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Age-related Macular Degeneration

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 Age-related Macular Degeneration




Age-related macular degeneration (AMD) is the most common cause of severe vision loss in children 50 years of age and older in the Western world. The prevalence of age-related macular degeneration increases with age. It is estimated that in the United States in 2020, about 8 million adults aged 65 years and over will develop generation-related macular degeneration. The primary risk factor is age, but there is a relationship to family history, too.

The macula is the area in the center of the retina, responsible for central vision. Precise vision in reading, in driving, in perceiving the face, and in every other precise target, takes place in the macula, whose center is the fovea - the macula lutea.

There are two forms of macular degeneration in advanced age: the nonvascular (dry) form and the neovascular (wet) form. According to estimates, 10%-20% of all patients develop the disease in its wet form, which is responsible for 90% of acute vision loss due to GAM. It is worth noting that in certain cases, serious damage to vision occurs in the dry form of the disease, as well, but with a lower prevalence. The first symptom of dry form AMD is the appearance of drusen in the eye, which are yellow dots in the macula at the bottom of the eye. In its wet form, AMD is characterized by the development of abnormal blood vessels under the retina (Choroidal Neovascularization - CNV). These lesions develop when new, abnormal blood vessels grow from the choroid under the retina, and spread through ruptures in Bruch's membrane - a layer of connective tissue between the retina and choroid). retina. Serum, fat, and blood leak from these abnormal vessels and accumulate under the retinal pigment epithelium, and under the retina itself. Subsequently, scar tissue is formed that replaces the retinal tissue of the macula and leads to irreversible vision loss. There are usually no symptoms of dry, avascular AMD. In wet, neovascular AMD, there is generally an injury to the central vision that appears as a macular or distortion in the central vision (called Metamorphopsia). Sometimes patients see a thumbnail, or a different size, image in each eye. In rare cases, visual hallucinations may also occur. There are usually no symptoms of dry, avascular AMD. In wet, neovascular AMD, there is generally an injury to the central vision that appears as a macular or distortion in the central vision (called Metamorphopsia). Sometimes patients see a thumbnail, or a different size, image in each eye. In rare cases, visual hallucinations may also occur. There are usually no symptoms of dry, avascular AMD. In wet, neovascular AMD, there is generally an injury to the central vision that appears as a macular or distortion in the central vision (called Metamorphopsia). Sometimes patients see a thumbnail, or a different size, image in each eye. In rare cases, visual hallucinations may also occur.

The prognosis for the maintenance of good vision in patients with neovascular AMD is low. Severe loss of central vision can occur quickly. A visual acuity of 6/60 or less (which is considered central blindness) develops in the eyes of many patients within two years of the date of diagnosis. About 12% of patients who develop neovascular AMD in one eye, and 50% of patients who develop neovascular AMD in both eyes, develop partial blindness within 5 years of onset. Although the disease does not cause complete blindness, it leads to restriction of patients in daily functioning, such as reading, watching television, identifying/recognizing faces, spatial orientation on the street and in unknown places, etc.

macular degeneration diagnosis

Diagnosis of macular degeneration related to generation is based on examining the fundus of the eye with an ophthalmoscope, on the examination of the ophthalmologist with the help of a special lens, in addition to imaging with the injection of a fluorescein contrast substance ( fluorescein angiography ).

On ophthalmoscopy, if the fundus layers are raised, blood, fluid, or fat deposits are observed under the retina or under the layer of the retinal epithelium beneath it, abnormal blood vessels should be suspected. Also, when there is an area of ​​the greenish-gray color of scar tissue (with scars) in the fundus of the eye, the presence of macular degeneration related to the gel should be suspected. Fluorescein imaging gives a special image of imaging (not x-ray imaging), through which new, newly vascularised blood vessel tissue can be detected. The composition, location, and size of the CNV - influences treatment recommendations and methods.

macular degeneration treatment

In the case of nonvascular AMD, macular degeneration treatment aims to reduce the risk of progression to neovascular AMD.

Recently published results of a very large, multicenter, research demonstrating the efficacy of vitamins and minerals antioxidants in preventing the transition from dry AMD to wet AMD. The research was conducted by the National Institutes of Health - NIH in the United States. In fact, this is the first time that food additives are effective in inhibiting the development of age-related macular degeneration. If neovascular AMD remains untreated, a rapid worsening of central vision occurs. The detection of macular degeneration related to the early generation is crucial and crucial to refer the patient at an early stage to an ophthalmologist who specializes in retinal diseases, so that it is possible, thus, to reduce the chances of a sharp decline in visual ability. In the past, the only treatment that was proven to be effective in peer-reviewed studies was laser therapy. But laser treatment was possible in only a small portion of patients. modern therapy, The one that has been developed in recent years, and which constitutes a major breakthrough in the treatment of age-related macular degeneration, is Photo Dynamic Therapy - PDT. This treatment is considered an achievement, but it also leads to the stabilization of the visual condition only and does not lead to its improvement.

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