Macular degeneration of the eye - symptoms, causes, approaches to treatment

There are many diseases affecting the organs of vision, but some of them are more serious than others. Macular degeneration is a rather serious pathology, which leads to serious consequences.

This pathology is the most common cause of complete loss of vision in people over 50 years of age. It affects the central part of the retina and causes its exhaustion. The lumen of the vessels of the shell of the eye is shortened, as a result of which the oxygen starvation of tissues develops. As a result of improper operation of the macula, the central system of vision also suffers.

Definition of disease

Age-related macular degeneration affects the most important part of the retina - the macula, which leads to irreversible visual impairment in patients aged 50 years and older.Since they account for a significant part of the population of our planet, one can speak of the high importance of the problem itself and the need to create effective schemes for its treatment.

Structure of the eye

In recent years, there has been a trend towards a significant "rejuvenation" of such a pathology as macular degeneration.

Peripheral vision with macular degeneration practically does not suffer, since degenerative changes affect primarily the macula of the retina(it is she who is responsible for the sharpness and sharpness of the central vision necessary for driving vehicles, reading, etc.). The social and medical significance of the disease is associated with the rapid loss of normal central vision and, as a result, a loss in the level of overall performance, i. is assigned disability. The degree of impairment of visual function and severity of the pathological process as a whole depends on the form of AMD in a particular patient.

Age-related macular degeneration of central vision

Dry form

The dry form of AMD is diagnosed much more often than the wet form - it accounts for about 85% of all cases of macular degeneration.Dry form of pathology is accompanied by the appearance of spots of a yellow shade, which are called druses. The loss of vision occurs gradually, as a result of which the patient begins to discern little detail, but still the degree of distortion will be lower than with a wet form.

The dry form of AMD is the presence of drusen

The main danger of dry AMD is a slow progression to the geographical atrophy of the eye, accompanied by complete degradation of retinal cells. And the cellular degradation of the macula always leads to blindness.

There are no radical methods of treatment of dry macular degeneration of the retina in modern medicine, but some developments are being actively tested in clinical practice.Sufficient intake of vitamins C, E and A can prevent the development of degenerative processes in the macula or suspend them. Ophthalmologists strongly recommend patients with AMD dry form wearing sunglasses with a high level of protection against UV rays.

Distribution of vitamins in food

Wet form

The macular degeneration of the moist form accounts for about 10-15% of all cases of the disease.The pathology develops very quickly and causes a complete loss of central vision.When the form of AMD is wet, the active growth of new blood vessels (or neovascularization) always begins. In this case, the walls of such vessels are inferior - they pass blood and fluid accumulating in space under the retina of the eye. Such leaks negatively affect the photosensitive cells of the retina, eventually they die, forming "blind spots" in the organs of central vision.

Latent choroidal neovascularization

At the heart of the development of wet macular degeneration lies CNV - that is, choroidal neovascularization. Abnormal growth of the vessels causes scarring.

Causes

Age is the main cause of development of macular degeneration. In patients between 65 and 75 years of age, pathology is diagnosed in 20% of cases, and after 75 years it is manifested in every third.

At the moment, there are no precise reasons for the occurrence of this phenomenon. According to the doctors' assumption, the main cause may be vascular pathologies and problems with feeding the retina zone, which is responsible for central vision. But there is no absolute certainty about this.

Other reasons include hereditary genetic predisposition and a lack of certain groups of vitamins.

The reasons for the development of AMD:

• Age - over 50 years.
• Hereditary predisposition - if there are people with this diagnosis in the family, the risks of morbidity increase threefold.
• Race - most often malokudistrofiya diagnosed in Europeans.
• Cardiovascular diseases - atherosclerosis of the macula increases the risk of getting sick 3 times, and hypertension is 7 times.
• Smoking.
• Direct exposure to sunlight
• Nutrition, saturated with cholesterol, harmful fats.
• Obesity.
• Bright iris.
• Cataract (especially nuclear).

External manifestation of nuclear cataracts

Surgical removal of cataract often causes progression of AMD patients with pathological changes in the macular area.

Symptoms

The disease develops very gradually.At first a person begins to need more powerful lighting for reading - and this is the first sign on which it is important to pay attention.

In the beginning, you can not notice any special problems, because problems with one eye are compensated for by another eye.

Then the following symptoms appear:

• Distortion of vision.The text becomes harder to read, even face recognition is difficult. Straight lines become curved if you look directly at them. According to such signs astigmatism can be mistakenly diagnosed.
• Hallucinations.People start to see figures and even people and animals, but, as a rule, they are afraid to tell others about it, considering that they will be considered as crazy. Although the reason is not at all insane, but in problems with vision.
• Decreased vision. Man not only begins to see worse in general, but he also has a dark spot (scotoma) in the center of his visual field, which prevents him from perceiving objects.
• The appearance of dark spots in the area of ​​central vision.
• Unclear perception of images and distortion of color perception.
• Sharp deterioration of visual function in conditions of poor illumination (night blindness).
• Difficulties with reading.
• Problems with recognizing faces.

Symptoms of AMD

Although the disease can be established quite accurately by the symptomatology, in many cases an additional diagnostics, especially ophthalmoscopy, electrophysiological research and other diagnostic methods that will be prescribed ophthalmologist.

Possible complications

All possible complications of macular degeneration of the retina:

1. Irreversible changes in the functions of the visual system - largely due to the fact that the disease has long been unnoticed.
2. Expressed painful sensations.
3. Pronounced and very strong distortion of vision.
4. Complete blindness in especially severe cases, leading to disability of the patient.

Although malokulodistrofiya rarely leads to complete blindness, central vision suffers severely and may disappear altogether. This negatively affects the quality of life of the patient, reduces its performance, makes it impossible professional activity in certain areas, prohibits reading, watching TV, and so on. Further.

Diagnostics

The diagnosis of AMD is performed taking into account the data of anamnesis, patient complaints, the evaluation of visual function, examination of the retina with the use of modern techniques (at the discretion of the doctor) is necessarily performed.Precisely to make the diagnosis the test of Amsler allows - at a sight on a special grid the patient sees not all lines or all, but in the garbled kind, dark maculae can appear.Based on this check, the doctor makes a conclusion about the presence of the patient's macular degeneration of the retina. Often, fluorescence angiography of the fundus is used (FAGH). For the FAAG, various camera models are used, as well as special contrast media (this is fluorescein or indocyanine green). Contrast substances are injected into the patient's vein, after which a series of images of the fundus are performed.

Amsler test

Stereoscopic images are valuable initial data for the dynamic observation of patients with severe dry form of AMD, as well as in the treatment of macular degeneration.

To perform a fine assessment of changes in the retina and macula, OCT (optical coherence tomography) is used. The technique allows to reveal structural changes at the earliest stages of degeneration.

Treatment

Medication

Conservative therapy involves the appointment of dodystrophic drugs, antioxidants, immunomodulating drugs (drops, injections, tablets).The effectiveness of the drug method is low.

The basic preparations:

• Avastin.
• Anthocyanus.
• Lutsentis.
• Lutein.

Lucentis

The most effective tool in the therapy of AMD is Lucentis, an inhibitor of angiogenesis.It specifically suppresses the activity of the growth factor of the endothelial part of the vessels, thus stopping the retinal damage. The growth of pathological vessels is suspended, and the structure of the macula is normalized.

Surgery

Laser coagulation provides the most effective results in the treatment of macular degeneration.But keep in mind that this technique causes thermal damage to the shells of the fundus, resulting in tissue atrophy - and this is not always permissible for patients aged. That is why the scope of laser coagulation in the treatment of age-related wet macular degeneration of the retina is severely limited.

Laser Coagulation Procedure

In comparison with laser coagulation photodynamic therapy on the retina has a more gentle effect and does not contribute to the atrophy of the membranes of the fundus.

The second surgical technique is photodynamic therapy (PDT), a relatively new way of treating AMD, which is based on the photochemical effect on new vessels.The doctor injects the patient with an intravenous photosensitizer (a special drug), and then irradiates the treated area with laser radiation. As a result of processes of photochemical decomposition of the photosensitizer, atomic oxygen is released, occlusion of abnormal vessels is eliminated, retinal edema disappears.

PDT in recent years supplanted angiogenesis inhibitors, the use of which gives higher functional results. They block the growth of newly formed vessels, closing them and eliminating edema.

Drugs are injected into the operating room inside the eye with a thin needle. After a month, the patient is examined and, if necessary, repeated the procedure.The average number of injections is three, but there is enough and one injection.

Photodynamic therapy

People's means

Cure the disease with folk remedies is not possible.It is necessary to adhere to medication and other approaches to treatment. But as an additional action, folk therapy can slow the progression of the disease.

You need to eat more legumes and cereals (preferably in a spilled form), and also eat more positively affecting the eyesight of fruits, vegetables (for example, tomatoes) and berries (for example, strawberries or blueberry).To improve the visual function, you can drip into the eyes infusion on the juice of aloe and mummies.

Prevention

To minimize the likelihood of a problem occurring, the following precautions should be observed:

• Reduce the load on the eyes.Do not read in a shady room, do not watch it in TV.
• Refuse to smoke. Also it does not take long to stay in the smoke-filled premises.
• Do sport.Or just act actively according to age.
• Normalize the fat content in the diet. Also, it will not be superfluous to take vitamin complexes.

Video

conclusions

Macular degeneration is a serious phenomenon, even more serious than most other common diseases of the retina. But you can cope with it. The main thing is to promptly consult your doctor as soon as you notice the first signs of the problem. Do not be afraid to honestly talk about the symptoms, do not hesitate to share even the observations of hallucinations. The problem in any case is removable, but it is very important to diagnose it correctly, and therefore you need to describe everything in as much detail as possible.