Age-Related Macular Degeneration

• Age-Related Macular Degeneration (Macular Degeneration)

Macular Macular Degeneration (Macular Degeneration)

Macular degeneration occurs in people over the age of 55-60 in Turkey, as in the rest of the world. It is one of the diseases that most commonly causes vision loss in the age group. People with macular degeneration have problems doing daily tasks such as reading, driving, recognizing people's faces, and watching television. However, even in the advanced stages of the disease, the person does not experience complete blindness and continues his daily life with a field of vision other than central vision.

• What is Macular Degeneration?

The retina of the eye is a layer composed of nerve cells that detect light coming from outside and transmit it to the brain. If we compare the eye to a camera, the retina is the film strip inside the camera. The macula region is located in the middle of this layer. In the middle of the macula area, there is the fovea region, where the light is focused and approximately the diameter of a pinhead. The fovea region, or "yellow spot" as it is popularly known, is the most important region of the retina layer responsible for central vision and detailed vision. In macular degeneration, the person experiences distortion and vision loss.

Macular dot (fovea) is the most important part of the eye that provides visual function p>

Although the retinal layer contains a vascular layer within itself, it is largely nourished by a vascular-rich layer just below it.

There is a thin membrane between these two layers and a barrier between the two layers. acts as a filter. Throughout life, the waste substances that accumulate in the macular degeneration area due to the toxic effect of light are cleared from this area by a certain mechanism and are transmitted to the vascular-rich layer underneath and removed through the blood.

In macular degeneration, most often after the age of 50-55. In some people, the residues between the layers cannot be removed from this area for an unknown reason and accumulate in this area, triggering some undesirable events. This is how the disease begins.

Macular degeneration is divided into two: dry type and wet type. In the dry type, there is a certain amount of loss due to the residues accumulated in the cells in this region. �p is experienced. In the wet type, unwanted vascular buds form between the layers, just below the yellow spot. Leaks and bleeding occur in a very short time from these vascular buds, and vision loss begins. Although 90% of all macular degeneration is the dry type, the wet type is responsible for 90% of the vision loss caused by macular degeneration. In other words, although it is seen less frequently, it causes more vision loss. Macular degeneration, which starts as a dry type, may turn into a wet type over time. That's why regular check-ups are essential.

• What are the Symptoms of Yellow Spot Disease?

If the disease turns into wet type, early symptoms It is the feeling of distortion in straight lines and a decrease in the amount of vision.

In wet-type macular degeneration, there is primarily distortion in straight lines, followed by a decrease in the amount of vision in the center

• Lack of vision in the center of wet-type blind spot disease

In order to detect the feeling of distortion in the lines, patients are asked to test themselves from time to time by using a simple grid-patterned test. card is given. This card is called the Amsler card. The patient puts on glasses (if he/she uses them) and closes each eye one by one, looks at the middle point of the Amsler card in his hand and tests whether there is any deformity in the lines forming this card. In this way, distortion in straight lines can be detected in wet macular degeneration. If a different image than usual is noticed, a retinal examination should be performed without delay.

 

• Is the Other Eye Affected in Macular Macular Disease?

Macular degeneration is a disease that affects both eyes. However, often the condition in one eye is more severe than the other.

• Are there any Protective Measures? If so, what are they?

Although it is not completely possible to prevent the transition from the dry type to the wet type, some changes in lifestyle and nutrition reduce the risk of the disease progressing to more serious stages.

The role of smoking in the progression of this disease has been proven. If If the patient smokes, he should quit as soon as possible. In addition, it has been proven by studies that consumption of dark green fibrous vegetables and fruits slows down the course of the disease.

In addition, multi-center and large-scale studies on this disease have shown that some anti-oxidant vitamins and mineral-containing drugs reduce the risk of transition from the dry type to the wet type. Therefore, it has been proven to reduce the risk of vision loss. The vitamins recommended in these studies are as follows:

• 500mg vitamin C
• 400 IU vitamin E
• 15mg Beta carotene
• 80 mg zinc oxide
• 2mg copper oxide

It is necessary to consult an ophthalmologist before taking vitamin/mineral combinations. There may be some additional recommendations on this subject (for example, smokers should not use beta-carotene, vitamin E should not exceed 400 IU, etc.).

Risk Factors for Age-Related Macular Degeneration (Macular Degeneration)

• Family presence of macular degeneration
• Smoking
• High arm blood pressure and high lipid-cholesterol
• Obesity (obesity)

What Should Be Done to Protect from Yellow Spot Disease?

No smoking

Green fibrous fruit A diet rich in vegetables and vegetables and containing fish at least 1-2 times a week should be adopted.

Fried foods containing trans fats should be avoided, and the use of olive oil should be increased. should be done

Weight control should be done

Exercise habits should be acquired

If dry type macular degeneration has started, combination pills containing the above-mentioned vitamins and minerals should be started, with the recommendation of a doctor

If there is a family history of macular degeneration or other risk factors, regular retinal examinations should be performed at regular intervals.

What is the Macular Macular Disease Treatment?

Macular degeneration, which has transitioned from dry type to wet type, is a condition that requires urgent treatment. While the treatments applied to this disease until recently did not yield satisfactory results, today, extremely successful results are obtained with developing technologies and new forms of treatment.

The aim of treatment in wet macular degeneration is to dry the unwanted vascular buds, fluid leaks and bleeding between the layers that cause the disease. There are different treatment options for this.

• Laser Treatment

It is the oldest treatment method used in wet macular degeneration. Situations where laser treatment can be applied are limited today. Approximately 15% of all age-type macular degeneration patients are suitable for standard laser treatment. In patients receiving laser treatment, vascular buds can be reactivated in 50% of cases.

It is a treatment method developed after standard laser treatment and has been used for about 10 years.Verteporfin in PDT (Visudyn A substance called ) is injected into the arm to ensure that this drug binds to the damaged tissue in the eye. Then, a special laser treatment is applied to the eye for 83 seconds. It is effective in some types of wet macular degeneration. It generally does not increase vision; the rate of preservation of current vision is approximately 50-60% during the 1-year treatment period. This rate will decrease in the following years. Today it is rarely used alone, only in appropriate cases. Apart from this, it can be used in combination with the new drugs given by injection into the eye, mentioned in the section below.

• Treatment to Prevent Vascular Development (Anti-VEGF treatment)

Today, it is the most effective and most recently developed treatment method for wet macular degeneration. It consists of active ingredients such as bevacizumab (Avastin, Altuzan) and ranibizumab.

In wet type macular degeneration, unwanted vascular buds form between the layers forming the back wall of the eye (see Macular Macular Disease). What is the disease?). Vascular growth factors affecting that area play a role in the formation of these vascular buds. With treatment to prevent vascular development in wet macular degeneration, these growth factors are neutralized and the formed vascular bud is eliminated, preventing leakage and bleeding. In this treatment, drugs such as bevacizumab (Avastin, Altuzan) are given by direct injection into the eye.

With this treatment, wet macular degeneration is treated. The rate of preserving current vision in 1 year is over 90%. Again, the rate of vision increase in the same period is around 30%. These injections are frequently repeated at certain intervals to prevent vision loss and even increase vision.

• Is there any Surgical Treatment?

Rarely, very intense bleeding may occur in macular degeneration. The needle treatment just mentioned is ineffective in the treatment of this condition. In this case, the retina can be cut and removed using special methods, the bleeding underneath can be cleaned, and a tissue patch can be applied. You can find the video about this below.

• What should be done in follow-up?

Macular degeneration, whether dry type or wet type It is a disease that requires regular follow-up. During the diagnosis phase and follow-up, eye angiography (FFA- fundus fluorescein angiography) and retinal tomography (OCT- optical coherence tomography) must be performed.

_{Read: 0}