When the diameter of the vessels decreases, the nutrition of the retina is disrupted. As a result, due to a lack of oxygen and nutrients, the retina of the eye undergoes dystrophic changes. This manifestation is most often observed in both eyes. In this case, one of them suffers more than the other.

The risk group for macular degeneration of the retina includes older people. With age, central vision is subject to great changes due to the fact that problems with the circulatory system progress.

Macular degeneration code according to ICD-10

H35.3 Macular and posterior pole degeneration

Causes of macular degeneration

Doctors and scientists have not recorded the causes of macular degeneration as an absolute list. They are identified as a series of assumptions indicating possible factors, which could serve as an impetus for the formation of dystrophic changes. Among them:

• Age-related changes.
• Heredity.
• Smoking.
• Exposure to ultraviolet radiation.
• Unbalanced diet.
• Having excess weight.
• Diseases of the cardiovascular system.

Macular degeneration occurs more often in women due to their longer life expectancy compared to men. Moreover, those who have crossed the threshold of 50 years are predisposed to this disease.

Macular degeneration in children

Macular degeneration rarely develops in children. It occurs in them if their parents had a predisposition to this disease. At the same time, vascular sclerosis develops at the genetic level, which becomes the impetus for dystrophic changes in the retina.

Classification of macular degeneration

There are dry and wet forms of macular degeneration. Moreover, each of them has a certain set of characteristics and symptomatic manifestations.

Dry macular degeneration

Diagnosed in 90% of cases. It represents the first stage of macular degeneration in which new vessels have not had time to form. A characteristic manifestation of dry macular degeneration is thinning of the retinal tissue and accumulation of pigments in its layers yellow color(Druze). In the dry form of the disease, 3 stages of development are observed:

1. The early stage does not manifest itself as visual impairment. It can be identified by the formation of drusen.
2. The intermediate stage is characterized by the fusion of small drusen into medium-sized spots or into one large one. As a visual defect, a blurry silhouette appears before the eyes.
3. The pronounced stage implies an increase in the silhouette and its blackening. This suggests that light-sensitive cells are dying.

The dry form of macular degeneration causes vision loss if not treated at an early stage.

Wet macular degeneration

The wet form of the disease damages vision more than the dry form. This is due to the formation of new vessels (neovascularization process). They are very fragile, so they are often damaged, causing hemorrhages. They, in turn, lead to the death of light-sensitive cells and the appearance of a blind spot in the field of vision.

There are latent and classic types of macular degeneration. In the latter case, dystrophic processes are more pronounced. At the same time, vascular neoplasms appear more often. This is accompanied by the development of scar tissue.

Symptoms of the disease

If we talk about dry macular degeneration, then initial stages she doesn't call pain And symptomatic manifestation. It is necessary to take the appearance of such signs seriously in order to identify the disease on time.:

• It becomes difficult to navigate in the dark.
• Vision begins to decline.
• Visible text becomes harder to see.
• It is more difficult to recognize surrounding faces.
• The field of vision is clouded by a dark spot without pronounced contours.

The same symptoms are characteristic of wet macular degeneration. Added to these are distortion of the outlines of the visible image and visual bending of straight lines.

Diagnosis of macular degeneration

Diagnosis of a disease involves drawing up clinical picture in accordance with patient complaints and research results. The following methods are used to detect the disease::

• Examination of the eye using an alkaline lamp and an ophthalmoscope.
• Determination of visual acuity and field using various tests (including the Amsler test).
• Fluorescein angiography.
• CT scan.

As a result of the research, the stage of the disease and the location of the lesion are revealed. Treatment is prescribed according to the data obtained.

Treatment of dry macular degeneration

Dry macular degeneration can be treated with conservative methods. The purpose of the measures taken is to stop the formation of new vessels, thereby eliminating the further development of the disease. The risk of further vision loss is prevented by antioxidant agents and preparations containing zinc. In the dry form of the disease, the patient is prescribed medicines, which include vitamins A, C and E, copper and zinc. In addition, the ophthalmologist prescribes Lutein and Zeaxanthin. The same drugs are used to prevent macular degeneration.

Treatment of wet macular degeneration

The conservative method in the treatment of wet macular degeneration is ineffective. Therefore, preference is given to such procedures:

• Laser surgery. It is used if the newly formed vessels are located at a distance from the fossa of the macula. Those that are characterized by fragility and bleeding are removed. They are destroyed by laser radiation, however healthy tissue may also be accidentally damaged. Laser treatment does not always help. In many cases, even after a second procedure, vision continues to deteriorate.
• Photodynamic therapy is a safer method compared to laser surgery. Represents intravenous administration Vizudina. Medicinal substances are attached to the walls of painful vessels and irradiate them with light radiation for 1.5 minutes without affecting healthy tissue. The result is a slowdown in the rate of vision deterioration. For 5 days after the procedure, you need to protect your eyes from bright sunlight and room lighting. The effect of photodynamics is unstable. After some time, a repeat procedure may be necessary.
• Intraocular injections or anti-VEGF therapy. To begin with, it is carried out local anesthesia. After this, Avastin, Lucentis, Macugen and other modern medications are injected into the eye cavity. Their action is to block the growth factor of new non-viable vessels. The procedure is carried out monthly. Doses of the drug are calculated for each patient separately.

Doctors talk about the treatment of macular degeneration this way:

Only intraocular injections can improve vision. Other treatment methods only stop the further development of dystrophic changes.

Folk remedies

Since dystrophic changes can be caused by poor nutrition, treatment with folk remedies involves its correction. It is recommended to eat chickpeas and wheat germ. Eye drops made from tinctures of aloe and mumiyo juice help improve vision. It is worth remembering that folk remedies are auxiliary and are used along with the main treatment. You should talk to your doctor about their effectiveness before using them.

Prevention of macular degeneration

Here's what they say about disease prevention on the Internet:

Thus, to reduce the risk of macular degeneration, you need to follow these tips:

1. Protect your eyes from ultraviolet exposure. For these purposes, before going outside, wear Sunglasses.
2. Quit smoking and the risk of developing the disease will decrease by 5 times.
3. Eat more fish, fruits and vegetables.
4. Set limits on fatty foods.
5. Take vitamins as advised by your doctor.
6. Make it a habit to exercise daily.
7. Monitor your weight.
8. Monitor your blood pressure and blood cholesterol levels.

An annual visit to an ophthalmologist will help to detect the disease in a timely manner.

Getting old 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. The tissue of the eye is one of the first to suffer. It is believed that vision deteriorates from the age of 40-45. This happens even in cases where a person has not previously had problems with vision during his life. Vision deterioration occurs gradually. Most people are concerned about “farsightedness,” that is, the inability to see objects that are close. Sometimes, more serious problems develop. These include pathologies such as cataracts, glaucoma, etc. Another common disease is age-related macular degeneration. This disease is dangerous because it can lead to loss of vision.

Concept of age-related retinal degeneration

Age-related macular degeneration (AMD) is a pathology that develops due to degenerative processes in the retina of the eye. This area 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. On the surface of the peripheral analyzer there is a zone that contains many receptors - rods and cones. It is called the 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 light is focused. Thanks to this function, human vision is sharp and clear. Age-related macular degeneration of the retina leads to degeneration of the macular tissue. Not only the pigment layer undergoes changes, but also the vessels feeding this area. Although the disease is called “age-related macular degeneration,” it does not only affect older people. Often the first symptoms pathological changes in the eye they begin to be felt by the age of 55. To the elderly and old age the disease progresses to such an extent that the person may lose the ability to see completely.

Age-related macular degeneration of the retina is a common disease. Often this pathology causes loss of ability to work and disability. It is widespread in America, Asia and Europe. Unfortunately, the disease is often diagnosed in late stages. In these cases, you have to resort to surgical treatment. However, with timely therapeutic treatment, as well as 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 tends to be slow and progressive. The causes of dystrophic changes in the macula of the retina can be different. The main one is considered to be the involution of eye tissue. However, in some people, dystrophic changes occur more quickly, while in others, more slowly. Therefore, there is an opinion that age-related macular degeneration is inherited (genetically), and also predominates in people of European nationality. Other risk factors include: smoking, arterial hypertension, frequent exposure to the sun. Based on this, the causes of macular degeneration can be identified. These include:

1. Vascular lesions. Atherosclerosis of small arteries is considered one of the risk factors. Impaired oxygen delivery to eye tissues is one of the main mechanisms for the development of degeneration.
2. Excess body weight.
3. Lack of vitamins and some microelements. Among the substances necessary to maintain retinal tissue are lutein and zeaxanthin.
4. The presence of a large number of “free radicals”. They increase the risk of developing organ degeneration several times.
5. Ethnic characteristics. The disease is more common in people with light color eye. The fact is that representatives of the Caucasian race have a low density of pigment contained in the retina. For this reason, degenerative processes develop faster, as do the symptoms of the disease.
6. Poor nutrition.
7. Exposure to direct sunlight without protective glasses.

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

Age-related macular degeneration: pathophysiology of the process

Surgical treatment of retinal degeneration

Drug therapy 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, almost every ophthalmology clinic held laser treatment macular degeneration. It may vary. The choice of method depends on the stage of AMD and the manifestations of the pathology. The following methods of surgical correction are distinguished:

1. Laser coagulation of neovascular membrane.
2. Photodynamic therapy with Visudin.
3. Transpupillary laser thermal correction.

If possible and there are no contraindications, pigment epithelium transplantation and vitrectomy (in case of hemorrhage into the vitreous body of the eye) are performed.

Prevention of age-related retinal degeneration

Preventive measures include: dieting, weight loss. In case of vascular lesions, smoking cessation is recommended. You should also avoid direct exposure to sunlight for people with light color eye. In addition, prevention includes the use of vitamins to strengthen vision and microelements.

Macular degeneration of the retina is a disease that affects the most important area of ​​the retina - the macula. This part provides the basic function of vision; with its help we see objects.

The disease has serious consequences, one of the most dangerous is the loss of vision without the ability to restore it. There are dry and wet forms. The first is more common and is characterized by yellow spots when diagnosing the macula. Wet is more dangerous, because it leads to the worst diseases with vision, and without proper treatment, to blindness.

Treatment is usually surgical, and the drugs Lucentis and Eylea are also taken. In this article we will look at 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 vision.

Age-related macular degeneration is the leading cause of irreversible vision loss and blindness among people aged 50 years and older in the developed world. Because people in this group represent a growing proportion of the population, vision loss from macular degeneration is a growing problem.

Age-related macular degeneration is a chronic, progressive disease that affects the central area of ​​the retina and choroid eyes. In this case, damage to cells and intercellular space occurs and, as a result, dysfunction. IN in this case We are talking about dysfunction of central vision.

According to WHO, the share 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 pressing. Moreover, in last years there has been a clear trend towards “rejuvenation” of this disease.

The cause of decreased vision is degeneration of the macula, the most important area of ​​the retina, responsible for the sharpness and acuity of central vision necessary for reading or driving a car, while peripheral vision is practically unaffected.

The socio-medical significance of this disease is due precisely quick loss central vision and loss of general performance. The severity of the process and loss of central vision depends on the form of AMD.

Dry and wet forms

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

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

With the deposition of drusen, atrophy of the adjacent layers of the retina occurs and the growth of pathological newly formed vessels in the retinal pigment epithelium is noted. Subsequently, 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) forms 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 patients' ability to see fine details, but it is not as severe as in the wet form.

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

There is currently no definitive treatment for dry AMD, although some are currently in clinical trials.

A huge number of clinical studies have 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.

Research shows that taking high doses of certain eye supplements and vitamins can reduce the risk of developing early-stage AMD by 25%. Eye doctors It is also recommended that patients with dry AMD wear sunglasses with UV protection.

The wet form of AMD is present in approximately 10-15% of cases. The disease progresses quickly and often results in significant loss of central vision, with dry AMD progressing to more advanced and damaging forms of the eye disease. In the wet form of AMD, the process of new growth begins. blood vessels(neovascularization).

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 leakage 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 than the “dry” form (in approximately one or two cases out of 10), but is more dangerous - rapid progression occurs and vision deteriorates very quickly.

Symptoms of the “wet” form of AMD:

• A sharp decrease in visual acuity, inability to improve vision with glasses correction.
• Blurred vision, decreased contrast sensitivity.
• Dropout of individual letters or crooked 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 wet AMD. Abnormal vascular growth is the body's faulty way of creating a new network of blood vessels to ensure the required amount of nutrients and oxygen reaches the retina.

Instead of this process, scarring occurs, resulting in severe loss of central vision.

Development mechanism

The macula is made up of several layers of special cells. A layer of photoreceptors is located above the layer of retinal pigment epithelial cells, and below is a thin Bruch's membrane, separating the upper layers from the network of blood vessels (choriocapillaris), which provide the macula with oxygen and nutrients.

As the eye ages, waste products from cell metabolism accumulate, forming so-called “drusen” - yellowish thickenings under the retinal pigment epithelium.

The presence of many small drusen or one (or several) large drusen is considered the first sign of the early stage of the “dry” form of AMD. The “dry” (non-exudative) form is the most common (in approximately 90% of cases).

As drusen accumulate, they can cause inflammation by triggering the release of vascular endothelial growth factor, a protein that promotes the growth of new blood vessels in the eye. New pathological blood vessels begin to grow, a process called angiogenesis.

New blood vessels grow through Bruch's membrane. Since 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 moment on, AMD begins to progress, moving into another, more aggressive form- “wet”. Fluid accumulates between Bruch's membrane and the photoreceptor layer, affecting the vulnerable nerves that provide healthy vision.

If this process is not stopped, 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 on AMD, the causes of this disease remain unclear to date. AMD is a multifactorial disease.

Age is the main reason. The incidence increases sharply 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 person.

A significant portion of the population has a congenital 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:

1. Race – the highest prevalence of AMD is observed in Caucasians
2. Heredity - Family history is an important risk factor in 20% of patients with AMD. A threefold increase in the risk of developing AMD has been established if the disease occurs in relatives in the first generation
3. Cardiovascular disease plays a significant role in the development of AMD. It has been established that with atherosclerosis, the risk of damage to the macular area increases 3 times, and in the presence hypertension– 7 times.
4. Cigarette smoking is the only risk factor whose significance was confirmed in all studies. Quitting smoking reduces the risk of developing AMD.
5. Direct exposure to sunlight
6. Diet—The risk of AMD is higher in people who eat more saturated fat and cholesterol, and who are overweight.
7. Light iris
8. Cataracts, especially nuclear ones, are a risk factor for the development of AMD. Cataract surgery may contribute to the progression of the disease in patients with existing changes in the macular area.

Symptoms of macular degeneration of the retina

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

As the disease progresses, a person suffering from age-related macular degeneration begins to complain of decreased visual acuity and difficulty reading, especially in low light conditions. Patients may also notice the loss of individual letters during fluent reading, and distortion of the shape of the objects in question.

The complaint of changes in color perception is much less common. Unfortunately, more than half of patients do not notice deterioration in vision in one eye until the pathological process affects the fellow eye. As a result, changes are often detected in advanced stages, when treatment is no longer effective.

Early signs of vision loss from AMD include:

• appearance of dark spots in central vision
• blurred image
• distortion of objects
• deterioration in color perception
• sharp deterioration of vision in poor lighting and darkness

The most basic 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 symptoms of AMD may see that some lines appear blurred or wavy, and dark spots appear in the field of vision.

An ophthalmologist can distinguish the manifestations of this disease even before changes in the patient’s vision develop and refer him for additional examinations.

Diagnostics

Diagnosis of AMD is based on medical history, patient complaints, assessment of visual functions and retinal examination data various methods. Currently, fundus fluorescein angiography (FAGD) is recognized as one of the most informative methods for detecting retinal pathology.

To conduct FAHD, 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 photographs are taken.

Stereoscopic images can also be used as a baseline for dynamic monitoring of a number of patients with severe dry AMD and patients during treatment.

OCT (optical coherence tomography) is used to finely assess changes in the retina and macula, which makes it possible to detect structural changes at the most early stages retinal degeneration.

With AMD, central vision gradually becomes blurred and foggy, dark spots appear in the center of the visual field, straight lines and objects begin to distort, and color perception deteriorates. Peripheral vision while being preserved.

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

The doctor will probably perform a fundoscopy (examination of the retina) after dilating your pupils with special eye drops. Several additional diagnostic procedures may be required to determine the type of AMD and treatment method.

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

At the same time, its structure and thickness can be assessed and observed over time during treatment. And fluorescein angiography allows you to assess the condition of the retinal vessels, the prevalence and activity of the dystrophic process and determine indications or contraindications for treatment.

These studies are the gold standard in diagnosing age-related macular degeneration worldwide.

Treatment of dry and wet forms

AMD cannot be completely cured. However, the progression 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 containing fresh fruits, dark green vegetables and salad rich in vitamins C and E, lutein and zeaxanthin.

The following vegetables and fruits are key to eye health: carrots, pumpkin, zucchini, squash, 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 adequate in omega-3 fatty acids and lutein.

Large-scale studies have found that a healthy diet and biological intake active additives to food containing specially selected micronutrients (vitamins, microelements and antioxidants) can slow down 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 stop smoking because smoking increases your risk of developing AMD. Fight excess weight and high blood pressure. Increase your physical activity.

To protect eyes from direct exposure sunlight You should wear high-quality sunglasses with a reliable UV filter. Clinical researches showed that the sooner they start preventive actions, 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 photocoagulation 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 reasons blindness and low vision in people of the older age group. Age-related macular degeneration is a chronic degenerative disorder that most often affects people over 50 years of age.

According to official materials from the WHO Center for the Prevention of Avoidable Blindness, the prevalence of this pathology in terms of appeal in the world is 300 per 100 thousand 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 aged 65 to 75 years and 30% over 75 years have central vision loss due to AMD. End-stage AMD (blindness) occurs in 1.7% of the total population over 50 years of age and about 18% of the population over 85 years of age. In Russia, the incidence of AMD is 15 per 1000 population.

AMD is characterized by progressive deterioration of central vision and irreversible damage to the macular area. 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 can begin to develop after 5-8 years.

Often, the patient does not immediately notice problems with vision, since at the initial stage the better seeing eye takes on all the visual load.

When visual acuity decreases; difficulties encountered when reading and writing; the need for stronger lighting; If a fixed spot appears in front of the eye, as well as distortion of the contours of objects, their color and contrast, you should immediately consult an ophthalmologist.

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

Despite enormous strides in improving diagnostic methods for AMD, its treatment remains a rather difficult problem. In the treatment of dry forms of AMD and with a high risk of developing the disease for the purpose of normalization metabolic processes courses of antioxidant therapy are recommended in the retina.

It should be remembered that replacement therapy for the prevention and treatment of dry AMD cannot be a course; its use is possible only for permanent basis. It should be used in persons over 50 years of age, and in the presence of risk factors (smoking, overweight, complicated medical history, cataract extraction), and earlier.

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

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

The retina itself is the layer lining the back surface of the eye and contains light-sensitive cells. The retina transmits the images it perceives to the brain. AMD causes permanent loss of central vision, although peripheral vision is retained.

Age-related macular degeneration manifests itself as irreversible damage to the macular (central) zone of the retina with progressive deterioration of central vision. According to available data, the fellow eye is affected no later than 5 years after the disease of the first.

There are two forms of AMD:

1. “Dry” (atrophic) AMD is more common. It is detected in approximately 90% of people with this disease.
2. The remaining cases are the “wet” (exudative) form, often affecting patients who were previously diagnosed with dry AMD.

The “dry” form (9 out of 10 patients with AMD) progresses over many years, causing profound loss of central vision in only 10-15% of patients with macular degeneration. The “wet” form progresses quickly (weeks to months) and occurs in approximately 1-2 out of 10 patients with age-related macular degeneration.

It is this form of the disease that is main reason visual impairment (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.

Moreover, the risk of developing AMD increases threefold if this disease occurs in close relatives. Increased risk 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 developing AMD, which, fortunately, can be influenced. In particular, the risk of damage to the macular area increases with elevated levels of cholesterol in the blood plasma, vascular atherosclerosis and high blood pressure.

Diets high in saturated fat and cholesterol can lead to the deposition of atherosclerotic plaques. cholesterol plaques in the macular vessels and increase the risk of developing AMD. One of the most significant reasons is diabetes mellitus.

Goal of treatment for macular degeneration

Retinal dystrophy is a disease in which dystrophic changes occur in the macula. The cone photoreceptors that perceive light are affected, and the person gradually loses central vision. The name of the disease comes from two words: macula - spot - and degeneration (dystrophy) - nutritional disorder.

The structure of the eye.

The development of retinal dystrophy is associated with atherosclerotic changes in the vessels of the choriocapillaris layer eyeball. Poor circulation in the choriocapillaris, which, in fact, are the only source of nutrition for the macular area against the background age-related changes in the retina of the eye, can serve as an impetus for the development of the dystrophic process. The mechanism of development of atherosclerotic changes in the vessels of the eye is the same as in the vessels of the heart, brain and other organs. It is assumed that this disorder is associated with genetically determined sclerosis of the vessels related to the macula.
The level of macular pigmentation is of great importance in the development of retinal dystrophy. Macular pigment is the only retinal antioxidant that neutralizes the effects of free radicals and limits blue light, which is phototoxic to the retina.

Fundus: 1.- yellow spot; 2-disc optic nerve; 3- artery; 4 - vein.

Numerous studies in recent years have revealed the hereditary nature of retinal dystrophy. Children of parents suffering from this disease have high risk development of the disease. If you are diagnosed with this, warn your children and grandchildren. They could have inherited structural features of the macula that increase the risk of developing the disease.

With age-related macular degeneration, the central and color vision, therefore, the first signs of the disease are decreased visual acuity and impaired color vision. As a result, difficulties arise when reading, writing, working at a computer, watching television, driving, etc. Peripheral vision does not change with age-related macular degeneration, due to which the patient can freely navigate in space and cope with everyday tasks. The patient needs brighter light when reading, writing and painstaking work. Very often, people do not notice the deterioration of their vision for a long time - after all, with one normally seeing eye you can read and do small work.

With the further development of the disease, a spot appears in front of the affected eye, letters and lines are distorted, and vision deteriorates sharply.

The older a person is, the higher the risk of developing the disease. However, in recent years there has been a significant “rejuvenation” of this disease. According to statistics, at the age of about 50 years, 2% of people may develop macular degeneration. This figure reaches 30% as soon as a person crosses the age limit of 75 years. Women are more likely to suffer from age-related macular degeneration.

Risk factors for age-related macular degeneration:

age (50 years and older);

gender (women get sick more often than men in a ratio of 3:1);

genetic predisposition(presence of disease in relatives);

White color skin and blue iris

cardiovascular diseases (arterial hypertension, cerebral atherosclerosis);

unbalanced diet;

high blood cholesterol levels;

overweight, obesity;

smoking;

frequent and long-term stress;

deficiency of vitamins and antioxidants in food;

low carotenoid content in the macula;

irradiation of the eye with the ultraviolet part of the spectrum of sunlight;

bad ecology.

With age-related macular degeneration, complaints about a noticeable decrease in vision appear, as a rule, only in the late stages of the disease.

There are two forms of age-related macular degeneration: dry and wet. The dry form of the disease occurs in approximately 90% of patients. Over the course of 5-6 years, it develops first in one eye and then moves to the other eye. Dystrophic changes appear in the macular region of the retina in the form of small focal dispigmentation and light yellow spots of round or oval shape. There is no sharp decrease in vision, but objects in front of the eyes may become distorted.

Retinal dystrophy (central macular degeneration)

Note:

If you have the dry form of age-related macular degeneration, you should be examined by an ophthalmologist at least once a year. An ophthalmologist must examine the retina of both eyes with a dilated pupil.

Although only 10% of people have wet macular degeneration, 90% of severe vision loss occurs from this form of the disease.

Vision loss occurs because new blood vessels begin to grow into the retina towards the macula. These newly formed vessels have incomplete defective walls through which blood begins to leak. Vision decreases sharply.

One of the symptoms of the wet form of age-related macular degeneration is the feeling of distortion of objects in front of the affected eye. Straight lines begin to appear wavy to the patient. This optical effect occurs because swelling occurs in the macular area. In this case, central vision decreases very quickly and a visual field defect appears in front of the eye in the form of a dark spot.

This is how objects look with retinal dystrophy.

If you have distortions of objects in front of your eye, a spot and you feel a sharp decline vision, you should consult a doctor immediately.

Often patients with age-related macular degeneration with concomitant cardiovascular and neurological diseases Consultations with a cardiologist and neurologist are required.

TREATMENT. For the prevention and treatment of the early stages of age-related macular degeneration, paramount importance is given to maintaining a healthy diet, reducing the consumption of foods with high level cholesterol and mandatory antioxidant protection of the macula, which includes the intake of carotenoids (lutein and zeaxanthin) - red, yellow or orange pigments found in plant and animal tissues, as well as minerals, zinc, selenium, vitamins C, E and anthocyanosides.

Lutein and zeaxanthin are the main pigments of the macula and provide natural optical protection to visual cells. Of the 600 natural carotenoids, only two - lutein and zeaxanthin - have the ability to penetrate the eye tissue. Lutein enters the body with food, and zeaxanthin is formed directly in the retina from lutein.

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Sources of lutein and zeaxanthin include egg yolks, broccoli, beans, peas, cabbage, spinach, lettuce, kiwi, etc. Lutein and zeaxanthin are also found in nettles, seaweeds and the petals of many yellow flowers.

Considering the “rejuvenation” of this disease, Special attention You should pay attention to its prevention, which includes:

a mandatory course of oral administration of lutein, zeaxanthin and anthocyanosides;

quitting smoking and cholesterol-rich foods;

protection from direct impact sun rays (sunglasses, hat, awning, etc.);

the use of contact lenses that protect the eyes from ultraviolet radiation;

correction of arterial hypertension;

regular retinal examinations to identify signs of disease progression (at least once a year);

self-monitoring of visual impairments using Amsler grids and, if necessary, contact an ophthalmologist.

Amsler test.

To carry out this test use"Amsler grid"- a sheet of checkered paper with a black dot in the center. This test is an integral part of checking the condition of the eyes, as it helps to identifydistortion of vision.This is especially important whenwet AMD,which can be treated in the early stages (although if the retinal macula is damaged, this is almost impossible).

The test is quite simple: look at the point in the center of the Amsler grid. If the lines near the dot appear fuzzy, there is a possibility of AMD. If your doctor suspects you have wet AMD, you will likely have to undergo a fluorescein angiography procedure. The essence of the survey is as follows. A dye is injected into a vein in your forearm and eventually reaches the retina of your eye. A special device allows you to trace the entire path of paint through the blood vessels of the retina.

This procedure helps the ophthalmologist determine whether damaged blood vessels can be treated with laser. If the walls of the vessels are too thin and there is a possibility heavy bleeding, then your doctor may recommend optical devices instead of laser surgery. If your vision deteriorates, optics can help you restore the functions of your eye, but will not be able to fully compensate for the loss of vision.

Amsler grid .

"LUTEIN FORTE"

For complex treatment AMD, glaucoma, cataracts, complicated myopia and in the postoperative period, with the goal of a speedy recovery.

All components included in the drug provide effective protection and enhance the overall antioxidant effect, which helps improve and stabilize visual functions.

Peculiarities psychological state patients with age-related macular degeneration.

An unfavorable prognosis for visual impairment is often accompanied by changes in the psychological state of patients.

When a person first learns about the diagnosis after consulting a doctor, as well as in the later stages of the disease with a sharp deterioration in vision, he begins to worry about the quality of life and experiences fear. Sometimes a feeling of fear leads to a deterioration in general well-being and loss of interest in life.

To avoid unfavorable psychological changes in the patient’s condition, he needs to receive as many positive emotions as possible.

This is facilitated by the normalization of the psychological climate in the family; breathing exercises and walks on fresh air; work on a personal plot or dacha (caring for plants, animals, birds); eating fresh vegetables and berries containing vitamins, minerals, antioxidants (spinach, carrots, celery, zucchini, Jerusalem artichoke, blueberries, lingonberries, black currants, rose hips, rowan, etc.).

Content

With macular degeneration, the central or peripheral tissues of the retina “die off”, which leads to a progressive decrease in vision. The rate at which it worsens depends on the type of disease. Macular degeneration is considered an age-related pathology, since it occurs more often at the age of 45-50 years. Without treatment, the disease leads to blindness.

Treatment of macular degeneration of the retina

The main symptom of macular degeneration is distortion of the mesh on special test Amsler, when the gaze is focused on the central point. Macular degeneration cannot be completely cured. Therefore, therapy for this disease is symptomatic. The goal of treatment is to stop the development of degenerative changes in the retina. Principles of therapy depending on the form of macular degeneration:

• In the dry form, normalization of metabolic processes in the retina is necessary. This is achieved through courses of antioxidant therapy.
• In the wet form, treatment is aimed at suppressing the growth of abnormal blood vessels.

Please note that age-related macular degeneration can recur even if treatment has been successful. Therefore, the patient should be constantly monitored by an ophthalmologist.

The main methods of treating macular degeneration:

• Conservative. This includes taking medications, physiotherapy courses, folk remedies and some minimally invasive procedures.
• Surgical. Surgery is suggested depending on the clinical picture of the disease.

Drug treatment

For macular degeneration, medications are used in the form of tablets, eye drops, and intraocular injections, which are given directly into the vitreous body. Pharmacological groups medications used:

Group of drugs	Mechanism of action	Names of drugs	Price, rubles
Antiplatelet agents	Prevents the formation of blood clots in blood vessels.	Acetylsalicylic acid
		Clopidogrel
Angioprotectors and vasodilators	Helps strengthen and dilate blood vessels.	Papaverine
		Askorutin
Hypolipidemic	Helps lower cholesterol levels.	Simvastatin
		Methionine
		Atorvastatin
Polypeptides	Improve vascular permeability, restore retinal function.	Retinalamine	4400 for 10 pcs.
Corticosteroids	Stops the inflammatory process.	Dexamethasone
Intraocular injections	Prevents the development of new blood vessels in the retina.	Lucentis

Vitamins

Reception vitamin complexes in case of macular degeneration of the retina, it is necessary to restore its functioning. Vitamins A, B, and E are beneficial for the eyes. They help improve the nutrition of eye tissue and slow down the progression of macular degeneration. The following complexes will help provide the body with these vitamins:

• Blueberry-Forte;
• Okyuvit-lutein;
• Vitrum Vision;
• Lutein-Intensive Evalar;
• Complivit Oftalmo.

Physiotherapy

Physiotherapeutic procedures help strengthen the muscles of the eye and retina. They are prescribed in combination with medications. Physiotherapy helps reduce unpleasant symptoms macular degeneration. Effective procedures for this disease include the following:

• Ultrasound therapy. This is a treatment technique using ultrasonic waves that improve metabolism in the eye tissues.
• Electrophoresis. During the procedure, medications are introduced into the body through an electric current. For macular degeneration, Heparin, No-shpa, and Nicotinic acid are used.
• Intravenous laser irradiation blood. This is the purification of the systemic bloodstream through exposure to light energy.
• Phonophoresis. The essence of the procedure is acoustic exposure to ultra-high frequency vibrations with the simultaneous use of medications.
• Magnetotherapy. Impact magnetic field on the body helps to normalize the functioning of basic biological fluids.
• Photostimulation of the retina. This is a procedure in which light signals are applied to the eyes to train the retina.
• Electrical stimulation of fiber. It consists of strengthening the motor muscles of the eye by applying pulsed electric current.

Laser coagulation

The cost of a course of laser coagulation for macular degeneration can vary greatly depending on the location. average price is 5-30 thousand rubles. The essence of the procedure is the impact on the retina of the eye with a laser beam: krypton, diode or argon. It stimulates the antioxidant activity of eye tissues and helps remove decay products from them.

After the procedure, tissue swelling in the macula area decreases and the membranes formed by new vessels are destroyed. Indications for laser coagulation:

• A non-exudative form of macular degeneration, in which there are no large retinal drusen.
• Exudative macular degeneration.
• Exudative-hemorrhagic macular degeneration.

Surgery

If conservative methods treatment long time do not give positive result, then the doctor decides on surgical intervention. Treatment of age-related macular degeneration is carried out using vasoreconstructive and revascularization operations. The first involves the restoration of the normal microvascular bed of the eye, the second - the complete destruction of abnormal vessels. Main types of prescribed operations:

• Vitrectomy. Is it partial or complete removal vitreous to gain access to the retina. In it, the doctor removes the subretinal membranes that impair vision. The vitreous tissue is replaced with a special liquid or gas. Price – 50-75 thousand rubles.
• Retinotomy. This is an operation to remove subretinal hemorrhages. After cutting the retina, the doctor removes the blood that has leaked underneath it. Clots are eliminated by administering special medications. Price - about 15 thousand rubles.
• Change in position of the macula. It is performed through subtotal vitrectomy and a circular incision in the retina. It is then peeled off to move it in the desired direction. The price of the operation can vary from 10 to 60 thousand rubles.

Folk remedies

Since age-related macular degeneration is a serious disease that can lead to blindness, folk remedies are used only as an addition to the main treatment. Judging by the reviews, the following recipes bring good results:

• Pour 1 tbsp. l. caraway seeds with a glass of boiling water, simmer for several minutes over low heat. Next add 1 tsp. cornflower blue, let cool completely. Strain the broth and drop 2 drops into your eyes. Carry out the procedure in the morning and evening.
• Pour 1 tbsp. l. dry celandine 0.5 tbsp. water, put on fire, boil for a couple of minutes. Allow to cool, then strain. Place 3 drops into eyes 3 times a day. for 1 month.
• Take homemade goat milk, dilute half with water. Place 1 drop into the eyes 2 times a day. The course of treatment lasts 1 week.

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