Dame Judi Dench says her eyesight has deteriorated to such an extent that she “can’t see on a film set any more”. Photo / AP
Dame Judi Dench says her eyesight has deteriorated to such an extent that she “can’t see on a film set any more”. Photo / AP
She is one of our best-loved actors, but her ability to set stage and screen alight is growing more difficult for Dame Judi Dench, who has revealed her eyesight has deteriorated to such an extent that she “can’t see on a film set any more”.
The 88-year-old star of films suchas Skyfall and The Second Best Marigold Hotel has spoken candidly about the age-related macular degeneration she was diagnosed with in 2012, which had become so bad by 2017 that she had to stop driving, but of which she said this weekend, with remarkable stoicism, “you just deal with it”.
She is far from alone – age-related macular degeneration (AMD) is the biggest cause of sight loss in the UK, affecting one in every 200 of us by age 60 and one in every five of us by the age of 90.
“It is very common and, as the elderly population increases, we are seeing a 10 per cent year-on-year increase in people needing help,” says Andrew Lotery, professor of ophthalmology at the University of Southampton.
Up to 70 per cent of cases have a genetic factor – Dame Judi’s mother had AMD and her daughter Finty has regular eye tests.
“These genetic factors typically result in more ongoing inflammation in the eye and this ultimately leads to AMD,” says Professor Lotery. AMD impacts the macula, the part of the retina at the back of the eye that is responsible for our central vision.
Macular degeneration affects one or both eyes and there are two types – dry and wet. Photo / Engin Akyurt, Unsplash
It affects one or both eyes and there are two types – dry and wet. Dame Judi has said she has dry AMD in one eye and wet AMD in the other. In dry AMD, which is more common, the macula deteriorates as the retinal cells die off and are not renewed.
Progression varies, but sufferers – usually aged over 50 – often find the first symptom is a blurred area in their vision, which can make everyday demands such as driving or recognising faces difficult.
Dark spots can appear, straight lines are sometimes distorted and colour can fade. An optometrist can check for early signs, sometimes using a magnifying glass with a light to look at the back of the eyes or scans which create cross-sectional images of the retina. As there is currently no treatment for dry AMD, sufferers might not be referred to hospital.
Wet AMD, meanwhile, happens when unhealthy blood vessels damage the macula by growing into it, and can deteriorate sight more rapidly – over days or weeks.
Despite being so common, AMD is sadly still incurable, unlike cataracts, a cloudy area on the eye lens, which can be eliminated with surgery. (Glaucoma, another common eye condition where the optic nerve, which connects the eye to the brain, is damaged, cannot be cured but can also be treated with surgery.)
Treatment for wet AMD
There is, however, treatment for wet AMD, says Lotery – injections of anti-VEGF (vascular endothelial growth factor) drugs into the eyeball that inhibit the growth of abnormal blood vessels.
It is the same treatment used to treat diabetic retinopathy, a condition in which high blood sugar levels damage the retina. Dame Judi has said she has injections every six weeks.
“I compare the blood vessels that grow to weeds and the injections to weedkiller, but they have to be repeated. Some of my patients have had injections for over 10 years,” says Lotery.
Patients’ eyes are anaesthetised, the injections are performed in hospital and on an outpatient basis.
New hope for dry AMD
Meanwhile, an injection for dry AMD was recently made available in the United States, containing an antibody that inhibits the overactive immune system in some sufferers that causes inflammation at the back of the eye.
It is hoped it might become available in the UK in the next year. “It is exciting but will require a lot of resources to deliver as we would be at least doubling the patients receiving injections,” says Lotery, who stresses, however, that there are steps we can take to eliminate our chances of developing the disease.
Reducing our red meat consumption and switching to a Mediterranean diet rich in fish and green vegetables seem to reduce inflammation in the body – studies have shown vitamin C and E, copper and zinc supplements can reduce the risk of AMD progression by 25 per cent.
“Stop smoking and don’t drink too much alcohol, which also increases inflammation, and, if you’re susceptible because of your genetic background, could tip you over the balance,” he says.
Exercising to keep blood pressure healthy can also help – people with high blood pressure are one and a half times more likely to have AMD than those with normal blood pressure.
While the impact of AMD should not be underestimated – “Studies say it has the same psychological effect as being diagnosed with a terminal illness in terms of your quality of life,” Lotery says – sufferers shouldn’t lose their sight entirely, “because AMD affects central vision patients should always have some peripheral sight” – and there are steps they can take to live with it.
Tips to deal with macular degeneration
Try vision aids. These can come as stand magnifiers that rest directly on reading material, or can be worn like glasses to project the image onto the still functioning peripheral part of your eye. “Vision won’t be as sharp, but they can help,” Lotery says.
Swap books for tablets and e-readers. “Increasing font size or adjusting the brightness can help,” Lotery says. Dame Judi said in 2019 she read her scripts in a “ridiculous” font point size 22.
Use audio services. Apps and software can convert text to audio – a technique Dame Judi said she planned to experiment with earlier this year: “I need to find a machine that not only teaches me my lines but also tells me where they appear on the page.” Computers and phones can read messages out loud and you can buy devices such as talking microwaves and weighing scales.
Make sure your house is brightly lit, especially in areas where you often carry out close-up tasks.
Investigate eccentric viewing techniques, which can teach you to look around your blind spot and find your best point of focus. The Macular Society offers online training as well as advice and support.
