Keeping good eyesight into 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 the tissue of the eye. It is believed that vision deteriorates from the age of 40-45. This happens even in cases where a person has not previously had vision problems during his life. Visual impairment occurs gradually. Most people are worried 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. Such an ailment is dangerous because 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 related to the headbrain (is a peripheral analyzer). With the help of the retina, the perception of information is formed 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 macular degeneration. 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 old 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 disease. 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 at a late stage. In these cases, it is necessary 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 tends to be slow and progressive. The causes of dystrophic changes in the macula of the retina may be different. The main one is the involution of the tissues of the eye. However, in some people, dystrophic changes occur faster, while in others it is slower. Therefore, there is an opinion that age-related macular degeneration is inherited (genetically), and also prevails in people of European nationality. Other risk factors include: smoking, arterial hypertension, frequent exposure to the sun. Based on this, it is possible to identify the causes of macular degeneration. These include:
- Vascular lesions. One of the risk factors is atherosclerosis of small arteries. Violation of oxygen delivery to the tissues of the eye is one of the main mechanisms for the development of degeneration.
- Overweight.
- Lack of vitamins and some trace elements. Among the substances necessary for the maintenance of retinal tissues, one can single out: lutein and zeaxanthin.
- The presence of a large number of "free radicals". They increase the risk of developing organ degeneration several times.
- Ethnic features. The disease is more common in people with light eye color. The fact is that in 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 symptoms.diseases.
- Wrong diet.
- Staying in direct sunlight without safety glasses.
Pathology often develops in people with a burdened hereditary history (presence of the disease in parents, grandmothers). In most cases, the disease is diagnosed in the female population.
Age-related macular degeneration: pathophysiology of the process
Like all degenerative changes, this disease has a complex mechanism of development. In addition, the pathogenesis of dystrophic processes has not yet been fully studied. It is known that under the influence of adverse factors, the macula tissue undergoes irreversible damage. Most often, pathology begins to develop in people suffering from vascular diseases (atherosclerosis, diabetes mellitus), 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. Free radicals play a major role in this process. These substances are formed in the macula for several reasons. First, the macula of the retina is constantly exposed to oxygen and light. In addition, there is an accumulation of fatty acids in this area, 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 related tobrain. Therefore, she is especially sensitive to "oxygen starvation."
All of these factors contribute to the fact that the tissue of the macula gradually becomes thinner. 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 epithelium of the macula begins to "lose" pigment receptors, undergoes 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 the retinal tissue. Such a division is necessary to determine the tactics of treating the disease.
Morphological types of disease:
- Age-related macular degeneration - wet form: characterized by the presence of exudate. This option is rare, in 20% of cases. It has 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 the damage in cell membranes, their permeability increases. As a result, edema develops andhemorrhages.
- 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, insufficiency of the pigment layer, defects in the epithelium.
- Cicatricial form of macular degeneration. It is considered the end stage of AMD. It is characterized by detachment of the epithelium and the formation of connective tissue (scar). In this case, there is a complete loss of vision.
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 - diabetic retinopathy. Such changes indicate a deterioration in the forecast and are a signal for urgent action.
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 does not make itself felt for several years. In the dry form of AMD, drusen appear on the surface of the retina - areas of atrophy. As a result, vision gradually deteriorates. The pigment layer suffers to a greater extent, due to which the brightness of the colors is somewhat lost. Visual acuity may change, but only slightly. The wet form of macular degeneration develops quickly. In a few days, vision can deteriorate significantly, up to complete blindness. Because ofswelling and increased membrane permeability, hemorrhages can occur that are visible to the naked eye. Symptoms seen with AMD:
- Change the contrast and brightness of an image.
- Decrease in visual acuity.
- Curvature, distortion of objects.
- Fuzzy image.
- Appearance of visual field loss.
- Unable to read despite wearing glasses.
With the gradual development of pathology, signs of the disease may be absent for a long time. Then there is a gradual deterioration of central vision. When looking ahead, most of the image becomes blurred. However, peripheral (lateral) vision is preserved. Gradually, the affected area increases.
With the wet and cicatricial form of AMD, blindness occurs quickly. Unlike the dry type of degeneration, peripheral vision is rarely preserved. 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 early. Therefore, people suffering from vascular lesions should be examined by an ophthalmologist 1-2 times a year. Diagnosis of AMD is based on anamnesis data and a special examination. Elderly people most often complain of the appearance of a "spot" before their eyes, resembling fog. The diagnosis of "macular degeneration" is most often made when vision deteriorates in women, especially if there is a history ofthere is type 2 diabetes mellitus, atherosclerosis of the vessels. In addition to the survey, a number of ophthalmological examinations are performed. Among them are the measurement of visual acuity, perimetry, stereoscopic biomicroscopy.
To assess the condition of the vessels, conduct fluorescein angiography of the fundus. Thanks to this study, it is possible to detect zones of detachment of the epithelium, atrophic drusen, neovascularization. However, this method of instrumental diagnostics has contraindications and risks. Therefore, before deciding to undergo an examination, it is worth visiting an ophthalmologist and getting his advice.
How to treat dry macular degeneration?
When the diagnosis is confirmed, treatment for age-related macular degeneration should be started immediately. The dry form of the disease is less aggressive, so it is amenable to drug therapy. This will not help to 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 need to follow a diet. Considering that atrophic processes develop due to a lack of carotenoids and blockage of the fundus vessels, the patient should exclude animal fats. To prevent atherosclerotic changes in the small arteries of the retina, you should eat a large amount of fruits, herbs, and vegetables. In addition, such a diet will help compensate for the lack of vitamins and minerals.
To cope with free radicals, it is recommended to spend less time in the sun. Also, patients shouldconsume antioxidants. These include vitamin E and C. To improve the 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 is carried out, but also surgical treatment. Drugs that restore the pigment layer of the retina include drugs "Lutein" and "Zeaxanthin". These medicines 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 carry out hypoglycemic therapy under the control of the glycemic profile.
Surgical treatment of retinal degeneration
Medical therapy alone is not enough if a 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 ophthalmological clinic performs laser treatment of macular degeneration. It may be different. The choice of method depends on the stage of AMD and manifestations of pathology. There are the following methods of surgical correction:
- Laser coagulation of the neovascular membrane.
- Photodynamic therapy with Vizudin.
- Transpupillary laser thermocorrection.
If possible and there are no contraindications, pigment epithelium transplantation, vitrectomy (withhemorrhage in the vitreous body of the eye).
Prevention of age-related retinal degeneration
To preventive measures include: diet, weight loss. With vascular lesions, smoking cessation is recommended. Also avoid direct exposure to sunlight for people with light eye color. In addition, prevention includes the use of vitamins to strengthen vision and trace elements.
