Forms and stages of the disease
The macula is a small area of the retina with the highest density of light-sensitive cells. Underneath it is a layer of pigment epithelium that nourishes these cells and removes waste products. With age, deposits - drusen - accumulate underneath it, the blood supply is disrupted, and the cells gradually die. In the dry form, this happens slowly; at a later stage, areas of atrophy form. In the wet, or neovascular, form, fragile new vessels grow in response to lack of nutrition, leaking fluid and blood, which quickly destroys the macula.
- Early stage - small and medium drusen
- Intermediate stage - large drusen, pigment changes
- Late dry form - geographic atrophy
- Wet, neovascular form
- One- and two-sided damage
Causes and risk factors
AMD develops under the influence of age, heredity and lifestyle. The risk is markedly higher in people whose parents or siblings had macular degeneration. Smoking is the most significant factor that can be influenced: in smokers, the disease occurs more often and is more severe. Arterial hypertension, atherosclerosis, high cholesterol, obesity and inactivity are important. Diets low in vegetables, greens and fish are also associated with an increased risk. The role of prolonged exposure to bright sunlight without eye protection is discussed.
- Age over 50
- Smoking
- Macular degeneration in close relatives
- Arterial hypertension and atherosclerosis
- Obesity and sedentary lifestyle
- Diet lacking vegetables and fish
Symptoms
At an early stage, there may be no complaints, especially if the second eye sees well and compensates for the deficiency. The first signs are often difficulty reading small print, needing brighter light, decreased contrast, and dull colors. Distortion is typical: straight lines of door jambs, tiles, lines appear wavy or curved. A blurry, gray or dark spot appears in the center of the visual field, making it difficult to distinguish faces. With the wet form, symptoms increase quickly. Lateral vision is preserved, the person can navigate in space.
- Curvature of straight lines
- Blurry or dark spot in the center
- Difficulty reading and recognizing faces
- Need for bright lighting
- Dull colors
- Slow adaptation to darkness
Diagnostics
The ophthalmologist checks the visual acuity of each eye and suggests looking at the Amsler grid - a square of straight lines with a dot in the center, on which distortions are visible. Examination of the fundus with pupil dilation reveals drusen, pigment changes, and hemorrhages. The key test is optical coherence tomography, which shows the retina layer by layer, the fluid underneath it, and helps distinguish the dry form from the wet one. OCT angiography and fluorescein angiography allow you to see pathological vessels. The same methods are used to monitor treatment.
- Visual acuity test
- Amsler test
- Fundus examination with pupil dilation
- Optical coherence tomography
- OCT angiography
- Fluorescein angiography according to indications
Treatment and prevention
There is no effective treatment that restores cells in the dry form yet. In the intermediate stage, the ophthalmologist may recommend a vitamin-mineral complex of a special composition, which in studies slowed down the transition to the late stage; It is not needed for prevention in healthy people. The main treatment for the wet form is regular injections of angiogenesis inhibitors into the vitreous, which suppress the growth of pathological vessels and often stabilize or improve vision. The treatment is long-term, according to the doctor’s schedule. Smoking cessation, blood pressure control, a diet rich in vegetables and fish, self-monitoring using the Amsler grid, and in case of reduced vision, magnifying glasses and magnifying devices are important.
- Intravitreal injections of angiogenesis inhibitors
- Regular OCT controls
- Quitting smoking
- Blood pressure and cholesterol control
- Eating with green vegetables and fish
- Self-test using Amsler grid
- Magnifiers and aids for the visually impaired
