When I Saw a Change on the Amsler Grid: The Good News/Bad News Pendulum

Many of us worry about seeing a change on the Amsler grid, which we use to check our eyes. I’m one of the worriers, and I saw a change recently.

Desperately I tried to talk myself out of this situation. Probably just a smudge on my glasses, I thought. I got some spray cleaner and a cloth and cleaned them.

Hesitantly, I went back to the fridge and took down the chart again for another look. I put my glasses on and closed one eye, and then the other. There were definitely 2 new gray blotches when I looked with the left eye. They hadn’t been there before.

Vision changes with macular degeneration

Perhaps if I use more light, I won’t see them, I thought. I took the chart over to the window and had another look. They didn’t show up quite so much in the extra light, but they were definitely there. I couldn’t deny it.

I considered having another look tomorrow. But my conscience wouldn’t let me get away with that one! I knew what I had to do. We talk about it often enough on this site.

I phoned my optometrist first because I can get in almost immediately with her. She did an optical coherence tomography (OCT) scan and a thorough eye examination. She said she could see a change in the macula in the left eye and showed me the scan on her screen. When this result was compared to last year’s, even I could see the extra bumps.

Then I asked the question that was really on my mind. “Has it changed from dry to wet?” I crossed my fingers waiting for her answer, and I was very surprised when she said, “I can’t tell, but your retinal specialist will know.”

At least she was honest. I understand the retinal specialist has much more training and possibly better equipment, but this was puzzling.

Visiting my retinal specialist

The next day I was able to see the specialist. I went through all the tests again with her technician and had another OCT. When I got in to see her, I crossed my fingers once again and asked the question about turning to wet, before she had a chance to tell me anything.

She said the good news was that the dry macular degeneration had not turned to wet in either eye. But I did get copious amounts of praise from her, for coming in quickly when I noticed a change. She said she would much rather see me sooner than later just in case it was wet developing.

She could see the extra bump in the macula on the left eye that was causing the grey shading in my sight. That was a progression of the dry AMD (age-related macular degeneration), still at intermediate stage.

The bad news

Now for the right eye which wasn’t even worrying me. She showed me the OCT on her screen and another from last year. She said, “See where this bump has flattened out. You might think that is good news, but even though it now looks flat, it is actually thinner. It is the beginning of the advanced form of dry AMD called geographic atrophy.”

This was something I was not expecting to hear. This was the bad news. She said, “At least it’s not right in the very center of your vision – I hate having to tell patients that their central vision will deteriorate.” I think this was meant to be more good news, but I was still too stunned to appreciate it.

The good news

This was followed by what I think was meant to be the really good news. She told me that a couple of promising trials will be finishing up in the next 18 months or so. These trials are looking at treating the geographic atrophy stage of dry macular degeneration.

The aim is to slow the progression of the disease and they have had some success already. They use the drug pegcetacoplan delivered by injections into the eye. The last time my retinal specialist had discussed treatments for dry AMD she had talked about “in my lifetime.” The timeframe she mentioned at my last visit sounded much more optimistic.

Remaining diligent

Now I will get two spare Amsler grids, one for each eye, and mark on them as many of my blotches and squiggly lines as I can. This will be my new benchmark. I will still be on the lookout for any further changes. Most importantly, I can move on with a little more hope for treatment in the not-too-distant future.

Editor's Note: As of August 2023, 2 drugs known as complement inhibitors — Syfovre® and Izervay™ — have been approved by the US Food and Drug Administration (FDA) to treat geographic atrophy (GA).