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AMD (age-related macular degeneration)


Maintaining good vision until old age is very difficult. Often in old age, the ability to see is gradually lost. This is due to the fact that all human organs begin to “wear out” over time. One of the first to suffer is eye tissue. It is believed that vision deteriorates from 40-45 years. This happens even in cases where a person previously had no problems with vision throughout life. Visual impairment occurs gradually. Most people are concerned about “farsightedness,” that is, the inability to see objects close by. Sometimes, more serious problems develop. These include pathologies such as cataracts, glaucoma, etc. Age-related macular degeneration is considered another common disease. Such an ailment is dangerous in that it can lead to loss of vision.

The concept of age-related retinal degeneration

Age-related macular degeneration (AMD) is a pathology that develops due to dystrophic processes in the retina of the eye. This area is directly connected to the brain (it is a peripheral analyzer). With the help of the retina, the perception of information and its transformation into visual images is formed. On the surface of the peripheral analyzer there is a zone that contains many receptors - rods and cones. It is called a macula (yellow spot). The receptors that make up the center of the retina provide color vision in humans. In addition, it is in the macula that the focusing of light occurs. Due to this function, a person’s vision is clear and precise. Age-related macular degeneration of the retina leads to dystrophy of macular tissue. Not only the pigment layer undergoes changes, but also the vessels that feed this area. Despite the fact that the disease is called “age-related macular degeneration”, it can develop not only in older people. Often, the first symptoms of pathological changes in the eye begin to be felt by the age of 55. By the elderly and senile age, the disease progresses to such an extent that a person can completely lose the ability to see.

Age-related macular degeneration of the retina is a common ailment. Often this pathology becomes the cause of disability and disability. It is widely distributed in America, Asia and Europe. Unfortunately, the disease is often diagnosed in the later stages. In these cases, you have to resort to surgical treatment. However, with timely therapeutic treatment, as well as the implementation of preventive measures, it is possible to avoid surgical intervention and complications of pathology (blindness).

Causes of age-related macular degeneration

Like all degenerative processes, this disease has a tendency to slow and progressive course. The causes of dystrophic changes in the macula of the retina can be various. The main one is the involution of eye tissue. Nevertheless, in some people, dystrophic changes occur faster, while in others - more slowly. Therefore, there is an opinion that age-related macular degeneration is inherited (genetically), and also prevails among people of European nationality. Other risk factors include: smoking, hypertension, frequent exposure to the sun. Based on this, we can identify the causes of macular degeneration. These include:

  1. Vascular lesions. Atherosclerosis of the small arteries is considered one of the risk factors. Disruption in the delivery of oxygen to the tissues of the eye is one of the main mechanisms for the development of degeneration.
  2. Overweight.
  3. Lack of vitamins and certain trace elements. Among the substances necessary to maintain retinal tissues, there are: lutein and zeaxanthin.
  4. The presence of a large number of "free radicals." They increase the risk of organ degeneration several times.
  5. Ethnic features. The disease is more common in people with light-colored eyes. The fact is that among the representatives of the Caucasian race, the density of the pigment contained in the retina is low. For this reason, dystrophic processes develop faster, as do the symptoms of the disease.
  6. Improper nutrition.
  7. Being in direct sunlight without safety glasses.

Pathology often develops in people with a burdened hereditary history (the presence of the disease in parents and grandmothers). In most cases, the disease is diagnosed in the female population.

Age-related macular degeneration: the pathophysiology of the process

Like all degenerative changes, this disease has a complex development mechanism. In addition, the pathogenesis of dystrophic processes is still not fully understood. It is known that under the influence of adverse factors, the tissue of the macula is irreversibly damaged. Most often, pathology begins to develop in people suffering from vascular diseases (atherosclerosis, diabetes mellitus), and obesity. Also, the disease is almost always found among the smoking population. Due to blockage of the vascular bed and insufficient nutrition of eye tissues, age-related macular degeneration develops. The pathogenesis of the disease is based on a violation of the redox balance. The main role in this process is played by free radicals. These substances form in the macula for several reasons. Firstly, oxygen and light constantly influence the macula of the retina. In addition, in this area there is an accumulation of fatty acids, which tend to oxidize. Another factor in the pathogenesis of the development of pathology is the origin of the retina. After all, this shell of the eye is considered a peripheral analyzer and is directly connected to the brain. Therefore, it is particularly sensitive to "oxygen starvation."

All of these factors predispose to the fact that the tissue of the macula is gradually thinning. As a result of exposure to radicals, cell membranes are destroyed. The retina becomes even more sensitive to light. Under the influence of ultraviolet and infrared radiation, AMD develops even faster. All these processes lead to the fact that the macula epithelium begins to “lose” pigment receptors and undergo atrophy. If the destruction of the macula is not stopped in time, tissue detachment occurs. The final stage is the appearance of scars and the development of blindness.

Forms of age-related retinal degeneration

There are 3 forms of macular degeneration. This classification is based on morphological changes occurring in retinal tissue. Such a division is necessary to determine the tactics of treating the disease.

Morphological types of disease:

  1. Age-related macular degeneration - wet form: characterized by the presence of exudate. This option is rare, in 20% of cases. It is characterized by a rapidly progressive course. If a person's vision is rapidly deteriorating (within a few days), then it is worth suspecting a disease such as age-related macular degeneration. The wet form develops due to neovascularization, that is, the appearance of a large number of new vessels on the retina. Given damage to cell membranes, their permeability increases. As a result, edema and hemorrhages develop.
  2. Age-related macular degeneration - dry form: characterized by a slow course. In another way, this type of pathology is called atrophy. Dry age-related macular degeneration develops in 90% of patients. On examination, drusen are noted - light foci of atrophy, pigment layer insufficiency, defects on the epithelium.
  3. Cicatricial form of macular degeneration. It is considered the final stage of AMD. It is characterized by detachment of the epithelium and the formation of connective tissue (scar). In this case, complete loss of vision is noted.

In some cases, the dry form of AMD turns into an exudative variant of the disease. Most often this occurs with vascular lesions, and in particular with diabetic retinopathy. Such changes indicate a worsening forecast and are a signal for urgent measures.

Symptoms of age-related macular degeneration

Depending on the form of AMD, the symptoms of the disease can develop both slowly and quickly. Often, for a long time, macular degeneration has not been felt for several years. With a dry form of AMD, druses appear on the surface of the retina - areas of atrophy. As a result, vision is gradually deteriorating. The pigment layer suffers to a greater extent, because of which the brightness of the colors is somewhat lost. Visual acuity may vary, but not significantly. The wet form of macular degeneration develops rapidly. In a few days, vision can significantly deteriorate, up to complete blindness. Due to edema and increased permeability of the membranes, hemorrhages can occur that are visible to the naked eye. Symptoms observed in AMD:

  1. Change the contrast and brightness of the image.
  2. Decreased visual acuity.
  3. Curvature, distortion of objects.
  4. Blurred image.
  5. The appearance of loss of visual fields.
  6. Inability to read despite wearing glasses.

With the gradual development of pathology, signs of the disease may be absent for a long time. Then a gradual deterioration of central vision occurs. When looking forward, most of the image becomes blurred. Nevertheless, peripheral (lateral) vision is maintained. Gradually, the affected area increases.

With a wet and scarred AMD, blindness occurs quickly. Unlike the dry type of degeneration, peripheral vision is rarely maintained. With timely treatment of AMD, the development of blindness can be stopped.

Diagnosis of age-related retinal degeneration

Age-related macular degeneration can be diagnosed in the early stages. Therefore, people suffering from vascular lesions need to be examined by an ophthalmologist 1-2 times a year. Diagnosis of AMD is based on anamnesis and a special examination. Older people often complain about the appearance of a "spot" in front of their eyes, resembling fog. The diagnosis of "macular degeneration" is most often made with visual impairment in women, especially if there is a history of type 2 diabetes mellitus, vascular atherosclerosis. In addition to the survey, a number of ophthalmological examinations are performed. Among them - the measurement of visual acuity, perimetry, stereoscopic biomicroscopy.

To assess the condition of the vessels, conduct fundus fluorescence angiography. Thanks to this study, it is possible to detect areas of epithelial detachment, atrophic drusen, neovascularization. However, such a method of instrumental diagnostics has contraindications and risks. Therefore, before deciding to have an examination, it is worth visiting an ophthalmologist and getting his consultation.

How to treat a dry form of macular degeneration?

When confirming the diagnosis, it is necessary to immediately begin treatment of age-related macular degeneration. The dry form of the disease is less aggressive, so it gives in to drug therapy. This will not help get rid of the pathology in full, however, it will suspend (slow down) the process for several months or years. First of all, with AMD, you must follow a diet. Given that atrophic processes develop due to a lack of carotenoids and occlusion of the vessels of the fundus, the patient should exclude animal fats. To prevent atherosclerotic changes in the small arteries of the retina, you should eat a large number of fruits, herbs, vegetables. In addition, such a diet will help make up for the lack of vitamins and minerals.

To cope with free radicals, it is recommended to spend less time in the sun. Also, patients should use antioxidants. They include vitamin E and C. To improve blood supply to the fundus, it is recommended to use antiplatelet agents, vasodilators.

Age-related macular degeneration - wet form: treatment of pathology

With the wet form of macular degeneration, not only drug therapy, but also surgical treatment is performed. Drugs that restore the pigment layer of the retina include Lutein and Zeaxanthin. These drugs belong to the group of antioxidants. In addition, it is recommended to eat foods containing zinc. If the disease has developed as a result of diabetic retinopathy, it is necessary to conduct a hypoglycemic therapy under the control of the glycemic profile.

Surgical treatment of retinal degeneration

Medication alone is not enough if the patient is diagnosed with age-related macular degeneration. Treatment of pathology should be combined with surgical correction. This is especially true for the wet form of AMD. Currently, laser treatment of macular degeneration is carried out in almost every ophthalmological clinic. It may be different. The choice of method depends on the stage of AMD and the manifestations of pathology. The following methods of surgical correction are distinguished:

  1. Laser coagulation of a neovascular membrane.
  2. Photodynamic therapy with the drug "Vizudin."
  3. Transpupillary laser thermal correction.

If possible and the absence of contraindications, transplantation of pigment epithelium, vitrectomy (with hemorrhage in the vitreous body of the eye) are performed.

Prevention of age-related retinal degeneration

Preventive measures include: following a diet, reducing body weight. For vascular lesions, smoking cessation is recommended. Also, direct sunlight should be avoided for people with light eye color. In addition, the use of vitamins to strengthen vision and trace elements refers to prevention.

Why do you need a macula?

Where light gathers in a beam on the retina, there is a yellow spot a little more than half a centimeter, which allows you to see the surrounding world in color. This center of human perception - the macula cannot be replaced by the rest of the retina, because a yellow spot is responsible for everything visible. The spot is colored with a pigment that protects the eye from aggressive blue light on the retina cones. Cones fill the macula and are responsible for the perception of color and clarity of vision of objects, and the rods provide peripheral vision. There are no vessels in the spot, because the pulsation of blood in the vessel should not interfere with seeing.

Age-related macular degeneration (AMD) or macular degeneration, a change in the eye, or rather, the center of the retina, leading to a gradual loss of vision. The disease after the 50th anniversary is observed in every fifth, and after 75 years of life - already in every third, while the invisible pathological degenerative changes in the eye begin after the 35th anniversary.

What is age-related macular degeneration?

Two large forms of AMD are qualified: dry and wet, the first degeneration occurs in eight out of ten cases.

  1. With wet macular degeneration, new blood vessels appear, fluid drips from them and accumulates under the retina, squeezing and separating the cones that die, there is no color perception at this place - these are blind spots.
  2. With dry macular degeneration, drusen are formed - lumps of proteins and lipofuscin pigment, which change the clarity of visual perception. Druze are large soft and small solid, mixed and confluent. They grow, hard ones turn into soft ones, merge with each other, causing retinal detachment and atrophy at the site of their localization.

Symptoms of age-related macular degeneration (AMD) are specific, in all cases the characteristic clinical signs, combined with visual impairment, make it possible to suspect the pathology of the retinal macula, especially in an elderly patient. Suspicion is confirmed by complaints of reading difficulties in low light.

Characteristic Symptoms of Macular Degeneration

Macular degeneration changes the worldview, changing objects around a person, in fact, the world remains the same, only the sick eye sees absolutely nothing and deceives the brain.

Degeneration begins with the loss of individual letters from words during fluent reading.

During macular degeneration, the patient complains of metamorphopsies that distort the shape of the object, its size and color. Usually abnormalities are noticed in familiar things, for example, suddenly a leg bends at the table or becomes unlike the other three. In fright, a person looks at this leg from a different angle, and with it everything is fine, but the countertop is already becoming curved.

The patient may not understand whether the object is standing or moving toward it, it is just right to panic from such ambiguous symptoms, but the distortion is not permanent and this is even more confusing.

With age-related retinal degeneration, micropsy occurs - this is a fairly proportional decrease in objects, as happened with a mysterious liquid drinker and Alice who bit a pie in Wonderland. Microsia is therefore called the "Alice symptom" or "midgets hallucination."

Но и это ещё не все симптомы, пациента беспокоят движущиеся перед глазами светящиеся и сверкающие точки и чёрточки — фотопсии.

Влияние макулярной дегенерации на зоркость глаз?

Visual acuity with subject-distorting symptoms can be normal or even tend to farsightedness.

In the wet variant of degeneration, the retina exfoliates with inflammatory edema, formed elements of blood leak through the loose wall of vessels that have increased in diameter, and then a veil appears in front of the eye, the object is not seen entirely, but with the loss of some parts, visual acuity quickly decreases. The spread of edema beyond the retinal macula disturbs peripheral vision.

The degree of visual impairment depends on the volume of the leaked blood, if a little - a symptom of "floating" dots and worms appears, a lot - the patient is only able to distinguish between light and darkness. At night, blood flows down, the vitreous body clears, and in the morning the symptoms disappear in order to occur in the evening, when the edematous fluid with blood cells swells in the eye.

Complaints about changes in the perception of colors and worsening twilight vision are much less common.

The reasons for the development of AMD

Despite the many studies carried out, the causes of this disease are still unclear. But scientists suggest with great certainty that the following factors can lead to its development:

  • Age is the main reason. Incidence increases rapidly with age. Thus, signs of AMD occur in 2% of middle-aged people, in 20% of the elderly aged 65-75 years, and in every third, after 75 - 80 years.
  • Most people have a genetic predisposition to the development of this disease, but there are a number of factors that contribute either to the onset of the disease or its prevention.
  • Race - the greatest prevalence of macular degeneration is observed in people of the Caucasian race.
  • Heredity - a family predisposition, is one of the risk factors in almost 20% of patients with age-related macular degeneration. Moreover, the risk of AMD increases three times when the disease occurs in close relatives.
  • Cardiovascular disease is one of the main risk factors for AMD. So, with atherosclerosis, the risk of the disease increases three times, and with hypertension - seven times.
  • Cigarette smoking is the only risk factor confirmed in all studies. Quitting this habit really reduces the risk of developing the disease.
  • The effect of UV rays on the retina is also considered an important factor leading to the development of AMD.
  • Improper diet - the risk of AMD is significantly higher in people who eat a lot of saturated fat and have an increased body weight.
  • Bright iris. People with a bright iris (blue, gray, green eyes) suffer from AMD more often.
  • Cataracts, especially nuclear, are one of the main risk factors for AMD. Surgical removal of cataracts often contributes to the progression of the disease in people with already existing changes in the macula.

Symptoms of AMD

Age-related macular degeneration is a disease that usually has a slow and painless development, with a gradual loss of vision. In rare cases, the onset of vision loss occurs abruptly.

Early signs of gradual loss of vision in AMD are:

  • The appearance in the central vision of dark spots.
  • Blurry images.
  • Distorting the boundaries of objects.
  • Deterioration in color perception.
  • Weakened vision in the dark and in low light.

The easiest way to determine the presence of AMD is the Amsler test. The Amsler grid or grid shows intersecting straight lines with a black dot in the center. In the presence of AMD, the lines of the pattern may appear blurry or wavy, and some fragments of the lattice are darkened with opaque spots.

After conducting this test, an ophthalmologist is able to identify the manifestations of the disease long before the development of serious changes in the patient’s vision and recommend additional examination.

Diagnosis of AMD

For the diagnosis of age-related macular degeneration, an accurate history is enough, assessment of visual functions and examination of the patient's retina by various methods. Today, fluorescence fundus angiography (FAGD) is considered one of the most informative methods for identifying this pathology. FAGD involves the use of contrast agents - fluorescein or green indocyanin, which are injected into the patient's vein, after which a series of fundus images is performed.

The obtained stereoscopic images can be used in the same way as the initial ones for dynamic observation of a patient with a pronounced dry form of AMD or for assessing treatment results.

To accurately assess changes in the macula, optical coherence tomography (OCT) is usually used, which makes it possible to detect structural changes even in the early stages of retinal dystrophy.

Treatment of various forms of AMD

Despite considerable success in improving the methods for diagnosing AMD, its treatment remains a rather difficult problem. With dry forms of AMD or a high risk of its development, in order to normalize metabolic processes in the retina, it is recommended to conduct a course of antioxidant therapy.

According to scientific studies, the beneficial effect of taking antioxidants was noted in participants with intermediate or late stage AMD. Combination therapy with antioxidants, copper and zinc for 5 years reduces the incidence of AMD to the late stage by 25% and 19%, the risk of reducing visual acuity by three or more lines.

It should be remembered that the use of replacement therapy for the treatment of the dry form of age-related macular degeneration should be carried out on an ongoing basis. It must be used in people over 50 or at any age, in the presence of risk factors (overweight, hypertension, smoking, cataract extraction, a burdened history).

Therapy of wet AMD is aimed at suppressing the growth of newly formed abnormal vessels. Today, there are a number of methods and medicines registered in Russia that make it possible to stop and reduce the manifestations of neovascularization, which improves the vision of patients with a wet form of AMD.

Price of treatment

In the Moscow Eye Clinic, you can undergo a full diagnostic examination and receive recommendations on the most effective treatment methods. A comprehensive examination of the patient (including such methods as checking visual acuity, biomicroscopy, autorefractometry, ophthalmoscopy with a narrow pupil, pneumotonometry) is 3500 rubles.

The final cost of treatment is determined in each case individually and depends on the specific diagnosis, stage of the disease, tests available on the hands, etc.

You can clarify the cost of a procedure by calling 8 (800) 777-38-81 and 8 (499) 322-36-36 or online, using the appropriate form on the website, you can also familiarize yourself with the "Prices" section.