Degeneration

Up to perhaps 15% of people with ARMD have wet macular
degeneration. This is different to dry macular degeneration as it is
caused by new blood vessels growing underneath the retina.
These vessels are very fine and delicate and leak fluid and blood
M


and it is this that causes the problems with the patients eyesight.



The appearance of the back of the eye in wet ARMD

How do you know if you have ARMD?

The simple answer is that you cannot diagnose the condition in
yourself.

Only a doctor with special expertise in conditions affecting the
eye an ophthalmologist can accurately diagnose ARMD.
Neither can your GP or optician make the diagnosis, although they
may suspect ARMD is the cause of your symptoms.

The other thing is that the symptoms can often creep up on you
as they may take a long time to develop. And of course, by the time
you notice the symptoms the damage has already occurred.

With both types of macular degeneration people progressively
lose their central vision and that can be very disabling and
distressing. Although they never go completely blind they can still
see in the periphery - poor vision can mean people lose confidence
in getting out and about in unfamiliar places and stay indoors. Poor
vision can mean people socialise less and become withdrawn. And
poor vision makes us more likely to fall or injure ourselves in other
ways.



That is why I find treating eye problems so rewarding: because
helping to improve patients eyesight can give people a whole new
lease of life and return some of their independence and self-
confidence.



How is Dry Macular Degeneration Treated?

eople with any type of ARMD must be carefully assessed
and monitored over a period of years by an expert,
because many people with dry ARMD will go on to develop
the more aggressive and severe wet form of the disease.

There is no specific treatment for dry AMD although some
studies (The Age-Related Eye Disease Study, AREDS) have
shown that taking high-doses of certain vitamins and zinc slowed
down vision loss in people with intermediate or advanced AMD.
Another study ('AREDS II') is looking at the effects of other
vitamins (including Lutein and Zeaxanthin which are found in the
macula) on people with ARMD.

The supplements that are thought to help are:

Vitamin C
Vitamin E
Beta-Carotene
Zinc oxide
Cupric oxide

Certain foods contain higher levels of these compounds, foods
such as:

Oranges
Kiwi fruit
Tomatoes
Carrots (Yes they really are good for your eyes!)
Leafy green vegetables
Mangoes
Peas
Sweetcorn

Supplementing your diet with these foods may help your vision
and will certainly give you other general health benefits, but please
consult your doctor/eye specialist before taking them.
P


How is Wet Macular Degeneration Treated?

eople with wet macular degeneration until recently were in
considerable trouble, because there was no really effective
treatment available. Laser had been used (and
occasionally is still used) but was not particularly effective in
treating the condition.

Thankfully, over the last few years there has been something of
a revolution in treating wet ARMD as new treatments have become
available. The most exciting of these are the anti-VEGF drugs
Lucentis and Eyelea.

How do anti-VEGF Medicines Work?

VEGF or Vascular Endothelial Growth Factor is a naturally
produced 'signaling' substance in the body that is thought to be
partly responsible for the growth of the abnormal blood vessels in
the eye that are responsible for Wet AMD.

Lucentis and Eyelea work by blocking the action of the VEGF in
the eye and so reduce the growth of these blood vessels.

Unfortunately, the only way we can get these medicines where
they need to be is with an injection in to the eye.

Now although this sounds very unpleasant and dramatic, the
good news is that it is nowhere near as awful as it sounds. Let me
reassure you that it is nowhere near as bad as you might think -
most people aren't even aware of the injection happening!

This is because I always give drops into the eye to make it go
numb first of all. These local anaesthetic drops prevent the
injection from hurting you.

Next, I always use a very fine needle to give the injection - it is
much finer than the ones used to take blood tests from your arm.
The needle is almost as thin as a human hair.

P


And finally I always give the injection just into the very corner of
your eye - you won't see any nasty needles or feel anyone very
close to your face.

After this you will be able to go home you do not need to be
admitted to hospital for treatment and I will arrange a follow-up
appointment to see how you are getting on.



What Can I Expect During a Consultation for ARMD?

fter booking your appointment you will be greeted at the
clinic by one of my nurses and reception staff. You will
then be brought in to the clinical room where I will see you
personally you will not be seen by a junior doctors or specialist
trainee as often happens in the NHS.

We will go through details of your medical history as well as
discuss the problems you have been having with your eyesight. I
will then examine your eyes thoroughly.

Your vision will be checked and your pupils dilated to allow the
back of the eye to be examined. Your pupils are dilated with drops
that take about 30 minutes to work. They will make you sensitive to
light and cause your vision to be blurry. The drops allow me to see
the inside of your eye more easily. The effect of the drops usually
wears off in about six hours though sometimes it can happen
overnight. It is not safe to drive until the effects have worn off.

I will look at the inside of your eye using a special microscope
called a slit lamp. You place your chin on a rest and I will ask you
to look in various directions while shining a light into your eye. This
allows me to see your retina and any changes that ARMD may
have caused. Although very bright, the light cannot damage your
eye.

Often I can tell you whether you are likely to have ARMD or not
from this examination. However, you may need a test called a
Fluorescein angiogram to find out for certain if you have ARMD and
if so to determine which type, wet or dry.

The fluorescein angiogram

The fluorescein angiogram looks at the network of blood vessels
underneath your retina can't be seen by examining your eyes with
a slit lamp. You are given an injection in the arm of Fluorescein, a
yellow dye that shows up the blood vessels at the back of the eye.
The injection isnt painful but does make some people feel a bit
A


sick sometimes.

Once the dye has been injected pictures of the back of your eye
are taken as the dye is travelling through the blood vessels. This
takes about 10 minutes.

It is a very common test and very few people have any serious
side effects. The injection may give your skin a slight yellow tinge
from the dye and it soon passes into your urine, which may also
appear a darker yellow than normal (possibly for up to two to three
days) but often it fades quicker than that. Some people are dazzled
for a while after the flashing lights but most people find the test
straightforward.

These tests help the ophthalmologist decide which type of ARMD
you have and so guides him to the correct treatment.




Frequently Asked Questions

Can you have ARMD in only one eye?

Yes, you can. However it is much commoner to have ARMD in
both eyes. The reason you only notice symptoms in one eye
though is because it is worse in that eye.

Can you have dry ARMD in one eye and wet ARMD in the other?

Yes, you can. In fact, it is possible to have both wet AND dry
ARMD in the same eye! This shows just how important it is to have
your eyes looked after by an expert.

Dame J udi Dench, the actress in fact has dry ARMD in one eye
and wet ARMD in the other.


Dame J udi Dench - M in the Bond films

Does ARMD ever get better?

No. Dry ARMD usually gets worse only very slowly though, which
is obviously good news. Wet AMD however can progress very
quickly, causing serious problems with your vision. However, if
picked up early you can see a dramatic improvement with
treatment.



Does dry ARMD always go on to wet ARMD?

No. You can have dry AMD for many years and still not get wet
AMD. The big 'but' though is you need to keep a very close watch
on people with dry ARMD because quite a few go on to develop
wet ARMD - and Wet ARMD is a serious (but treatable) condition.

Will vitamins prevent dry ARMD getting worse?

We're still not sure. There is some evidence that it slows the
condition down at least - but this is not yet proven.

Does dry ARMD require injections?

No.

Do injections into the eye hurt?

Most people only feel slight discomfort only, because I always
give local anaesthetic drops first. I also always use a very fine
needle - almost as thin as a human hair - and I always inject just in
to the corner of the eye.

If you have Wet ARMD you will need several injections over time,
and I have never had a patient cancel an appointment because the
injections hurt her - not even once.

Will I see the needle?

Only if you want to! The injection is given into the corner of the
eye so no, you won't normally see the needle at all.

Do you give any anaesthetic before giving the injections?

Always. I always give eye drops into the eye to make it nice and
numb before giving the injection.




Can you have cataracts and ARMD?

Yes you can. And because both conditions affect older people
there are many people with both conditions. This is another reason
to see an expert early if you have any trouble with your vision at all.
Your vision is too precious to risk anything else.

Are you more likely to get ARMD if you have cataracts?

No. But both are common conditions and both affect the same
sorts of people, so many people do have both.

Can you treat ARMD with stem cells?

Not yet. One day perhaps, but any treatment with stem cells is
many years away yet.

Will taking high doses of vitamins prevent me getting ARMD?

No. We do not believe that taking high doses of vitamins will
prevent ARMD.

What will happen if I have ARMD and dont get treated?

ARMD is a serious, progressive condition affecting your vision. If
it is left untreated your vision will continue to deteriorate. If you go
on to develop wet ARMD then your eyesight can deteriorate very
quickly indeed over a matter of days or weeks, even. Its just not
worth risking your eyesight at all.

How long do the injections take?

A few moments only then its all done. There really is nothing to
be afraid of.




Afterword

s you will probably have realized this has been a whistle-stop
summary about age-related macular degeneration - what it is,
what causes it and how it is treated. I have also summarized
what you can expect if you should need treatment for wet ARMD and
the common questions I get asked by patients. I hope it has been
useful.

As a consultant ophthalmologist I am fully trained in the
management of all conditions affecting the eye, and my special
expertise is in treating ARMD and cataracts.

If you have problems with your eyes and would like to see me via
the NHS then have a word with your GP and ask to be referred.

If you wish to be seen privately then you do not need a GP referral
and can simply contact my secretary directly.

I look forward to seeing you.

Best wishes,



Mr. J aheed Khan FRCOphth


A


How to Contact Mr. J aheed Khan
rivately I practice at both Moorfields and at Harley Street
either telephone or send my secretary an email. A GP referral
is not necessary for Private Patients.

Moorfields Eye Hospital



Private Consulting Rooms
J ohn Saunders Suite
9-11 Bath Street
London EC1V 9LF

Tel: (020) 7566 2803

enquiries@moorfields-private.co.uk











View Larger Map
P




Clinica London
140 Harley Street
London W1G 7LB

Tel: (020) 7935 7990
secretary@clinicalondon.co.uk

View Larger Map