It describes a disorder that occurs in the visual center (macula = yellow spot) as age progresses.
Today, it is the leading cause of vision loss in people over the age of 75. Considering the increase in the elderly population, the importance of this disease also increases. While the incidence of the disease is 4% in those over 75 years of age, it reaches 15% in those over 90 years of age. Additionally, as age increases, the frequency of its occurrence in both
eyes increases.
There are various factors that are thought to cause the disease:
Heredity, ultraviolet effect of the sun, vitamin deficiency, excessive calorie intake, atherosclerosis, smoking. ,
high blood pressure, enlarged heart, obesity, light colored eyes…
Types of the disease:
Dry Type:
It occurs with the accumulation of lipid (oily) material in the layers under the retina. It progresses more slowly and causes vision loss over a long period of time. Over time, it can turn into wet type.
Wet Type:
It occurs when damaged capillaries in the patient area progress towards the retina. This type can lead to sudden
loss of vision. It is less than the dry type. However, it causes 80% vision loss
. Especially if the tear type has started in one eye of the patient, the other eye is also in danger. The rate of disease onset in the other eye within five years
is 50%.
Symptoms:
Patients may consult a doctor with complaints such as distorted vision, blurred vision, small vision, seeing a dark spot in the examined area.
. Sometimes the disease may not cause symptoms. It can be detected during a routine eye examination
. The most important reason for this is that while vision is good in one eye, the patient does not notice the loss in the other eye and disrupts regular eye examination. Both types are distinguished from each other by angiographic examination (FFA) and OCT (Optical Coherence Tomography).
.
In FFA examination, the presence of damaged capillaries is confirmed by taking photos of the eye for 3 minutes while the forearm vein is entered and a given dye (fluorescein) circulates in the eye.
In some cases, this technique is used. Sufficient information may not be obtained and a second angiography is required, which is performed with a green dye called indocyanated green angiography (ICGA) and takes about half an hour. This
angiography, macular degeneration It is also necessary to distinguish other diseases that can be confused with the disease. If wet type is suspected and there is an atypical appearance during the examination of some
patients, two
angiographies may need to be performed simultaneously.
OCT (Optical coherence tomography) is also an important method for diagnosis and follow-up. It is used to visualize
sections and thickness of the retina, the formed bleeding membrane and subretinal fluid. In addition, follow-ups after intraocular injections are made with OCT of the response to the drug.
Treatment:
The earlier this disease is diagnosed and the patient is followed up, the better the vision loss.
/> can be prevented somehow. In fact, when caught early, a 1-2 line increase can be achieved.
In the dry type, the patient is followed up and precautions can be taken by making recommendations
in terms of general health. In addition, with newly developed special drugs, the progression of the disease can at least be slowed down. For this reason, it is recommended that patients frequently check their vision by using the checkered paper tests given to them, by wearing near
glasses, and if there is a change in vision, they are advised to be examined by a retina specialist within a few days without wasting time.
> Thus, when a type-specific capillary network - membrane formation - is detected, the membrane is destroyed with intraocular drug injections to prevent vision loss. The smaller the membrane formed in the wet type and the better the vision, the higher the chance of success of the treatment.
Intraocular drug injections are now the methods that give the best results and can increase vision
Intraocular drug injections directly ensure the regression of vessels prone to bleeding,
remission of edema and stopping the disease. However, these injections
need to be repeated every month. Definitive results can be obtained after a few months.
These injections have important systemic and ocular side effects. However, patients are required not to have had a stroke
within 6 months and to have their blood pressure under control.
After the disease is taken under control with daily outpatient follow-up and treatments, the patient
will not have any symptoms. Even if there is no record, it should be followed frequently. Thus, recurrences are caught early and vision loss is prevented.
In new studies, intraocular drug applications and PDT (photodynamic therapy) are also applied in combination.
Photodynamic therapy (PDT) A very special dye is administered intravenously, and a different laser is applied that only affects damaged capillaries in the
retina and does not damage healthy cells. In the following months after the treatment, the closure of the membrane is checked with angiography and OCT
, and if necessary, PDT is repeated after 3 months.
Although there are different protocols for combined treatment, photodynamic therapy is applied 1 week
after the intraocular drug injection. It can be done in the past. Surgically removing the membranes formed in this area or trying to provide vision by shifting intact areas of the retina to the center (retinal translocation)
has been tried, but it has not been seen to be beneficial in the long term. In addition, studies on retinal pigment
epithelium transplantation, gene therapy and nanotechnology are ongoing.
As a result, age-related macular degeneration is a disease that requires early diagnosis and
treatment as it may cause vision loss.
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