Macula retinal dystrophy treatment with drops. Macular degeneration treatment. Symptoms of "wet" AMD

Retinal macular degeneration is a disease that affects the most important area of the retina - the macula. This part provides the main function of vision, with the help of it we see objects.

The disease has serious consequences, one of the most dangerous is the loss of vision without the ability to resume it. Distinguish between dry and wet form. The first is more common and is characterized by yellow spots when diagnosing the macula. Wet is more dangerous, because it leads to worse vision diseases, and without proper treatment, blindness.

Treatment is usually surgical, and Lucentis and Eilea are also taken. In this article, we will consider the forms of macular degeneration of the retina, symptoms, diagnosis and treatment.

What is AMD?

What is AMD?
Source: mosgorzdrav.ru

Age-related macular degeneration (AMD), or macular degeneration, is a disease that affects the central, most important area of the retina - the macula, which plays a key role in providing vision.

Age-related macular degeneration is the leading cause of irreversible vision loss and blindness among the population of developed countries aged 50 and over. As people in this group represent an increasing proportion of the population, vision loss from macular degeneration is a growing problem.

Age-related macular degeneration is a chronic progressive disease in which the central area of the retina and choroid is affected. In this case, damage to cells and intercellular space occurs and, as a result, dysfunction. In this case, we are talking about a violation of the function of central vision.

According to the WHO, the proportion of the population of the older age group in economically developed countries is about 20%, and by 2050. will probably increase to 33%.

Accordingly, due to the expected increase in life expectancy, the steady increase in atherosclerosis and concomitant pathology, the problem of AMD remains the most urgent. In addition, in recent years there has been a clear tendency towards the "rejuvenation" of this disease.

The reason for the decrease in vision is the degeneration of the macula, the most important area of the retina, responsible for the sharpness and acuity of central vision required for reading or driving a car, while peripheral vision is practically not affected.

The social and medical significance of this disease is due precisely to the rapid loss of central vision and the loss of general performance. The severity of the process and loss of central vision depends on the form of AMD.

Dry and wet forms

Intensive metabolism in the retina leads to the formation of free radicals and other reactive oxygen species, which can cause the development of degenerative processes with insufficient work of the antioxidant system (AOS).

Then, in the retina, especially in the macula and paramacular region, under the influence of oxygen and light, non-cleavable polymer structures are formed - druses, the main component of which is lipofuscin.

With the deposition of druses, atrophy of the adjacent layers of the retina occurs and the growth of pathological newly formed vessels in the retinal pigment epithelium is noted. In the future, scarring processes occur, accompanied by the loss of a large number of retinal photoreceptors.

Ophthalmologists distinguish two variants of the course of this disease - dry (non-exudative, atrophic) and wet (exudative, neovascular) form of AMD.

The dry form of AMD is more common than the wet form and is detected in 85% of all cases of AMD. Yellowish spots known as drusen are diagnosed in the macular area. The gradual loss of central vision limits the ability of patients to see fine details, but it is not as severe as in the wet form.

However, the dry form of AMD can progress slowly over the years to advanced geographic atrophy (GA), a gradual degradation of retinal cells that can also lead to severe vision loss.

To date, there is no cure for dry AMD, although some are now in clinical trials.

An overwhelming amount of clinical research has proven that certain nutrients such as beta-carotene (vitamin A), vitamins C and E can help prevent or slow the progression of dry macular degeneration.

Studies show that taking high doses of certain dietary supplements and eye vitamins can reduce your risk of developing early AMD by 25%. Eye doctors also recommend that patients with dry AMD wear UV-protected sunglasses.

Wet AMD is present in about 10-15% of cases. The disease progresses rapidly and often leads to significant loss of central vision. Dry AMD progresses to a more advanced and damaging form of eye disease. With a wet form of AMD, the process of growth of new blood vessels (neovascularization) begins.

The wall of such vessels is defective and allows blood cells and fluid to pass through, which accumulate in the space under the retina. This leak causes permanent damage to the light-sensitive cells in the retina, which die and create blind spots in central vision.

The "wet" (exudative) form is much less common "dry" (approximately in one or two cases out of 10), but it is more dangerous - there is a rapid progression and vision deteriorates very quickly.

Symptoms of "wet" AMD:

A sharp decrease in visual acuity, the inability to improve vision with spectacle correction.
Blurred vision, decreased contrast sensitivity.
Loss of individual letters or curved lines when reading.
Distortion of objects (metamorphopsia).
The appearance of a dark spot in front of the eye (scotoma).

Choroidal neovascularization (CNV) underlies the development of the wet form of AMD. Abnormal vascular growth is an erroneous way of the body to create a new network of blood vessels in order to ensure the supply of the required amount of nutrients and oxygen to the retina.

Instead, scarring is formed, resulting in severe loss of central vision.

Development mechanism

Macula is several layers of special cells. The layer of photoreceptors is located above the layer of cells of the retinal pigment epithelium, and below is a thin Bruch's membrane, which separates the upper layers from the network of blood vessels (choriocapilars) that provide the macula with oxygen and nutrients.

As the eye ages, metabolic products of cells accumulate, forming the so-called "druses" - yellowish thickenings under the retinal pigment epithelium.

The presence of many small druses or one (or more) large druses is considered the first sign of an early stage of "dry" AMD. The "dry" (non-exudative) form is most common (in about 90% of cases).

As they accumulate, drusen can cause inflammation, triggering the appearance of vascular endothelial growth factor, a protein that promotes the growth of new blood vessels in the eye. The proliferation of new pathological blood vessels begins, this process is called angiogenesis.

New blood vessels grow through Bruch's membrane. Since the newly formed vessels are pathological in nature, blood plasma and even blood pass through their walls and enter the layers of the macula.

From this point on, AMD begins to progress, passing into another, more aggressive form - "wet". Fluid builds up between Bruch's membrane and the photoreceptor layer, damaging the vulnerable nerves, providing healthy vision.

If this process is not stopped, then hemorrhages will lead to detachments and the formation of scar tissue, which threatens irreparable loss of central vision.

Causes and risk factors

Despite numerous studies devoted to AMD, the causes of this disease remain unclear until now. AMD is a multifactorial disease.

Age is the main reason. The incidence increases dramatically with age. Among middle-aged people, this disease occurs in 2%, at the age of 65 to 75 years it is diagnosed in 20%, and in the group from 75 to 84 years, signs of AMD are found in every third.

A significant part of the population has an innate predisposition to AMD, but there are a number of factors that either contribute to the onset of the disease or prevent it.

A number of risk factors have been proven that negatively affect natural defense mechanisms and therefore contribute to the development of AMD, the most significant are:

Race - AMD is most common in Caucasians
Heredity - Family history is an important risk factor in 20% of AMD patients. There is a threefold increase in the risk of developing AMD if the disease occurs in first-generation relatives
Cardiovascular disease plays a significant role in the development of AMD. It was found that in atherosclerosis the risk of damage to the macular region increases 3 times, and in the presence of hypertension - 7 times.
Cigarette smoking is the only risk factor that has been shown to be significant in all studies. Stopping smoking reduces the risk of developing AMD.
Direct exposure to sunlight
Nutrition - The risk of AMD is higher in people who eat more saturated fat and cholesterol, and those who are overweight.
Light iris
Cataract, especially nuclear cataract, is a risk factor for the development of AMD. Surgical removal of cataracts can contribute to the progression of the disease in patients with pre-existing changes in the macular area.

Symptoms of macular retinal dystrophy

Age-related macular degeneration usually causes slow, painless, and irreversible vision loss. In rare cases, vision loss can be severe.

A person suffering from age-related macular degeneration, as the disease progresses, complains of decreased visual acuity, difficulty in reading, especially in low light conditions. Also, patients may notice the loss of individual letters during fluent reading, distortion of the shape of the objects in question.

A complaint about a change in color perception is much less common. Unfortunately, more than half of patients do not notice deterioration of vision in one eye until the pathological process affects the paired eye. As a result, changes are often detected in advanced stages, when treatment is already ineffective.

Early signs of vision loss from AMD are:

the appearance of dark spots in central vision
blurred image
distortion of objects
deterioration in color perception
a sharp deterioration in vision in low light and in the dark

The most elementary test for determining the manifestations of AMD is the Amsler test. The Amsler grid consists of intersecting straight lines with a central black dot in the middle. Patients with AMD may see some lines appear blurry or wavy, and dark spots appear in the field of view.

An ophthalmologist can distinguish the manifestations of this disease even before the development of changes in the patient's vision and send him for additional examinations.

Diagnostics

Diagnosis of AMD is based on data from anamnesis, patient complaints, assessment of visual functions, and data from examination of the retina by various methods. Currently, one of the most informative methods for detecting retinal pathology is the fundus fluorescence angiography (FAGD).

For FAGD, various models of cameras and special contrast agents — fluorescein or indocyanine green — are used, which are injected into the patient's vein, and then a series of fundus images are taken.

Stereoscopic images can also be used as initial ones for dynamic observation of a number of patients with a pronounced dry form of AMD and of patients in the course of treatment.

For a fine assessment of changes in the retina and macula, OCT (optical coherence tomography) is used, which makes it possible to detect structural changes at the earliest stages of retinal degeneration.

Central vision with AMD gradually becomes indistinct, blurred, dark spots appear in the center of the field of view, straight lines and objects begin to distort, color perception deteriorates. At the same time, peripheral vision is preserved.

If you have these symptoms, you should immediately contact an ophthalmologist for examination.

Probably, the doctor will conduct you a fundoscopy (examination of the retina), having previously dilated your pupils with the help of special eye drops. Several additional diagnostic procedures may be required to determine the form of AMD and the method of treatment.

Determination of visual acuity, examination of the fundus, as well as specialized high-tech techniques: optical coherence tomography of the retina and fluorescence angiography of the fundus are mandatory.

At the same time, it is possible to assess its structure and thickness and observe it in dynamics, against the background of treatment. And fluorescent angiography allows you to assess the state of the retinal vessels, the prevalence and activity of the dystrophic process and determine the indications or contraindications for treatment.

All over the world, these studies are the gold standard in the diagnosis of age-related macular degeneration.

Treatment of dry and wet forms

It is impossible to completely cure AMD. Nevertheless, the development of the disease can be slowed down, stopped, and sometimes even improved.

It is well known that the risk of AMD is reduced by a healthy diet rich in vitamins C and E, lutein and zeaxanthin, fresh fruits, dark green vegetables and lettuce.

The following vegetables and fruits are key to eye health: carrots, pumpkin, zucchini, zucchini, green beans, tomatoes, lettuce, spinach, broccoli, cabbage, turnips, melon, kiwi, dark grapes, dried apricots.

According to a number of studies, it is recommended to eat fish (salmon, tuna, mackerel) and nuts, which are rich in omega-3 fatty acids and copper, at least 2-3 times a week. There is evidence that a diet is sufficient in omega-3 fatty acids and lutein.

In large-scale studies, it has been found that a healthy diet and intake of dietary supplements containing specially selected micronutrients (vitamins, trace elements and antioxidants) can slow the progression of the disease.

In particular, it turned out that the use of sufficiently high doses of certain antioxidants (vitamins C and E, copper, zinc, carotenoids lutein and zeaxanthin *) can reduce the risk of progression of existing dry AMD.

If you smoke, you should quit smoking as smoking increases your risk of developing AMD. Fight excess weight and high blood pressure. Increase your physical activity.

To protect your eyes from direct sunlight, you should wear quality sunglasses with a reliable UV filter. Clinical studies have shown that the earlier preventive measures begin, the higher the chances of maintaining vision.

In the later stages, when a wet form of AMD is detected, the prognosis for maintaining high visual acuity is less favorable, and treatment requires more expensive and complex procedures, including laser coagulation of the retina, photodynamic therapy, and injections of drugs into the eye.

According to the World Health Organization, age-related macular degeneration is one of the most common causes of blindness and low vision in older people. Age-related macular degeneration is a chronic degenerative disorder that most often affects people over the age of 50.

According to the official materials of the WHO Center for the Prevention of Avoidable Blindness, the prevalence of this pathology in terms of appealability in the world is 300 per 100 thousand of the population. In economically developed countries of the world, AMD as a cause of low vision ranks third in the structure of eye pathology after glaucoma and diabetic retinopathy.

Statistics

In the United States, 10% of people 65 to 75 years old and 30% over 75 years old have central vision loss due to AMD. End-stage AMD (blindness) occurs in 1.7% of the total population over 50 and about 18% of the population over 85. In Russia, the incidence of AMD is 15 per 1000 population.

AMD is manifested by progressive deterioration of central vision and irreversible damage to the macular zone. Macular degeneration is a bilateral disease, however, as a rule, the lesion is more pronounced and develops faster in one eye, in the other eye AMD may begin to develop in 5-8 years.

Often, the patient does not immediately notice vision problems, because at the initial stage, the better seeing eye takes over the entire visual load.

With a decrease in visual acuity; difficulties in reading and writing; the need for stronger lighting; the appearance of a fixed spot in front of the eye, as well as distortion of the contours of objects, their color and contrast - you should immediately contact an ophthalmologist.

The diagnosis of macular degeneration can only be made by a specialist doctor. However, self-control of the visual functions of each eye separately using the Amsler test is highly informative.

Despite the tremendous progress in improving the methods of diagnosing AMD, its treatment remains a rather difficult problem. In the treatment of dry forms of AMD and at a high risk of developing the disease, in order to normalize metabolic processes in the retina, it is recommended to conduct courses of antioxidant therapy.

It should be remembered that replacement therapy for the prevention and treatment of dry AMD cannot be a course one, its use is possible only on an ongoing basis. It should be used in people over 50 years old, and in the presence of risk factors (smoking, overweight, burdened history, cataract extraction), even earlier.

Treatment of wet AMD is aimed at suppressing the growth of abnormal vessels. Today, there are a number of drugs and techniques that can stop the manifestations of abnormal neovascularization, which made it possible to improve vision in a significant number of people with wet AMD.

Age-related macular degeneration (AMD) is a chronic progressive dystrophic disease of the central region of the retina that leads to a gradual loss of central vision. Macula is an oval pigmented spot near the center of the retina that is responsible for visual acuity.

The retina itself is the layer that lines the back of the eye and contains light-sensitive cells. The retina transmits the images it perceives to the brain. AMD leads to irreversible loss of central vision, although peripheral vision is retained.

Age-related macular degeneration is manifested by irreversible damage to the macular (central) area of the retina with progressive deterioration of central vision. According to available data, the paired eye is affected no later than 5 years after the first disease.

There are two forms of AMD:

"Dry" (atrophic) AMD is more common. It occurs in about 90% of people with this condition.
The rest of the cases are "wet" (exudative) form, often affecting patients who have previously been diagnosed with dry AMD.

The "dry" form (9 out of 10 patients with AMD) progresses over many years, causing a deep loss of central vision in only 10-15% of patients with macular degeneration. The "wet" form progresses rapidly (weeks to months), occurs in about 1-2 out of 10 patients with age-related macular degeneration.

It is this form of the disease that is the main cause of vision disability (85-90% of patients with AMD).

Risk factors for AMD that cannot be influenced include heredity and age. It has been established that the incidence of AMD increases with age.

At the same time, the risk of developing AMD increases threefold if this disease occurs in close relatives. An increased risk of AMD is observed in people over 60 years of age, as well as in women.

In addition, there are quite a few risk factors for AMD that, fortunately, can be influenced. In particular, the risk of macular lesions increases with elevated plasma cholesterol levels, vascular atherosclerosis and high blood pressure.

Foods high in saturated fat and cholesterol can lead to the deposition of atherosclerotic cholesterol plaques in the macular vessels and increase the risk of AMD. Diabetes mellitus is one of the most significant causes.

Purpose of macular degeneration treatment

Macular retinal degeneration refers to diseases that affect the central part of the retina called the macula. It plays a major role in providing visual function. Age-related macular degeneration is one of the main causes of complete loss of vision in people over the age of fifty.

Macula is considered one of the important elements. Thanks to her work, a person sees objects that are located close to the eye, and also has the ability to read, write and perceive colors. The exact reasons for the occurrence of such a pathology have not yet been found. But age is considered to be the main factor.

It is also customary to attribute the following to the main reasons.

Gender. According to statistics, the female half of the population is much more likely to suffer from an illness.
Hereditary predisposition.
Excessive body weight.
The presence of bad habits in the form of smoking and drinking.
Lack of vitamins and minerals.
Long-term exposure to ultraviolet rays on the retina.
Injury to the optic organ.
Poor environmental situation.

Types of macular degeneration of the retina

Malacular dystrophy, as it develops, can go through various stages and forms. As a result, it can be divided into two types. This includes.

Dry form of macular degeneration. It is the initial stage of the disease and is considered the most common, since about ninety percent of the population suffers from it. It is characterized by a gradual loss of the central part of vision. But often the patient does not notice this.
Wet form of macular dystrophy. This stage manifests itself in the event that the dry form of the disease has not been diagnosed. The development of the disease is aggravated by the fact that new blood vessels of a fragile and brittle nature are formed. As a result, hemorrhage and the formation of yellow clusters in the retina occurs.

The gradual loss of central visual function leads to the inability to distinguish between small objects. The dry form of the disease is not as bad as the wet one. But if the disease is not diagnosed in time and the appropriate treatment is not started, then this threatens with degradation of retinal cells and complete loss of visual function. Wet macular degeneration occurs in ten percent of all cases. In the presence of this form, the process of growth of new vessels occurs. The walls of such tubules are underdeveloped, therefore, they allow blood to pass into the retina. As a result, the susceptibility of cells increases, due to which they die off and form spots in the central part of the view.

Macular dystrophy causes a gradual but painless loss of visual function. Only in the rarest situations, blindness occurs instantly. The main symptoms of macular degeneration are usually classified as follows.

The appearance of dark spots in the central part of the visual field.
Fuzzy image.
Distortion of objects.
Deterioration in color perception.
Deterioration of visual function at night.

Diagnosis of macular degeneration of the retina

It should be noted that the most elementary method for determining macular dystrophy is the Amsler test. A grid consisting of intersecting lines with a black dot in the middle is placed on the wall. The patient needs to look at her. A person who has a similar disease will see the lines fuzzy and broken, and a large dark spot will be located in the central part.

The optometrist will be able to recognize the disease even before the changes in visual function. For an accurate diagnosis, the patient needs to be examined.

Visometry. Using the method, you can assess visual acuity.
Ophthalmoscopy. Examines the condition of the retina and vascular tubules in the fundus.
Bio-ophthalmoscopy. Used to examine the fundus.
Optical coherence tomography. This method is considered the most effective for diagnosing macular degeneration at the initial stage.
Amsler test. This method can be carried out at home on your own.

Retinal macular degeneration treatment process

Macular dystrophy cannot be completely cured. But in practice, there are methods that allow you to overcome the disease and stop its progression. This includes the following procedures.

Laser therapy. With the help of a laser device, blood vessels that have been disturbed are removed.
Treatment of a photodynamic nature. The purpose of this method is to inject a special drug into the bloodstream that can penetrate the destroyed vessels of the eye. After that, they take a laser device that helps to hit new vessels of the pathological type.
Anti-angiogenesis factor. Thanks to such means, it is possible to stop the growth of pathological tubules.
Devices for impaired vision. Since macular dystrophy deprives a person of the ability to fully see, specialized electronic devices and lenses compensate for this loss, while creating an enlarged image of the surrounding world.

If the above methods do not help or an advanced stage is observed, then the patient is prescribed the following.

Submacular surgery. It is characterized by the removal of pathological vessels.
Retinal translocation. In such a situation, the affected vessels are eliminated under the retina.

In case of dry type macular degeneration, antioxidant therapy is recommended to normalize metabolic processes in the retina. According to statistics, an excellent result from the use of antioxidants was observed in those patients who were on an intermediate or advanced form of the disease. Combination treatment with antioxidants, zinc and copper significantly reduced the development of macular degeneration by twenty percent.

Treatment of wet type of dystrophy is aimed at reducing the growth of the affected vessels. In medicine, there are several means and methods that stop the manifestation of abnormal neovascularization.

Treatment of macular degeneration of the retina by alternative methods

Each patient is looking for the best way to treat macular dystrophy. One of these is treatment with folk remedies.

Use of goat milk. It has unique properties. It is enough to mix a little with water in equal parts and drip one drop into each eye. A dark bandage is then placed over the eyes and rest for half an hour. The treatment course lasts seven days.
The use of coniferous broth. To prepare the infusion, you need to add needles, rose hips and onion scales. Cover with water and boil for about ten minutes. After that, the broth should cool. You need to consume up to one and a half liters per day. The course of treatment is one month.
Using celandine. To prepare the infusion, you need to take one spoonful of dry leaves and pour a mug of boiled water. Place on fire for a few seconds and let it brew. The infusion must be filtered and placed in the refrigerator. The broth is used as eye drops. The duration of the treatment course is one month.
Lotions from a decoction based on nettle and lily of the valley. It is necessary to take herbs in equal proportions and pour a mug of boiled water. Let it brew for twenty minutes, then strain. Lotions must be done at least three times a day for two weeks.

Preventive measures to prevent macular degeneration of the retina

Macular dystrophy leads to various complications up to loss of visual function. But in order to warn yourself against the development of the disease, you need to follow several recommendations. These include the following activities.

Passing an annual examination by an ophthalmologist.
The use of sunglasses.
Quitting bad habits such as smoking and drinking alcohol.
Restriction in the intake of food of a fatty nature. It is also necessary to enrich the diet with vegetables, fruits and fish.
The use of vitamin complexes for the visual organ.
Leading a healthy lifestyle.
Timely treatment of any disease.
Conducting daily gymnastics for the visual organ.
Organization of good sleep and rest.

Previously, the disease was considered age-related, but nowadays you can find patients under forty years old. Therefore, do not forget about the health of the visual organ and adhere to all the recommended rules.

An important component of the structure of the visual apparatus is the retina, which ensures the unimpeded passage of light impulses. Under the influence of a number of factors, various degenerative processes can occur in the eyeball, which lead to loss of vision. One of the forms of such degeneration is macular degeneration - tissue death in the central part of the retina.

Macular degeneration is an ophthalmic disease in which the retinal tissue is damaged in its central part, which is commonly called the macula or yellow putu. In a normal state, the macula provides good color perception and high visual acuity. But with age, degenerative processes begin to occur in the structure of the eyeball, as a result of which central vision is impaired. Most often, this form of dystrophy occurs in the elderly, therefore it is also called age-related macular degeneration (AMD).

Stages of macular degeneration

Depending on the neglect of the degenerative process, 2 stages of the development of macular degeneration are distinguished:

Early. Age-related maculopathy is characterized by changes in the fundus that are almost asymptomatic. Taking into account the degree of changes, the doctor determines the rate of progression of the disease and selects conservative treatment.
Late. Launched dystrophic process, in which the eyeball undergoes serious changes. The ocular structure undergoes fibrous degeneration, hypersensitive cells rapidly die, provoking loss of vision. The dry and wet form of late retinal AMD is distinguished. Treatment in the late stage of macular degeneration of the eye should be started as early as possible, otherwise there is a high likelihood of complete loss of central vision.

In the early stages of the pathological process, there is a slight distortion of vision, which, without proper treatment, progresses and leads to severe complications. However, AMD cannot become a complete cause, since the peripheral part of the retina is not damaged.

Dry form

Dry or atrophic form of retinal macular degeneration occurs in most cases, resulting from age-related changes in the structure of the eye and impaired blood supply. It is characterized by slow progression and minor vision loss. In the area of the macula and the posterior pole, yellow spots (drusen) are formed, which affect the photoreceptors and provoke a gradual decrease in visual acuity.

Central vision deteriorates, a person begins to experience difficulties in distinguishing colors and small details. Atrophic age-related macular degeneration first affects one eye, and then spreads to the second organ of vision.

There is currently no effective treatment for dry retinal AMD.

Wet form

In 20% of cases, dry macular degeneration can progress to a wet form of degeneration, which is characterized by rapid loss of vision. Wet or exudative age-related macular degeneration of the retina is much less common, but it poses a great danger to the human visual system. With this form of pathology, new blood vessels are formed, growing in the direction of the macula. These vessels are capable of rupture and scarring, causing the death of photoreceptors.

The wet form of AMD is characterized by rapid progression and rapid loss of the central visual field; the prognosis is poor. First, the patient complains of image distortion, then light glare, lines appear in the field of view, and a little later a blind spot forms.

Symptoms

At the initial stage, macular degeneration develops asymptomatically, the patient may notice only a slight deterioration in the quality of vision. With the progression of the pathological process, the following symptoms begin to appear:

blurred image;
violation of color perception;
poor visibility in dim lighting;
shroud, dark spots in front of the eyes;
increased sensitivity to light;
violation of the outlines of objects;
curvature of straight lines.

The clinical picture of senile macular degeneration can develop gradually or rapidly. There is a progressive deterioration in central vision, as a result of which the patient begins to experience difficulties in reading, recognizing faces, working with small details and correctly identifying colors.

Pain and discomfort in the eyes with this disease is not observed.

Diagnostics

With pronounced symptoms of the degenerative process, the correct diagnosis is usually not difficult. To determine the form of pathology and select an effective treatment, the doctor first of all conducts a thorough survey and examination of the patient, after which he prescribes various diagnostic measures:

ophthalmoscopy;
biomicroscopy;
fluorescent angiography;
optical coherence tomography;
Indocyanine green angiography;
computer perimetry;
test with Amsler lattice.

You can also diagnose macular degeneration at home. To do this, you need to take a sheet from a notebook in a cage, cut out a 10 by 10 cm square from it and put a black dot in the middle. Next, this sheet must be attached to the wall, stand at a distance of 1 meter from the sheet, close one eye and slowly approach the wall, stopping 15 cm from the depicted point.

The presence of retinal dystrophy will be signaled by curved lines and dark spots.

Conservative treatment

It is impossible to cure the dry form of age-related macular degeneration in a conservative way. However, to normalize metabolic processes, antioxidant and vitamin therapy can be prescribed. Several modern clinics conduct research on cell transplantation. The therapy involves the intraocular administration of the drug Ailia or Lucentis. Additionally, antioxidants, immunostimulants, vitamins and folic acid are prescribed.

Laser treatment

The most effective treatment for any form of macular degeneration is laser coagulation, which stops the growth of blood vessels and blocks bleeding. Laser therapy stops visual impairment and helps to achieve a positive result, but its duration may not be long-term. With dry AMD, laser removal of drusen is performed. The wet form of the disease can be treated by laser activation of the drug administered intravenously.

Operative treatment

In addition to laser coagulation, for macular degeneration, radiation or photodynamic therapy can be performed. Sometimes a submacular operation is prescribed, the essence of which is the excision of the formed pathogenic vessels of the retina. Surgery helps to eliminate drusen, bleeding and unnecessary vessels, due to which the degenerative process stops and further loss of vision does not occur.

Indications for surgery for AMD

Surgical treatment of retinal degenerative processes is prescribed if it is not possible to eliminate the pathology in a conservative way. The operation can be performed by any patient who has a significant deterioration in central vision and there is a high likelihood of complications. The presence of concomitant ophthalmic diseases can also become an indication for surgery. Before carrying out a surgical intervention, it is necessary to consult a doctor and make sure that there are no contraindications.

Treatment of AMD with folk remedies

In addition to the main method of therapy with the permission of the doctor you can use the following folk remedies:

Mix 100 ml of aloe juice and 50 grams of mummy. Use the resulting product for instillation of the eyes, 1 drop twice a day for 10 days.
Combine 50 ml of goat's milk and water, add 1 drop of the resulting product, then cover the sore eye with a dark bandage for 30 minutes. Repeat the procedure for 7 days.
Boil 1 tablespoon of calendula flowers in a glass of boiling water for 5 minutes, let it brew, strain and instill 2 drops in the eyes, and also take 50 ml orally for six months.

Another good folk remedy for macular degeneration is hirudotherapy (treatment with leech saliva).

What not to do with macular degeneration

If a diagnosis of macular degeneration has been made, then it is strictly forbidden to let the disease take its course or to self-medicate. It is necessary to follow the treatment prescribed by the doctor and follow all recommendations. In case of age-related macular degeneration, it is prohibited.

In people with macular degeneration, the macula, the area responsible for central vision, is damaged. The disease leads to the destruction of the retinal nerve cells responsible for the perception of light waves.

As a result, patients' visual acuity decreases. It becomes difficult for them to read, watch TV, recognize friends on the street and even do their usual daily work. Treatment of retinal macular degeneration can slow the progression of the disease, but not cure it.

Causes

The reliable cause of retinal macular degeneration has not yet been established. However, there are several theories to explain the appearance of degenerative changes in the macula. Scientific studies have shown that they all make sense.

Theories of the development of macular degeneration:

Lack of vitamins and minerals. Many scientists believe that the deficiency of certain vitamins, antioxidants, carotenoids, zinc, zeaxanthin and lutein contributes to the development of the disease. Due to the lack of biologically active substances, the retina begins to gradually collapse, and the person goes blind.
High cholesterol and "wrong" fats. Scientific studies have shown that age-related macular degeneration occurs more often in people who consume a lot of saturated fatty acids and cholesterol (these substances are found in animal products, some vegetable oils, confectionery). But people who eat enough monounsaturated fats (in particular omega-3 fatty acids) are much less likely to get sick.
Smoking. It is known that cigarette abuse increases the risk of developing the disease by about three times. The link was established through thirteen different scientific studies.
Cytomegalovirus infection. Scientists claim that CMV is one of the factors causing the development of the wet form of age-related macular degeneration. It is worth noting that more than 80% of the world's population is infected with this virus, however, most are only asymptomatic carriers.
Hereditary predisposition. British scientists have discovered six mutations in the SERPING1 gene associated with the development of pathology. This explains the fact that close relatives have the disease much more often. As statistics show, women are more susceptible to macular degeneration.

Dystrophy of the macular zone develops due to impaired blood circulation in the small vessels of the retina. The reason for this may be atherosclerotic changes, capillary sclerosis or their spasm in smokers. Lack of blood leads to oxygen starvation of the retina. As a result, the patient begins to gradually collapse the macula.

Macula consists of a huge number of cones - nerve cells responsible for visual perception. For their normal functioning, vitamins, minerals and pigments are needed. Therefore, the lack of zinc, vitamins A, E and C, lutein and zeaxaltin in the body leads to malfunction of the rods and the development of macular degeneration.

Forms of the disease

Ophthalmologists distinguish dry and wet forms of age-related macular degeneration. The first occurs in 90% of cases and has a relatively favorable course. It develops very slowly and rarely leads to complete blindness. The wet form of the disease is much more dangerous. It progresses rapidly and causes a sharp deterioration in vision.

Dry

A yellow pigment accumulates in the macular region, which over time damages the light-sensitive cones. Initially, the disease affects one eye, later the second is involved in the pathological process.

With a dry form of macular degeneration, symptoms appear gradually and very slowly. As a rule, people go to the doctor in the late stages of the disease. It is almost impossible to restore vision in this case.

Wet

The wet form of age-related macular degeneration is characterized by pathological proliferation of blood vessels towards the macula. Fluid from the newly formed capillaries seeps out and permeates the retinal tissue, which leads to its edema. As a result, the patient's vision is very distorted.

Wet macular degeneration almost always develops against a dry background. This means that it affects sick people who already have dystrophic changes in the macular region. The wet form of the disease is ten times more likely to lead to complete blindness than the dry one.

Stages

In its development, dry macular degeneration passes through several successive stages. An ophthalmologist can distinguish them after examining the patient. To assess the severity of the disease, he needs to examine the fundus. For this purpose, he performs direct or indirect ophthalmoscopy.

Stages of dry macular degeneration:

Early. Has an asymptomatic course. The disease is detected by chance, during preventive examinations. With ophthalmoscopy on the fundus, the doctor detects small and medium-sized drusen. Outwardly, these formations have the appearance of rounded yellow-white spots.
Intermediate. During the examination, drusen of medium and large sizes or geographic atrophy of the macula, not affecting the central fossa, are revealed. At this stage, patients notice the appearance of a fuzzy spot in front of the eyes. Visual acuity begins to gradually decline.
Expressed... Due to the destruction of light-sensitive cells (cones), the patient's vision is greatly impaired. Geographic atrophy spreads to the central fossa, which is why a large black spot appears in front of a person's eyes, which makes it difficult to look at the world normally. At a pronounced stage of the disease, signs of neovascular maculopathy appear in the macular region.

Subsequently, active proliferation of blood vessels continues in the macular region. Soon, they begin to rupture with the formation of hemorrhages. Thus, the patient develops a wet form of the disease. Photoreceptors quickly die, and a person irrevocably loses his sight.

Symptoms

The dry form of age-related macular degeneration is characterized by a slow development of symptoms. At first, the patient notices that he needs a brighter light for reading. It becomes difficult for him to navigate in the dark, especially when entering a dark room from a lighted one. The person does not feel any pain in the eyes. Over time, the patient's vision is distorted, which greatly interferes with reading and disrupts the usual way of life. The patient has difficulty recognizing familiar faces and is poorly oriented in space.

Some people have what are called Charles Bonnet hallucinations. They are characterized by the appearance before the eyes of non-existent geometric figures, animals and even human faces. Many patients hesitate to talk about this symptom, because they are afraid that they will be mistaken for crazy.

The wet form of macular degeneration is manifested by a rapid decrease in visual acuity. In some cases, a dark spot (scotoma) appears before the eyes, preventing the patient from seeing normally. To a person with a wet form of macular degeneration, straight lines appear curved, wavy, distorted.

Which doctor deals with the treatment of macular degeneration of the retina

An ophthalmologist deals with the treatment of the dry form of the disease. At the appointment, he carefully examines the patient and prescribes suitable medications for him. Then the doctor puts the patient on the dispensary and explains that he will have to come for scheduled examinations once a year. Regular visits to an ophthalmologist allow you to notice the progression of the disease and take appropriate measures in time.

In the case of the development of a wet form, a person needs the help of a vitreoretinal surgeon or a laser ophthalmologist surgeon. These specialists are involved in the diagnosis and treatment of the vitreous body. They are eligible to perform intravitreal injections and laser surgeries.

Diagnostics

It is possible to suspect macular degeneration by the characteristic complaints of the patient and progressive deterioration of vision. To confirm the diagnosis, ophthalmologists use a number of additional research methods. With their help, you can establish the form and stage of the disease.

Methods used to diagnose macular degeneration:

Method	Target	results
Visiometry	Determine the visual acuity of each eye	Decreased visual acuity indirectly indicates damage to the macular region of the retina
Perimetry	Identify scotomas (defects in the visual field)	The appearance of a central scotoma (spots in front of the eyes) indicates the presence of pathological changes in the macula of the retina
Amsler test	Check if the person has vision distortion	A sheet of paper with a drawn even lattice is placed in front of the patient and asked to take turns looking at him with each eye. If the lines seem crooked or wavy to a person, the test is positive
Ophthalmoscopy	Detect pathological changes in the retina of the eye	With different forms of macular degeneration, the doctor can see drusen, newly formed vessels, foci of hemorrhagic impregnation and hemorrhage
Fluorescein angiography (FAG)	Examine the vessels of the retina.	In the picture, you can see absolutely all the vessels of the fundus and their location. The release of the contrast agent outside the vascular bed indicates capillary ruptures and hemorrhages.
Optical coherence tomography (OCT)	See structural changes in the macular area	In the early stages of the disease, OCT allows one to see the initial degenerative changes in the retina. When wet, the image usually shows macular edema.

Conservative treatment

In the initial stages, retinal macular degeneration is treated conservatively. To combat pathology, antioxidants, visual pigments, carotenoids and certain trace elements (zinc, copper) are used. In some cases, courses of anticoagulant therapy are carried out, sometimes preference is given to taking medications on a regular basis.

Vitamin-mineral complexes (VMC) inhibit the progression of the disease and help delay the development of irreversible changes in vision. Many doctors are skeptical about this treatment, but recent scientific studies have proven its effectiveness.

Effective IUDs should contain the following components:

lutein;
zeaxaltin;
anthocyanins;
lycopene;
beta carotene;
vitamins E, A, C;
copper;
zinc;
omega-3 fatty acids.

Among the vitamin and mineral complexes, the most effective in the treatment of macular degeneration are the following drugs:

Focus;
Nutrof Total;
Lutein Complex;
Vitrum Vision Forte;
Complivit Ophthalmo;
Okuwaite Lutein.

They have the richest and most balanced composition, due to which they actively nourish the mesh membrane and protect it from destruction.

Treatment of macular degeneration of the retina cannot do without a balanced diet. The patient should eat more green vegetables, carrots, fresh fruits, berries. Sprouted cereals and legumes are very useful in this regard. But rich broths, fatty meats, fried, salty and smoked foods should be excluded from the diet, since they can aggravate the course of the disease.

For the treatment of macular degeneration of the retina, you can additionally use folk remedies. Among them are:

aloe;
mummy;
calendula;
caraway;
celandine;
medical leeches.

It should be noted that traditional medicine methods do not always give the expected results and cannot replace traditional treatment.

Modern methods of treatment

Nowadays, several progressive techniques are used to treat age-related macular degeneration of the retina. They are effective in the last stage of dry and wet forms of the disease. With their help, it is possible to stop the proliferation of small vessels and the destruction of the macular region of the retina.

Intravitreal administration of anti-VEGF drugs

Since in the last stages retinal macular degeneration is accompanied by neovascularization, patients are prescribed drugs that destroy abnormal vessels and prevent their further proliferation. Medicines are injected intravitreally, that is, into the vitreous cavity.

Anti-VEGF drugs include:

Lucentis;
Ailia;
Makugen.

After administration of the drug, patients soon notice an improvement in vision. However, to obtain permanent visible results, at least 5 injections per year are required. The duration of anti-VEGF therapy should be at least 2 years. Unfortunately, due to the high cost, many people cannot complete the full course of treatment and are limited to 2-3 injections.

Retinal laser coagulation

The procedure is aimed at destroying newly formed vessels. The doctor uses a laser to clog the bleeding capillaries, thereby preventing the appearance of hemorrhages and foci of hemorrhagic leakage.

Unfortunately, laser coagulation does not affect the cause of the disease and does not prevent further neovascularization. Moreover, the laser cannot remove the vessels located in the macular region. This means that laser coagulation itself is ineffective. Therefore, the procedure is usually performed in conjunction with intravitreal administration of anti-VEGF drugs.

Photodynamic therapy

The essence of the procedure is the intravenous administration of light-sensitive drugs, followed by exposure to the retina with laser beams. With the help of photodynamic therapy, it is possible to remove fluid accumulated under the retina and even partially restore lost vision. The procedure is especially effective in the treatment of wet retinal macular degeneration.

Due to the high cost of drugs, such treatment is practically unavailable in our country. Abroad, photodynamic therapy is used together with intravitreal administration of anti-VEGF drugs.

When you need surgery

Surgical treatment of macular degeneration is necessary in the case of massive hemorrhages under the retina and the appearance of subretinal membranes. Surgical intervention helps to remove the serious consequences of the disease and partially restore vision.

Type of operations for macular degeneration:

Retinotomy. With the help of special equipment, the surgeon removes the vitreous body, which allows him to gain access to the macular area. Then he cuts the retina and removes the accumulated fluid from under it. Instead of the vitreous body, he injects a special solution.
Macular translocation. The operation also begins with a vitrectomy. During surgery, the doctor gently moves the macular area of the retina to the desired location. This allows for improved vision.
Pneumatic displacement of submacular hematoma. The surgeon introduces air into the eye cavity, which displaces the outflowing blood. After the procedure, the retina returns to its place, and the person sees much better.

Prophylaxis

A healthy lifestyle is very important for the prevention of disease. A person needs to quit smoking and exclude unhealthy foods from the diet. In the bright sun, he should wear wide-brimmed hats and sunglasses. Also, regular exercise will not hurt.

People over 50 years old, whose relatives suffered from macular degeneration, should take vitamin-mineral complexes for preventive purposes. Regular visits to the ophthalmologist are also mandatory. It is necessary to attend preventive examinations at this age at least once a year.

Useful video about retinal macular degeneration

The retina is responsible for human vision. Due to the development of macular degeneration, this part of the eye is damaged. Therefore, a person sees a blurry picture. In the presence of macular degeneration of the retina, medical or surgical treatment is prescribed, depending on the form and severity of the disease.

Macular degeneration of the eye - damage to the central part of the retina. The main reason for the development of pathology is insufficient blood flow. A yellow pigment accumulates around the macula. This damages the light-sensitive cones. First, vision deteriorates in one eye, and later in the other.

Dystrophic changes rarely appear at the age of 17-18. More often, the disease occurs in people over 50 due to age-related changes. It usually affects both eyes.

With macular degeneration, the first symptoms do not appear immediately. In such cases, people turn to an ophthalmologist when they have the last stage of the development of the disease. Therefore, it is impossible to completely restore vision.

In the presence of macular degeneration, they give disability, but the group depends on the severity and form of the disease. If the visual acuity decreases to 0.03, the person is assigned the 1st disability group. With a slight decrease to 0.1, the third group is given. In other cases, the 2nd group is assigned.

Macular degeneration does not lead to complete loss of vision. The disease affects a person's ability to work. It makes it difficult to drive a car, watch TV, recognize others, and count money.

Classification

In ophthalmology, pathological changes in the macular zone of the retina are dry and wet. In the first case, the disease is treated successfully. Macular degeneration in dry form is characterized by slow development. Wet retinal macular degeneration is dangerous for humans, as it progresses rapidly. Therefore, vision is rapidly deteriorating.

Wet macular degeneration with age-related changes is characterized by the proliferation of blood vessels that are directed towards the macula. Therefore, the liquid from the new capillaries flows out and permeates the tissue of the retina of the eye. As a result, this is the place.

The wet form of macular degeneration is the result of advanced dry macular degeneration. In contrast to the dry form, the wet form leads to a complete loss of vision. Dry dystrophic changes in the macula are distinguished according to the stages of development:

Initial. There are no symptoms. The disease is diagnosed at random when passing a medical commission. An ophthalmological examination of the fundus of a person reveals yellow spots. These neoplasms are called druses. At the beginning of the development of macular degeneration, they are small, almost invisible.
Intermediate. When examined, medium and large drusen are found. A person with such a stage is no longer able to distinguish objects.
Pronounced or last. With the destruction of light-sensitive cells, vision is sharply reduced. Dystrophic changes lead to disruption of the central vision. A person sees one solid spot of black color.

Causes

The exact causes of retinal macular degeneration are not known today in ophthalmology. Many doctors are sure that vascular changes in the macular region provoke the disease.

Scientists say that the disease is observed mainly in an elderly person. According to medical statistics, only 2% of people develop macular degeneration by the age of 55. But at 75 years of age, the risk of occurrence rises sharply to 30%. Wet macular degeneration appears in a rare case.

Symptoms

Macular degeneration of the retina differs in the stages and forms of the disease. Consider common symptoms:

distorted vision;
hallucinations in the form of distorted straight lines;
difficulty reading books;
poor visibility in the dark;
spots, dots in front of the eyes.

These symptoms appear on one or two eyes. In the second case, the person gradually gets used to the new state, therefore, starts the disease.

As a person with retinal macular degeneration sees:

You can see in more detail about the symptoms of this disease in the following video:

Diagnostics

First, the ophthalmologist examines the fundus. A person is given special drops in both eyes to dilate the pupils. The optometrist then examines the eye for 15 minutes.

Sometimes a diagnostic method is used at home - the Amsler test. This uses a special mesh and fluorescent angiography. In the presence of degenerative changes in the central region of the retina, a person does not see a spot in the center of the field.

Treatment

Treatment of dry macular degeneration of the retina is carried out with the use of medications. During therapy, a person is prescribed special drops, ointments. In the treatment of wet retinal macular degeneration, surgical and laser operations are used.

Conservative

Treatment of the initial stage of retinal macular degeneration involves the use of drops. To cure the disease, visual pigments, antioxidants and drops, which contain zinc and copper, are instilled into the eye.

A person can be prescribed vitamin-mineral complexes, the task of which is to slow down the development of pathological changes in vision. The composition of full-fledged vitamin and mineral complexes against retinal macular degeneration contains the following components:

zinc;
vitamins of groups A, C, E;
copper;
lycopene;
lutein;
omega-3 fatty acids;
beta carotene.

After diagnosis, the doctor prescribes medications containing vitamins and minerals:

"Complivit Oftalmo", is prescribed for periodic visual fatigue;
"Lutein Complex", used as a food supplement for vitamin deficiency;
"Metmorphine" is used as a prophylactic agent against ophthalmic complications for people with diabetes;
“Vitrum Vision Forte” is prescribed for changes in the macular area in the central or peripheral part.

In addition to taking these drugs, a person should eat a balanced diet. With dystrophic changes in the central part of the retina, it is forbidden to eat fatty foods:

rich soups;
pork;
smoked meats;
fried, salty foods.

Surgery and laser

Laser coagulation of the retina is used for the wet form of macular degeneration. During the operation, fragile, leaking vessels that have formed during the course of the disease are removed. The laser targets the vessels and destroys them, preventing loss of vision.

But sometimes surgery and laser surgery damage healthy blood vessels. Because of this, vision deteriorates. The surgical method of treatment is used only when the newly formed vessels are located farther from the central fossa of the macula.

Video about laser coagulation of the retina, see below:

Modern methods

Today it is treated with progressive methods. This therapy is effective in severe dry or wet form. The essence of modern treatment is to prevent the proliferation of small vessels, destruction of the macula. For this, the special Argus 2 glasses were invented in the UK.

People's

It is impossible to completely restore vision in the presence of degenerative changes in the retina. Treatment of macular degeneration of the retina involves the use of folk remedies. Consider non-standard medicine prescriptions:

The washed, sorted wheat is laid out in a thin layer, filled with water. After germination, the wheat is washed. The resulting consistency is passed through a meat grinder. The received medicine is stored in a cool place. People with macular degeneration are supposed to eat this wheat every morning until 5 tsp. Berries and honey are added for taste.
To restore vision, you will need an infusion of mummy and aloe juice. 5 g of mummy is mixed with 100 ml of fresh juice. The resulting solution is stored on the top shelves of the refrigerator. It is necessary to bury the prepared drops 2 r / day. The course of treatment is 15 days. Then there is a break for a week. If necessary, therapy is resumed.
Compliance with a diet prevents further development of the disease. It is important to eat foods that are filled with vitamins, useful microelements.

Prophylaxis

Age-related dystrophic changes in the retina now appear at an early age. Therefore, it is necessary to observe the measures for the prevention of macular degeneration:

Rejection of bad habits. It has been proven that alcohol and cigarettes age the body.
Eye protection in sunny weather. Ultraviolet exposure negatively affects the structure of the retina. Therefore, you need to wear sunglasses.
Annual examination by an ophthalmologist. A timely visit to a doctor is a guarantee of health.
Partial elimination of high cholesterol foods from the diet.
Hypertension cannot be ignored. The disease must be treated.
Take vitamin complexes if there is a hereditary predisposition to the disease. Many beneficial elements are found in vegetables, berries, fruits and seaweed.

At the first suspicion of retinal macular degeneration, it is necessary to consult a doctor. With timely treatment, the disease will not lead to irreversible consequences.

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