Ophthalmology VMD. Retinal pigmentary dystrophy. Concept of age-related retinal degeneration

Age-related macular degeneration (dystrophy) or AMD for short is the most dangerous for older people eye disease, since AMD most often leads to blindness in people over 50 years of age. There are more than 45 million AMD patients worldwide.

“- this phrase very clearly characterizes this disease.

« Age" means that advanced age is a decisive risk factor for the occurrence of AMD, moreover, than older man, the more susceptible he is to this disease. For example, for middle-aged people the risk of AMD is 2%, but for those over 75 years old, this figure increases to 30%!

« Macular"means that AMD affects the macula (or macula), the most sensitive area of the retina that provides central vision. It is thanks to central vision that a person is able to distinguish small objects and their details. The insidiousness of this disease lies in the fact that it is painless and patients usually turn to doctors for late stages AMD, when vision has already noticeably deteriorated.

« Degeneration“implies the gradual destruction of light-receiving cells of the retina (photoreceptors) due to disruption of their nutrition due to atherosclerotic changes in the blood vessels of the eye. As the disease progresses, a person's vision deteriorates in a manner similar to what is shown in this animated graphic:

If you suddenly suspect that your vision deterioration is due to AMD, you can do a self-diagnosis on.

AMD is explained in a very accessible and clear way in this 7-minute video:

As you probably understood from the video, there are two forms of AMD - dry and wet. Each of them has its own characteristics of course and treatment. Let's look at them in more detail.

Dry form of AMD

This is the most common form of AMD, occurring in 90% of cases. Because of age-related changes Metabolism in the retina (including the macula) produces non-cleavable polymer structures - drusen. The layers of the retina adjacent to these drusen experience an acute lack of nutrients and oxygen, due to which they degenerate (atrophy) with loss large quantity photoreceptors.

The fewer intact light-sensitive cells left in the macula, the more noticeable the loss of central vision. At first, a person feels the need for stronger lighting for reading and other visual work. Then patients notice the appearance and growth of a cloudy spot in the center of the field of vision. Over time, this spot increases in size and becomes darker. Because of this, difficulties begin when reading or recognizing faces even at a short distance.

Wet form of AMD

This is a more rapidly developing (and therefore more dangerous!) form of age-related macular degeneration, occurring in 10% of patients with AMD. In this case, the lack of retinal nutrition is compensated by the growth of new, but very fragile capillaries that allow blood and fluid to pass through. Macular swelling occurs.

In places of leakage, photoreceptors die and the photosensitive layer swells. As a result - sharp decline vision and the appearance of the effect of distortion of the visible image:

Prevention and treatment of AMD

As you already understand, the risk of developing age-related macular degeneration is directly related to the condition of the blood vessels of the eyes. Unhealthy lifestyle (physical inactivity, poor nutrition, obesity, hypertension, diabetes), bad habits (), - all these factors contribute to the deposition cholesterol plaques on the walls of blood vessels and deterioration of blood supply to the retina.

It's never too late to give up bad habits, increase physical activity, start eating right and enriching your food. Regular (at least once every six months) visits to an ophthalmologist to examine the fundus of the eye will help identify AMD at the initial stage, when treatment is most effective and the risk of vision loss is minimal.

Otherwise, in the later stages of AMD (when the photoreceptors of the macula have already died), it will be impossible to restore vision, unfortunately.

Ophthalmologists recommend that patients with AMD protect their eyes from direct exposure sun rays, but, in my opinion, this recommendation only aggravates the course of the disease. If you constantly hide your eyes from the sun, increased photosensitivity (photophobia) will be added to the symptoms of AMD, which will further worsen the patient’s condition.

It is well known that on a bright sunny day a person (including those suffering from AMD) sees much better than usual. But if bright light causes your eyes to reflexively close and water, then you simply won't be able to take advantage of the chance to see more clearly.

Still famous Dr. William Horatio Bates proved in practice the benefits of sunlight for the eyes. By using special exercise By irradiating the eyes with sunlight, you can not only get rid of photophobia, but also improve the condition of the retina due to the activation of metabolic processes in it under the influence of light. And this is exactly what AMD patients need.

An indispensable condition for effective prevention and treatment of early stages of AMD is antioxidant protection macula by taking carotenoids (lutein and zeaxanthin) - red, yellow or orange pigments found in plant and animal tissues, as well as the minerals zinc, selenium, vitamins C, E and anthocyanosides. "" is one of the most famous lutein-containing drugs that doctors recommend for AMD.

Lutein and zeaxanthin are the main pigments of the macula and provide natural optical protection to visual cells. Natural sources of lutein and zeaxanthin include egg yolks, broccoli, beans, peas, cabbage, spinach, lettuce, kiwi, etc. Lutein and zeaxanthin are also found in nettles. seaweed and the petals of many yellow flowers.

For dry AMD, treatment is usually limited to taking vitamins and the antioxidants mentioned above. Much less commonly used low-intensity (threshold) laser therapy to destroy drusen (yellowish deposits on the retina) using moderate doses laser radiation.

Laser therapy is also used to treat wet AMD. One of the types of such therapy is laser photocoagulation– involves the destruction of bleeding defective retinal vessels by a laser beam. However, there is a high risk of destruction of surrounding healthy tissue. Therefore, such laser surgery is more effective outside the macula, where the death of light-sensitive cells is not so critical for vision.

There is a more “gentle” option laser therapy wet AMD – photodynamic therapy. The patient is given intravenously special drug(“Visudin”), which tends to attach to the inner surface of blood vessels. After this, the retina of the diseased eye is irradiated with cold laser light, which activates this drug in the pathological capillaries that have grown into the retina. A chemical reaction occurs and the bleeding capillaries are destroyed, which slows down the rate of development of AMD. At the same time, the surrounding healthy tissue is not damaged.

But in first place in the treatment of wet AMD is the so-called anti-VEGF therapy blocking action specific factor growth (VEGF) of defective capillaries. One of the following drugs is injected into the eyeball using a special needle: Bevacizumab (Avastin), Ranibizumab (Lucentis), Pegaptanib (Macugen), Aflibercept (Eylea).

With this method of administration, the drug quickly penetrates all layers of the retina and begins its action aimed at reducing macular edema and preventing new hemorrhages. Some patients experience a positive effect within a week after the injection, but usually to achieve maximum results 3 injections are required at intervals of 1 month.

Here is a video that explains this method of treating wet AMD in more detail:

Unfortunately, the AMD treatment methods described above are not able to completely cure this disease. Yes, besides, they are not without negative side effects(eye infection, increased intraocular pressure, retinal detachment, temporary blurred vision, eye pain, etc.).

At best, patients experience some improvement in vision. But usually treatment is considered successful when vision at least stops deteriorating. But this is provided that the patient regularly visits the doctor and undergoes repeated medical procedures if necessary.

“The best treatment is prevention!” This saying is more appropriate than anywhere else in the case of age-related macular degeneration. If you lead a healthy lifestyle and regularly visit the ophthalmologist, then you have a chance to preserve your vision for up to old age increases significantly.

Good vision to you at any age!

Older people over the age of 60 know first-hand what age-related macular degeneration is. According to statistics, almost 30 million people around the world today suffer from this little-studied disease, which brings a lot of inconvenience. Recent data shows that macular degeneration is getting younger every year, now affecting 40-year-old men and women.

The main symptom of the disease is decreased central vision in one or two eyes. That is why it is important to contact an ophthalmologist in time if you notice a deterioration in visual acuity. Perhaps you suffer from myopia, or maybe it is - primary signs VKM.

What is macular degeneration associated with?

Age-related macular degeneration has understandable causes:

with age, cartanoids, which are protective elements of the visual organs, become less and less;
As a result, the eyes become defenseless against the harmful effects of solar radiation and UV rays.

The first to be affected is the macula, which is an integral part of central vision. Its function is to detail and indicate the activities in which the eyes are occupied, for example, to distinguish reading from writing. Thanks to the macula, a person also distinguishes colors.

Deviations in the central axis of vision associated with age are called degeneration. When it comes to young people, ophthalmologists diagnose macular degeneration.

Who is at risk of getting AMD?

The following categories of the population need to focus their attention on visual acuity for the appearance of VMD:

For smokers. It has been established that smokers suffer from macular degeneration more often than people leading a healthy lifestyle. The statistics are disappointing - among patients facing the disease, two thirds abuse cigarettes, which is associated with an increase in the levels of harmful free radicals that smoke produces.
If you like to eat heartily and at the same time do not follow a diet and diet, age-related macular degeneration will not be long in coming. Instead of consuming large amounts of fried, spicy, smoked foods, add salads of vegetables and fruits, low-fat varieties meats rich in protein. Cabbage, spinach, broccoli, and corn are rich in carotenoids that protect the retina.
On sunny days it is recommended to wear sunglasses with UV protection. Ordinary tinted glass can, on the contrary, harm the organs of vision.
AMD favors patients with fair skin and blue eyes, so if you fit the description and your vision has become worse, it’s time to make an appointment with an ophthalmologist.
Doctors have not yet figured out why women are more likely to suffer from the disease than the stronger sex.
When you encounter macular degeneration for the first time, ask if anyone else in your family has had the same disease. Genetic predisposition plays an important role in the appearance of AMD.
People with high blood pressure should be especially careful and monitor sharp jumps to avoid thrombosis of the ocular blood vessels. This phenomenon can also provoke age-related macular degeneration.
If the diagnosis is made in one eye, it is not at all certain that the other eye will not soon be affected.

As for the types of AMD, there are only two of them:

dry – complicated, therefore practically untreatable and develops slowly;
wet – correction and suspension of the development of the painful condition is possible.

Causes of dry and wet forms of AMD

Ophthalmologists identify the following reasons for the appearance of AMD of various forms:

If the dry form is diagnosed, thinning of the retina is assumed due to ongoing atrophy of the area and, as a result, lack of blood circulation. The pigment tissue on the macula dies, as evidenced by patches of atrophied cells visible when examined by doctors.
The wet type is less common, in no more than 20% of cases when patients are diagnosed with age-related macular degeneration. The reason is an increase in the volume of abnormal vessels that lie deep in the retina, but close to the macula. A defect in the layers leads to leakage of fluid, which forms swelling of the macula, as a result of which a person loses vision.

The aggravated form is considered to be the release of blood due to the excessive fragility of the vessels, which results in the formation of scars.

Symptoms of AMD

It is important to detect age-related macular degeneration early stages, then it is easier to cure or at least stop the development of the disease. Symptoms encountered by patients initial stages AMD includes the following complaints:

individual objects and images are distorted;
straight lines become curved;
it is impossible to determine the exact shapes and outlines of pictures;
photosensitivity develops.

Due to the lack of pain, many people mistake vision loss for eye strain and fatigue, so they do not consult a doctor. Over time they will have to face additional feature– appears in the center black spot which interferes with reading, writing, and driving.

How is macular degeneration diagnosed?

To make an accurate diagnosis, you need to visit a specialized ophthalmology clinic; in the clinic, the doctor does not have sufficient knowledge and equipment for research. He can only assume the disease and refer the patient for further examination, where you will be asked to undergo:

ophthalmoscopy – assessment of the condition of the retina of the diseased eye;
tomography - allows you to identify the cause of deviations from the norm in the early stages of the disease;
Amsler testing is possible at home. A person looks ahead of him through a special grid and determines whether there are distortions or not.

How to get rid of AMD

Treatment of age-related macular degeneration involves several types of therapy:

Laser exposure. The progression of the pathology slows down, the surgeon also has the ability to remove retinal scars.
Photodynamic laser exposure. A special composition is injected into the patient’s blood, which is then activated by a laser and affects pathological blood vessels.
Antiangiogenesis. Drugs that stop the increase in the number of affected vessels.
Devices that improve vision. Macular degeneration does not allow a person to see objects well; equipment and lenses will compensate for the losses and create enlarged images of what they saw.

TO the latest technologies Treatments for AMD include procedures that are still at an experimental stage:

an operation during which blood vessels are removed;
Retinal translocation involves the removal of blood vessels located under the retina.

Macular degeneration of the retina refers to a disease that affects the central part of the retina called the macula. It plays a major role in ensuring visual function. Age-related macular degeneration is one of the main causes of complete loss of vision in people over the age of fifty.

The macula is considered one of the important elements. Thanks to its work, a person sees objects that are located close to the eye, and also has the ability to read, write and perceive colors. The exact causes of this pathology have not yet been found. But age is considered the main factor.

The following are also considered to be the main reasons.

Gender. According to statistics, the female half of the population suffers from the disease much more often.
Hereditary predisposition.
Excess body weight.
Having bad habits such as smoking and drinking alcohol.
Lack of vitamins and minerals.
Long term exposure ultraviolet rays to the retina of the eye.
Injury visual organ.
Poor environmental situation.

Types of macular degeneration of the retina

Malacular dystrophy can go through various stages and forms as it develops. As a result, it can be divided into two types. This includes.

Dry form of macular degeneration. It is the initial stage of the disease and is considered the most common, as it affects about ninety percent of the population. Characterized by gradual loss of the central part of vision. But often the patient does not notice this.
Wet form of macular degeneration. This stage manifests itself if the dry form of the disease has not been diagnosed. The development of the disease is aggravated by the fact that new blood vessels of a fragile and brittle nature are formed. This results in hemorrhage and the formation of yellow deposits in the retina.

The gradual loss of central visual function leads to the inability to distinguish small objects. The dry form of the disease is not as bad as the wet form. But if the disease is not diagnosed in time and appropriate treatment is not started, this threatens the degradation of retinal cells and the complete loss of visual function. Wet macular degeneration occurs in ten percent of all cases. In the presence of this form, the process of growth of new vessels occurs. The walls of such tubules are underdeveloped, so they allow blood to pass into the retina. As a result, the cells become more susceptible, causing them to die and form spots in the central part of the view.

Macular degeneration causes a gradual but painless loss of visual function. Only in the rarest situations does blindness occur instantly. The main symptoms of macular degeneration include the following.

The appearance of dark spots in the central part of the visual field.
Fuzzy image.
Distortion of objects.
Deterioration of color perception.
Deterioration of visual function in the dark.

Diagnosis of macular degeneration of the retina

It is worth noting that the most basic method for determining macular degeneration is the Amsler test. A grid consisting of intersecting lines with a black dot in the middle is placed on the wall. The patient needs to look at it. A person who has similar illness, will see the lines unclear and broken, and in the central part there will be a large spot of dark color.

An ophthalmologist will be able to recognize the disease even before changes in visual function. For an accurate diagnosis, the patient must undergo examination.

Visometry. Using the method, you can evaluate visual acuity.
Ophthalmoscopy. Studies the condition of the retina and vascular tubules in the fundus.
Bioophthalmoscopy. Used to examine the fundus of the eye.
optical type. This method is considered the most effective for diagnosing macular degeneration at an early stage.
Amsler test. This method can also be done at home on your own.

Treatment process for macular degeneration of the retina

Macular degeneration is not treatable complete cure. But in practice there are methods that allow you to overcome the disease and stop its progression. This includes the following procedures.

Laser therapy. A laser device is used to remove damaged blood vessels.
Photodynamic treatment. Purpose this method is the introduction into the blood of a special medicine that can penetrate the damaged vessels of the eye. After this, they take a laser device that helps to hit new vessels of the pathological type.
Anti-angiogenesis factor. Thanks to such means, it is possible to stop the growth of pathological tubules.
Devices for low vision. Since macular degeneration deprives a person of the ability to fully see, specialized electronic devices and lenses compensate for this loss, while creating an enlarged image of the surrounding world.

If the above methods do not help or an advanced stage is observed, then the patient is prescribed the following.

Submacular surgery. Characterized by the removal of pathological vessels.
Retinal translocation. In such a situation, the affected vessels under the retina are eliminated.

In dry type macular degeneration, antioxidant therapy is recommended to normalize metabolic processes in the retina. According to statistical data, excellent results from the use of antioxidants were observed in those patients who were in intermediate or neglected form diseases. Combination treatment with antioxidants, zinc and copper significantly reduced the development of macular degeneration by twenty percent.

Treatment of wet type dystrophy is aimed at reducing the growth of affected vessels. In medicine, there are several means and methods that stop the manifestation of abnormal neovascularization.

Treatment of macular degeneration of the retina with traditional methods

Each patient is looking for the best way to treat macular degeneration. One of these is treatment with folk remedies.

Usage goat milk. It has unique properties. It is enough to mix a little with water in equal parts and drop one drop into each eye. After this, a dark bandage is placed over the eyes and rest is provided for half an hour. The treatment course lasts seven days.
The use of pine decoction. To prepare the infusion, you need to add pine needles, rose hips and onion scales. Pour in water and boil for approximately ten minutes. After this, the broth should cool. You need to consume up to one and a half liters per day. The course of treatment is one month.
Use of celandine. To prepare the infusion, you need to take one spoon of dry leaves and pour a cup of boiled water. Place on the fire for a few seconds and let it brew. The infusion must be filtered and placed in the refrigerator. The decoction is used as eye drops. The duration of the treatment course is one month.
Lotions made from a decoction based on nettle and lily of the valley. It is necessary to take equal proportions of herbs and pour a cup of boiled water. Let it brew for twenty minutes, then strain. Lotions must be done at least three times a day for two weeks.

Preventive measures to prevent macular degeneration of the retina

Macular degeneration leads to various complications up to loss of visual function. But in order to protect yourself from developing the disease, you need to follow several recommendations. These include the following activities.

An annual examination by an ophthalmologist.
Use of sunglasses.
Quitting bad habits such as smoking and drinking alcohol.
Restriction on fatty foods. It is also necessary to enrich the diet with vegetables, fruits and fish.
Use vitamin complexes for the visual organ.
Maintaining a healthy lifestyle.
Timely treatment of any diseases.
Carrying out daily gymnastics for the visual organ.
Organization good sleep and rest.

Previously, the disease was considered age-related, but nowadays you can find patients under forty years of age. Therefore, do not forget about the health of the visual organ and adhere to all recommended rules.

Macular retinal degeneration is one of the causes of irreversible loss of central vision in people over 55-60 years of age. In 2007, age-related macular degeneration was responsible for 8.7% of all cases of blindness on the planet. According to the current trend, this number of cases is expected to double by 2020.

The reason for the decline of visual functions is the degeneration of the macula - the most significant part of the retina, responsible for the acuity, sharpness and level of central object vision required for visual work or reading text at close range or driving vehicles, while peripheral vision Such patients, as a rule, do not suffer at all.

Macular degeneration leads to loss of objective vision, a decrease in overall performance and subsequent disability of the patient, which determines the high socio-medical significance of the disease. At the same time, macular degeneration of the retina can provoke both a slow gradual decrease in vision over several years, and rapid, within just a few months, loss of vision, which depends on the form of age-related macular degeneration and the severity of the disease.

What is the essence of age-related retinal degeneration?

To understand the essence of the pathological process, it is necessary to navigate the structure of the light-sensitive part of the eyeball - the retina. The retina is located at the back of the organ of vision and consists of two main layers. The inner layer is made of special light-sensitive cells - rods and cones. These cells act as receptors - they react to the light signal entering the retina and transmit data about it to the optic nerve. Cones help you see objects in daylight and also form color vision. The rods, in turn, are responsible for twilight vision. The outer layer of retinal cells is made of retinal pigment epithelium, which performs protective function and is involved in the nutrition of photosensitive receptors.

The macula or macula is a small part of the retina that is responsible for the formation of central vision. The macular region has the highest density of photoreceptors. In the very center there is a special depression - the fovea or fovea, made only by cones. It is the central fovea that is the main point responsible for human object vision.

Age-related macular degeneration of the retina affects this particular area, which is accompanied by a decrease in central object vision, up to irreversible blindness. Age-related macular degeneration is characterized by the deposition of cellular breakdown products between the retina and the choroid (choroid). This process is also associated simultaneously with morphologically determined hyper- and hypopigmentation of the retina. Such initial changes do not yet cause deterioration and reduction in visual acuity. However, further progression of the disease determines clinically significant changes. There are two forms of age-related macular degeneration of the retina, which will be discussed in detail below.

Forms of age-related retinal degeneration

Age-related macular degeneration, depending on pathophysiological changes, can be represented by two types, which are different in pathogenesis and manifestations of the development of degenerative changes in the macula and the posterior pole of the eye.

Dry form of macular degeneration

Atrophic or dry age-related macular degeneration accounts for about 85%-90% of cases of this disease and occurs with equal frequency among male and female patients.

This form of the disease is characterized by the deposition of cellular breakdown products, so-called drusen, between pigment epithelial cells and Bruch's membrane. Bruch's membrane is an acellular formation consisting of 5 layers and acts as a barrier between the retina and the choroid. Nutrients and necessary for normal functioning oxygen diffuses through Bruch's membrane to the pigment epithelium and photosensitive receptors of the retina. Metabolic products, on the contrary, are transported from the retina to choroid eyes.

With age, Bruch's membrane undergoes significant morphological changes, which include thickening, calcification, and degeneration of collagen and elastin fibers. Incomplete elimination and accumulation of metabolic products of lipid nature also occur. Deposits of metabolic products consisting of lipofuscin are called drusen. Drusen are the earliest indicator of macular degeneration of the retina and come in two varieties - soft and hard.

Hard drusen are small, round deposits with well-defined boundaries. They are often a sign of age-related changes in the retina, but do not cause clinically significant visual impairment. As macular degeneration of the eye progresses, small single deposits accumulate into larger formations - soft drusen.

The appearance of soft confluent drusen is associated with unfavorable prognosis maintaining high subject vision. There is a disconnection between the retina and the choroid, which disrupts the nutrition of all cellular layers of the retina, causes degradation of photoreceptors and gradual replacement of damaged retinal cells with scar connective tissue.

Geographic atrophy is the final stage of dry macular degeneration, in which large areas of atrophy and death of the retinal pigment epithelium and proliferation of connective tissue are visualized. Such processes lead to significant loss of central vision, which can progress over years. Slow decay of visual functions and a decrease in central vision significantly reduce the patient’s ability to visually work, but not as pronounced as with the wet form of macular degeneration.

Neovascular or wet age-related degeneration of the macula and posterior pole of the eye is alternative way the development of a pathological process in which the separation of the retinal pigment epithelium and choroid is accompanied by an increase in the concentration of vascular endothelial growth factor. This biologically active substance stimulates angiogenesis, that is, the ingrowth of newly formed vessels under the retina in the projection of the central macular zone.

Neovascularization processes are accompanied by vasodilation, impaired vascular permeability and migration of endothelial cells. Newly formed vessels, penetrating into the subretinal space, destroy the anatomical barrier in the form of Bruch's membrane between the choroid and the retina and form a kind of vascular network, called the “subretinal neovascular membrane”. The wall of the newly formed vessels is functionally defective, which leads to leakage of fluid, plasma and blood cells under the central zone of the retina and is accompanied by subretinal hemorrhages of varying volumes into the macula.

The constant presence of blood and fluid under the retina ultimately leads to the separation of Bruch's membrane, pigment epithelium and the photosensitive layer of the retina from each other, with subsequent disruption of the structure and function of photoreceptors, their degenerative degeneration, fibroglial transformation of tissue in the macular zone into a single scar conglomerate. Over time, a specific ridge forms in the area of the macula, surrounded by scar tissue and small hemorrhages.

Clinically, the processes described above are manifested by disturbances in central vision and the appearance of dark spots (scotomas) before the eyes. Thus, choroidal subretinal neovascularization, being a reparative reaction of the body aimed at improving trophism central retina, an increase in the supply of oxygen and nutrients to the macula leads to progression of the disease and inevitable loss of objective vision.

The wet form of age-related macular degeneration of the retina often develops in a short time - the disease can greatly impair the patient's quality of life in a few months or even weeks.

Causes of development of age-related macular degeneration

Until now, scientists have not been able to identify the only reliable cause of age-related macular degeneration of the eyes. However, age-related macular degeneration is believed to have a direct correlation with the age of the patients. So in patients with average age group the disease occurs in only 2% of cases; at the age of 65-75 years, the disease is detected in 20% of patients. And when people reach the 75-year barrier, the risk of developing the disease increases by 35%, that is, age-related macular degeneration of the retina is diagnosed in every third person. That is why, according to most researchers, the main reason for the development of the disease is age.

However, there are a lot of predisposing factors that, when combined with hereditary predisposition, determine the high risks of this pathology. Some of them will be listed below:

The risk of vision loss associated with macular degeneration in smokers is twice as high as in people without this bad habit.
Arterial hypertension, various cardiac pathologies, alcohol abuse, obesity, and Alzheimer's disease increase the likelihood of developing degenerative changes in the retina.
Hereditary predisposition, especially in combination with smoking, should increase suspicion for age-related macular degeneration of the retina.

All these factors cannot directly influence the condition of the retina. However, the biochemical reactions induced by them are the basis of macular degeneration of the eyes.

The retina is thought to be particularly susceptible to oxidative stress due to chronic exposure to visible light and high concentrations oxygen. The discovery of the role of oxidative stress in the development of macular degeneration identified the possibilities preventive treatment antioxidants for people at increased risk of age-related macular degeneration of the retina. This issue will be discussed in more detail in the section on therapeutic options.

Symptoms of age-related macular degeneration

The initial stages of age-related macular degeneration, especially if only one eye is involved in the pathological process, are most often asymptomatic. Painful sensations, which could cause discomfort and prompt a person to visit an ophthalmologist, are also absent. Age-related macular degeneration of the retina has many symptoms that affect daily life patients, the main ones of which are the following:

Decrease in varying degrees, up to complete loss of object vision with the formation of a spot or spots of gray or black colors in the central field of vision. Distortion of the image in the form of metamorphopsia - the objects in question have an elongated shape, a larger or smaller size than they actually are, broken straight lines. These symptoms are the most common and characteristic of pathology of the macular zone.
Cloudy and defective central vision causes problems with reading, writing, driving, watching TV, and recognizing faces.


	Vision of a patient with retinal degeneration

Impaired contrast sensitivity. It becomes difficult for patients to distinguish the textures of environmental objects and their changes. For example, such people may not notice small changes under their feet in the form of a drop in the sidewalk or a step. This increases the risk of falls and injury. Difficulties arise in differentiating colors that are similar in color range.
Poor tolerance to changes in light levels. Difficulties are caused by walking or driving a car at sunset or dawn, as well as moving from a well-lit room to a darker one.
Need for more lighting. Patients with age-related macular degeneration need brighter light for reading, cooking, and performing daily tasks.
Impaired perception of distances. People cannot adequately estimate the distance between objects, skipping steps or tripping over a threshold when walking.

Dry macular degeneration, as a rule, is characterized by a slow decrease in objective vision, a gradual increase in symptoms and the development of blurred images when viewing objects both near and from afar. Over time, central vision becomes increasingly blurry, and this area increases in size as the disease progresses.

Wet age-related macular degeneration is characterized by a sharp increase in symptoms of the disease and causes much more rapid vision loss, sometimes even within a few weeks.

Modern methods of diagnosing the disease

The examination always begins with a conversation, clarifying the details of the disease and complaints of patients who are suspected of age-related macular degeneration of the retina. The symptoms presented by the patient are quite characteristic and typical, which allows one to assume the nature of the pathology, which is subsequently confirmed by standard ophthalmological examinations and instrumental methods diagnostics

First of all, a fundus examination or fundoscopy is performed. During visual assessment, characteristic drusen are clearly visible in the form of pale yellow dots. In the wet form of the pathology, abnormal choroidal vessels, as well as foci of local hemorrhage, are well differentiated.

Amsler grid. The Amsler test is the simplest and most functional test for diagnosing the condition of the central visual field, and is often used for self-monitoring. If a patient has macular degeneration, the visible lines appear broken and wavy, and there are gray or dark spots in the field of vision.


Normal vision	Dry macular degeneration	Wet retinal degeneration

Fluorescein angiography is performed if choroidal neovascularization is suspected. Hypofluorescent changes are usually associated with hemorrhages and pigmentary hyperplasia. The causes of hyperfluorescent changes are more numerous and include soft and hard drusen, a network of newly formed vessels, atrophy of the pigment epithelium, and subretinal fibrosis.

Optical coherence tomography is a highly effective non-invasive diagnostic method that allows you to detect the presence of intra- and subretinal fluid, as well as evaluate the effect of the treatment.

Optical coherence tomography of the macula of a healthy eye

Optical coherence tomography for age-related macular degeneration of the retina

Age-related degeneration of the macula and posterior pole requires constant monitoring in order to timely identify the progression of the disease or the transition of the disease from a dry form to a more aggressive wet one.

Dynamic instrumental observation 2-3 times a year in patients suffering from age-related macular degeneration of the retina can significantly improve the prognosis and promptly stop the irreversible decline in central object vision.

If the patient has a complicated medical history, but in the absence of clinical signs of the disease, control examinations of the fundus and dynamic monitoring of the results are usually recommended instrumental examination for early detection of hard or soft drusen 1-2 times a year.

Age-related macular degeneration. Treatment

Despite significant achievements modern methods diagnostic examination and early referral to a doctor for patients who have been diagnosed with age-related macular degeneration, its treatment is still a difficult task to solve.

How to treat dry macular degeneration?

Unfortunately, there is no therapeutic intervention that would be able to stop the progression or cure patients with dry macular degeneration of the eyes. Taking into account the theory of oxidative stress, patients with a large number drusen, pigmentary changes or geographic atrophy, antioxidant intake according to various regimens is indicated.

The goal of this treatment for age-related macular degeneration of the retina is to neutralize oxygen free radicals that provoke pathological reactions. Dosages and individual dosage regimens are determined by the doctor. The main components of such therapeutic regimens are vitamin C, vitamin E, zinc oxide, lutein, beta-carotene, vitamin A, copper oxide. Patients are also usually advised to stop smoking and eat foods rich in polyunsaturated omega-3 fatty acids.

Macular degeneration - wet form: treatment of pathology

Treatment of the wet form of age-related macular degeneration of the retina is aimed at inhibiting the processes of subretinal neovascularization, preventing and treating complications.

Angiogenesis inhibitors

Inhibition of angiogenesis is currently one of the most effective methods treatment of wet macular degeneration of the retina. basis therapeutic action is the intravitreal administration of antiangiogenic drugs, that is, drugs that block vascular growth factor and, accordingly, suppress the process of subretinal neovascularization.

Most commonly used in practical activities are Pegaptanib (Macugen), Bevacizumab (Avastin), Ranibizumab (Lucentis), and Aflibercept (Aylia). The use of drugs in this group for age-related macular degeneration helps stop the growth of pathological blood vessels, thereby reducing the risk of vision loss. Over the past decade, numerous clinical studies confirmed them high efficiency in patients who have been diagnosed with wet age-related macular degeneration.

Treatment with angiogenesis inhibitors allowed them not only to stabilize, but also to improve visual function. Significant disadvantages of this type of treatment are the invasive nature of the intervention, a decrease in the effect of treatment if it is abandoned, and the significant cost of treatment, especially taking into account the need for a course of intravitreal injections to achieve a clinically significant result.

Laser coagulation for macular and posterior pole degeneration

Laser treatment methods are indicated for the presence of subretinal neovascular membrane in patients who have been diagnosed with age-related macular degeneration. Treatment consists of laser coagulation of the neovascular membrane located extrafoveolar to the central fovea of the retina.

The purpose of laser coagulation is to stop blood flow in newly formed vessels due to the coagulating effect of laser radiation on their wall. The main disadvantage of this treatment for macular degeneration is the presence of an undesirable damaging effect on the photoreceptors of the retina, which significantly limits the indications for the use of laser treatment, both in terms of the localization of the pathological process and the magnitude of object vision.

Photodynamic therapy

When treating the wet form of age-related macular degeneration of the retina, photodynamic therapy is a worthy alternative to laser treatment. Often photodynamic therapy is even more in an efficient way combating the phenomena of wet degeneration of the macula and posterior pole of the eye in comparison with the above treatment methods.

The clinical result of treatment is due to the laser effect on newly formed vessels and blocking blood flow in them. The photosensitive drug “Visudin” used in photodynamic therapy accumulates only in areas of neovascularization. Laser irradiation“Visudin” accumulated in newly formed vessels leads to the formation of a blood clot in them and obliteration of the lumen, as a result of which blood flow in the neovascular vascular network completely stops.

The undoubted advantage of photodynamic therapy compared to laser treatment is its exclusive effect only on newly formed vessels without damaging the photoreceptor cells of the retina. It is also necessary to note the possibility of combined use of photodynamic therapy in combination with other methods of treating the wet form of age-related macular degeneration of the retina.

Transpupillary thermotherapy

Transpupillary thermotherapy is one of the safe and effective methods of treating age-related macular degeneration of the retina, which has proven itself in the wet form of macular degeneration with the presence of hidden choroidal neovascularization of any type, including subfoveal localization.

Carrying out transpupillary thermotherapy in the macular region of the retina does not lead to coagulation and photochemical damage to photoreceptor cells, since the main objective of the method is to reduce blood flow in the choroid as a result of irradiation with an infrared laser.

Transpupillary thermotherapy is usually an alternative to photodynamic therapy when there is no positive healing effect the last one.

Surgical treatment of macular degeneration

Surgical treatment of age-related macular degeneration of the retina is carried out to improve central vision in advanced stages of the disease when other less invasive treatment methods are ineffective or futile. In some cases, the indication for surgery is the presence of hemorrhagic complications in the form of massive subretinal hemorrhages in the wet form of macular degeneration. Surgical treatment is performed in the form of subtotal vitrectomy, during which the vitreous body is excised and access to the retina and subretinal space is provided.

All types of surgical treatment of retinal degeneration can be divided into three groups: removal (exeresis) of the subretinal membrane and drainage of subretinal hemorrhages, macular translocation and transplantation of pigment epithelial cells.


Removal of the subretinal membrane	Macular translocation

Unfortunately, advanced stages of macular degeneration, in which surgical intervention is indicated, are accompanied by severe morphological changes retina and underlying intraocular structures, which does not significantly improve visual acuity after surgery.

However, surgical treatment of retinal degeneration provides the patient with a subjective improvement in vision due to the formation of stable eccentric fixation and a reduction in the phenomena of metamorphopsia.

Forecast of visual functions

Age-related macular degeneration is an irreversible disease that is difficult to treat. This is why periodic preventive visits to an ophthalmologist are necessary for older people. This will help to identify the pathology in time and prevent its pronounced progression.

If there are symptoms and clinical data of macular retinal degeneration in one eye, the frequency of manifestation of the disease in the fellow eye, according to various researchers, is in the range of 5-15%. Over the next year, approximately 25% of these patients completely lose object vision.

At the same time, timely diagnostic examinations and adequate appropriate treatment of retinal degeneration can significantly reduce the number of episodes of severe loss of visual function.

In people with macular degeneration, the macula, the area responsible for central vision, is damaged. Disease leads to destruction nerve cells retina, responsible for the perception of light waves.

As a result, patients' visual acuity decreases. It becomes difficult for them to read, watch TV, recognize acquaintances on the street, and even do their usual daily work. Treatment of macular degeneration of the retina can slow down the progression of the disease, but does not cure it.

Reasons

The reliable cause of macular degeneration of the retina has not yet been established. However, there are several theories to explain the appearance of degenerative changes in the macula. As shown scientific research, they all make sense.

Theories of the development of macular degeneration:

Lack of vitamins and microelements. Many scientists believe that a deficiency of certain vitamins, antioxidants, carotenoids, zinc, zeaxanthin and lutein contributes to the development of the disease. Due to lack of biological active substances the retina begins to gradually deteriorate, and the person begins to go blind.
High cholesterol and “wrong” fats. Scientific studies have shown that age-related macular degeneration is more likely to occur in people who consume a lot of saturated fats. fatty acids and cholesterol (these substances are found in animal products, some vegetable oils, and confectionery products). But people who eat enough monounsaturated fats (in particular omega-3 fatty acids) get sick much less often.
Smoking. It is known that cigarette abuse increases the risk of developing the disease by about three times. The connection was established through thirteen different scientific studies.
Cytomegalovirus infection. Scientists claim that CMV is one of the factors causing development wet form of age-related macular degeneration. It is worth noting that more than 80% of the world's population is infected with this virus, however, the majority are only asymptomatic carriers.
Hereditary predisposition. British scientists have discovered six mutations of the SERPING1 gene associated with the development of pathology. This explains the fact that the disease occurs much more often in close relatives. Statistics show that females are more susceptible to macular degeneration.

Dystrophy of the macular zone develops due to circulatory disorders in the small vessels of the retina. The reason for this may be atherosclerotic changes, sclerosis of capillaries or their spasm in smokers. Lack of blood leads to oxygen starvation mesh shell. As a result, the patient’s macula begins to gradually deteriorate.

The macula consists of a huge number of cones - nerve cells responsible for visual perception. For their normal functioning, vitamins, minerals and pigments are needed. Therefore, a lack of zinc, vitamins A, E and C, lutein and zeaxaltin in the body leads to disruption of the rods and the development of macular degeneration.

Forms of the disease

Ophthalmologists distinguish dry and wet forms of age-related macular degeneration. The first occurs in 90% of cases and has a relatively favorable course. It develops very slowly and rarely leads to complete blindness. The wet form of the disease is much more dangerous. It progresses quickly and causes sharp deterioration vision.

Dry

Yellow pigment accumulates in the macula area, which over time damages the light-sensitive cones. Initially, the disease affects one eye, and later the second is involved in the pathological process.

In the dry form of macular degeneration, symptoms appear gradually and very slowly. As a rule, people consult a doctor in the later stages of the disease. It is almost impossible to restore vision in this case.

Wet

The wet form of age-related macular degeneration is characterized by pathological growth blood vessels towards the macula. Fluid from the newly formed capillaries leaks and permeates the retinal tissue, which leads to its swelling. As a result, the patient's vision is greatly distorted.

Wet macular degeneration almost always develops against the background of dry macular degeneration. This means that it affects sick people who already have dystrophic changes macular area. The wet form of the disease is ten times more likely to lead to complete blindness than the dry form.

Stages

In its development, dry macular degeneration goes through several successive stages. An ophthalmologist can distinguish them after examining the patient. To assess the severity of the disease, he needs to examine the fundus. For this purpose, he performs direct or indirect ophthalmoscopy.

Stages of dry macular degeneration:

Early. Has an asymptomatic course. The disease is detected by chance during routine examinations. During ophthalmoscopy, the doctor detects small and medium-sized drusen in the fundus. Externally, these formations look like round yellow-white spots.
Intermediate. During the examination, drusen of medium and large sizes or geographic atrophy of the macula that does not affect the central fovea are detected. At this stage, patients notice the appearance of a fuzzy spot in front of their eyes. Visual acuity begins to gradually decrease.
Expressed. Due to the destruction of light-sensitive cells (cones), the patient's vision is greatly deteriorated. Geographic atrophy spreads to the fovea, causing a large black spot to appear before a person’s eyes, making it difficult to see the world normally. At an advanced stage of the disease, signs of neovascular maculopathy appear in the macular area.

Subsequently, active proliferation of blood vessels continues in the macular area. Soon they begin to rupture with the formation of hemorrhages. Thus, the patient develops a wet form of the disease. Photoreceptors quickly die, and a person permanently loses vision.

Symptoms

The dry form of age-related macular degeneration is characterized by a slow development of symptoms. At first, the patient notices that he needs brighter light for reading. It becomes difficult for him to navigate in the dark, especially when entering a dark room from a lit one. The person does not feel any pain in the eyes. Over time, the patient's vision becomes distorted, which greatly interferes with reading and disrupts the usual way of life. The patient has difficulty recognizing familiar faces and has poor spatial orientation.

Some people experience so-called Charles Bonnet hallucinations. They are characterized by the appearance before the eyes of non-existent geometric shapes, animals and even human faces. Many patients are hesitant to talk about this symptom because they are afraid that they will be taken for crazy.

The wet form of macular degeneration appears rapid decline visual acuity. In some cases, a dark spot (scotoma) appears in front of the eyes, preventing the patient from seeing normally. To a person with a wet form of macular degeneration, straight lines appear curved, wavy, and distorted.

Which doctor treats macular degeneration of the retina?

The dry form of the disease is treated by an ophthalmologist. At the reception, he carefully examines the patient and prescribes suitable drugs. Then the doctor registers the patient with a dispensary and explains that he will have to appear once a year for routine examinations. Regular visits to the ophthalmologist allow you to notice the progression of the disease and take appropriate measures in time.

If the wet form develops, a person requires the help of a vitreoretinal surgeon or laser ophthalmologist. These specialists are involved in the diagnosis and treatment and vitreous. They are qualified to perform intravitreal injections and laser surgeries.

Diagnostics

Macular degeneration can be suspected based on the patient’s characteristic complaints and progressive deterioration of vision. To confirm the diagnosis, ophthalmologists use a number of additional techniques research. With their help, you can determine the form and stage of the disease.

Methods used to diagnose macular degeneration:

Method	Target	Results
Visiometry	Determine visual acuity of each eye	A decrease in visual acuity indirectly indicates damage to the macular region of the retina
Perimetry	Identify scotomas (defects in the visual field)	The appearance of a central scotoma (spots before the eyes) indicates the presence of pathological changes in the macula of the retina
Amsler test	Check if a person has vision distortion	A sheet of paper with a drawn even grid is placed in front of the patient and asked to look at it with each eye in turn. If the lines appear crooked or wavy to a person, the test is positive.
Ophthalmoscopy	Discover pathological changes on the retina of the eye	In various forms of macular degeneration, the doctor can see drusen, newly formed vessels, areas of hemorrhagic impregnation and hemorrhage
Fluorescein angiography (FA)	Examine retinal vessels.	In the image you can see absolutely all the vessels of the fundus and their location. The release of the contrast agent beyond the vascular bed indicates capillary ruptures and hemorrhages.
Optical coherence tomography (OCT)	See structural changes macular area	In the early stages of the disease, OCT allows one to see the initial degenerative changes in the retina. In the wet form, the image usually reveals macular edema

Conservative treatment

In the initial stages, macular degeneration of the retina is treated conservatively. To combat pathology, antioxidants, visual pigments, carotenoids and certain trace elements (zinc, copper) are used. In some cases, courses of anticoagulant therapy are carried out, sometimes preference is given to regular use of drugs.

Vitamin-mineral complexes (VMC) inhibit the progression of the disease and help delay the development of irreversible changes in vision. Many doctors are skeptical about this treatment, but recent scientific studies have proven its effectiveness.

Effective IUDs must contain the following components:

lutein;
zeaxaltin;
anthocyanins;
lycopene;
beta-carotene;
vitamins E, A, C;
copper;
zinc;
omega-3 fatty acids.

Among the vitamin-mineral complexes, the most effective in the treatment of macular degeneration are the following drugs:

Focus;
Nutrof Total;
Lutein Complex;
Vitrum Vision Forte;
Complivit Oftalmo;
Okuwait Lutein.

They have the richest and most balanced composition, thanks to which they actively nourish the retina and protect it from destruction.

Treatment of macular degeneration of the retina cannot be done without balanced nutrition. The patient should eat more green vegetables, carrots, fresh fruits, and berries. Sprouted grains and legumes are very useful in this regard. But rich broths, fatty meats, fried, salted and smoked dishes It is better to exclude them from the diet, as they can aggravate the course of the disease.

To treat macular degeneration of the retina, you can additionally use folk remedies. Among them are:

aloe;
mumiyo;
calendula;
caraway;
celandine;
medical leeches.

It should be noted that traditional medicine methods do not always give the expected results and cannot replace traditional treatment.

Modern methods of treatment

Nowadays, several progressive techniques are used to treat age-related macular degeneration of the retina. They are effective in the last stage of dry and wet forms of the disease. With their help you can stop the growth small vessels and destruction of the macular region of the retina.

Intravitreal administration of anti-VEGF drugs

Since on late stages macular degeneration of the retina is accompanied by neovascularization; patients are prescribed drugs that destroy abnormal vessels and prevent their further growth. Medicines are administered intravitreally, that is, into the vitreous cavity.

Anti-VEGF agents include:

Lucentis;
Ilia;
Makugen.

After administration of the drug, patients soon notice an improvement in vision. However, to obtain lasting visible results, at least 5 injections per year are required. The duration of anti-VEGF therapy should be at least 2 years. Unfortunately, due to the high cost, many people cannot complete the full course of treatment and are limited to 2-3 injections.

Laser coagulation of the retina

The procedure is aimed at destroying newly formed vessels. The doctor uses a laser to clog the bleeding capillaries, thereby preventing the appearance of hemorrhages and foci of hemorrhagic leakage.

Unfortunately, laser coagulation does not affect the cause of the disease and does not prevent further neovascularization. Moreover, laser cannot remove vessels located in the macular area. This means that laser coagulation itself is ineffective. Therefore, the procedure is usually performed in conjunction with intravitreal administration of anti-VEGF drugs.

Photodynamic therapy

The essence of the procedure is intravenous administration photosensitive drugs followed by exposure of the retina to laser beams. With the help of photodynamic therapy, it is possible to remove fluid accumulated under the retina and even partially restore lost vision. The procedure is especially effective in the treatment of wet macular degeneration of the retina.

Due to the high cost of drugs similar treatment practically unavailable in our country. Abroad, photodynamic therapy is used together with intravitreal administration of anti-VEGF drugs.

When is surgery needed?

Surgical treatment of macular degeneration is necessary in the case of massive hemorrhages under the retina and the appearance of subretinal membranes. Surgical intervention helps to remove severe consequences illness and partially restore vision.

Types of operations for macular degeneration:

Retinotomy. Using special equipment, the surgeon removes the vitreous humor, which allows him to gain access to the macular area. He then cuts the retina and removes the accumulated fluid from underneath it. Instead of vitreous, he injects a special solution.
Macular translocation. The operation also begins with vitrectomy. During surgical intervention the doctor carefully moves the macular zone of the retina into right place. This allows for improved vision.
Pneumatic displacement of a submacular hematoma. The surgeon introduces air into the eye cavity, which displaces the spilled blood. After the procedure, the retina returns to its place, and the person sees much better.

Prevention

A healthy lifestyle is very important to prevent the disease. A person needs to stop smoking and eliminate unhealthy foods from their diet. In bright sunshine, he should wear wide-brimmed hats and sunglasses. Regular exercise will also help.

People over 50 years of age whose relatives suffered from macular degeneration for preventive purposes You should take vitamin and mineral complexes. Regular visits to an ophthalmologist are also required. At this age, it is necessary to attend preventive examinations at least once a year.