February is recognized worldwide as age-related macular degeneration awareness month
(Age Related Macular Degeneration Awareness Month)
Age-related macular degeneration (AMD) is a chronic progressive disease, яке проявляється ураженням важливої частини сітківки ока – макули. The macula is a small area in the center of the retina with the maximum concentration of light-sensitive cells, which is responsible for the high quality of central vision. AMD leads to loss of central vision, therefore, the patient does not distinguish the details of objects from a distance, not close. At the same time peripheral (lateral) vision is preserved.
Поширеність та прогресування ВМД зростають з віком пацієнта. This disease is the most common cause of vision decrease in the elderly and significantly affects the quality of their lives.
There are two forms of AMD:
- dry (non-exudative, atrophic);
- moisture (exudative, neovascular).
Most patients diagnosed with AMD have a dry form of the disease. It is characterized by pathological degenerative changes (the presence of friends) in the retina and choroid of the eye in the posterior pole due to or atrophy, or detachment of the retinal pigment epithelium.
Previously it was considered, that drusen is an accumulation of metabolic products from subretinal tissues (fabrics, which are under the retina), But now research data is indicating, that their accumulation is associated with inflammation in the subretinal space. These extracellular deposits consist of various substances, including vitronectin and protein material. The products of oxidative stress cause the development of chronic slow inflammatory process in patients with IMD.
At the heart of the development of exudative AMD is the formation of pathological nevascular (That is, that have newly formed vessels) chorioid membranes under the retina.
The pigment epithelium of the retina is a metabolically active layer, which supports the function of retinal photoreceptors. The formation of drusen is a sign not only of dysfunction of the pigment epithelium, but also loss of photoreceptors. Руйнування шарів сітківки та підвищення рівня факторів росту ендотелію судин (VEGF) провокують проростання аномальних судин під сітківкою. Increased permeability of blood vessels leads to seepage of plasma under the retina. The final stage of exudative AMD is the formation of a disc-shaped scar in the macula, that threatens the irreversible loss of central vision
Risk factors for the progression of age-related macular degeneration:
- Age. AMD usually affects people aged from 50 years.
- Smoking. Існує пряма залежність між розвитком пізньої стадії ВМД і кількістю сигарет, which a person smokes. Stopping smoking leads to stabilization of the process. According to recent studies - the risk of developing AMD increases in smokers, which use a combination of electronic and ordinary cigarettes.
- Excessive body weight. Body mass index >30 Not only increases the risk of developing the disease, but also causes its progression.
- Increased insolation. Studies have been found, that patients, who use sunglasses have less risks of illness on the AMD.
Diagnosis of age -old macular degeneration:
- Ammler test. The simplest test for self -control. Represents a sheet in a cell with a fixing point in the middle. Used to identify subjective changes in the central field of view. If there are changes in the macula, the squares may be distorted or dark areas may appear.
- Optical coherence tomography (OCT). OCT is the gold standard in the diagnosis of AMD. This is a non-invasive examination, using which you can evaluate the structure of the retina. OCT determines the architecture of the retina, which is not possible with any other imaging technology.
- OCT-angiography is a new visualization method, which is used for non-invasive assessment of retinal vessels without intravenous dye.
- Fluorescent angiography. It is recommended, If the review of the fundus (Ophthalmoscopy) or octa predict the presence of chorioid neovascularization. Needs the introduction of dye.
- Review of the fundus of the ophthalmologist.
Treatment of age-related macular degeneration
It is recommended for all AMD patients:
- give up smoking;
- follow a balanced diet, rich in fruit, vegetables and fish, with a sufficient content of omega-3 fatty acids.
Currently, there are no drugs for the treatment of dry VDM, therefore, prevention of this disease is important. Patients with early-stage dry AMD should consume adequate amounts of antioxidants, including vitamin A, vitamin E, zinc and lutein.
Варіанти лікування вологої ВМД включають:
- інтравітреальне введення препаратів – vascular endothelial growth factor inhibitors (anti-VEGF — anti-vascular endothelial growth factor);
- laser photocoagulation of the retina.
The choice of treatment tactics depends on the stage of the disease.
Prevention of age -old macular degeneration
Balanced nutrition rich in antioxidants — vitamins C and E, lutein and zeaxanthin, zinc, β-carotene and omega-3 fatty acids — reduces the risk of developing AMD. Because smoking is one of the main risk factors for the disease, smokers should quit smoking, especially if they already have the first signs of AMD. It is very important to have regular ophthalmological examinations for elderly people or those with any risk factors, associated with AMD.
The material is prepared with the assistance of the leading physician of the Medical Center "Laboratory of Biomedical Sensorics and Vision Correction" Okko-Plus "
Galina Mykhailivna Panasenko
