AMD is a wet form of manifestation in the fundus. AMD (age-related macular degeneration)

Macular retinal degeneration is a disease that affects the most important area of the retina - the macula. This part provides the main function of vision, with the help of it we see objects.

The disease has serious consequences, one of the most dangerous is the loss of vision without the possibility of resuming 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 worse diseases with vision, and without proper treatment to blindness.

Treatment is usually surgical, and 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 VMD?

What is VMD?
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 providing vision.

Age-related macular degeneration is the leading cause of irreversible vision loss and blindness in people aged 50 years and older in the developed world. As people in this group represent an increasing 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 zone of the retina and choroid. In this case, damage to cells and intercellular space occurs and, as a result, dysfunction. In this case, we are talking about a violation of the function of central vision.

According to WHO, the proportion of the population of the older age group in economically developed countries is about 20%, and by 2050. will probably rise to 33%.

Accordingly, due to the expected increase in life expectancy, the steady increase in atherosclerosis and comorbidity, the problem of AMD remains the most relevant. Moreover, in last years there is a clear trend towards "rejuvenation" this disease.

The reason for the decrease in vision is the degeneration of the macula, the most important area of the retina, responsible for the sharpness and sharpness of the central vision necessary for reading or driving a car, while peripheral vision is practically not affected.

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

Dry and wet forms

Intensive metabolism in the retina leads to the formation of free radicals and other active forms oxygen, which can cause the development of degenerative processes in case of insufficient work of the antioxidant system (AOS).

Then in the retina, especially in the macula and paramacular region, under the action of oxygen and light, non-splittable 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. In the future, scarring processes occur, accompanied by loss a large number retinal photoreceptors.

Ophthalmologists distinguish two variants of the course of this disease - dry (non-exudative, atrophic) and wet (exudative, neovascular) form of AMD.

Dry AMD is more common than wet AMD and is detected in 85% of all AMD cases. In the macular area, yellowish spots known as drusen are diagnosed. The gradual loss of central vision limits the ability of patients to see fine details, but is not as severe as in the wet form.

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

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

Great amount clinical research has proven that certain nutrients such as beta-carotene (vitamin A), vitamins C and E can help prevent or slow the progression of dry degeneration yellow spot.

Studies show that taking large doses of some food additives and eye vitamins can reduce the risk of early AMD by 25%. Eye doctors also recommend that patients with dry AMD wear UV-protective sunglasses.

Wet AMD is present in about 10-15% of cases. The disease progresses rapidly and often results in significant loss of central vision. Dry AMD progresses to a more advanced and damaging form of eye disease. With wet AMD, new blood vessels begin to grow (neovascularization).

The wall of such vessels is defective and passes blood cells and fluid that 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” one (in about one or two cases out of 10), but it is more dangerous - there is rapid progression and vision deteriorates very quickly.

Symptoms of the "wet" form of AMD:

A sharp decrease in visual acuity, the inability to improve vision with spectacle correction.
Blurred vision, decreased contrast sensitivity.
Loss of individual letters or distortion of 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 in order to supply the required amount of nutrients and oxygen to the retina.

Instead, scarring forms, resulting in a severe loss of central vision.

Development mechanism

The macula is made up of several layers of specialized cells. A layer of photoreceptors is located above the layer of retinal pigment epithelium cells, and below is a thin Bruch's membrane that separates the upper layers from the network of blood vessels (choriocapillaries) that provide the macula with oxygen and nutrients.

As the eye ages, the products of cell metabolism accumulate, forming the 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 (about 90% of cases).

As they accumulate, drusen can cause inflammation by producing vascular endothelial growth factor, a protein that promotes the growth of new blood vessels in the eye. The growth of new pathological blood vessels begins, this process is called angiogenesis.

New blood vessels grow through Bruch's membrane. Since the 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 point on, AMD begins to progress, passing into another, more aggressive form - “wet”. Fluid builds up between Bruch's membrane and the photoreceptor layer, affecting vulnerable nerves, resulting in healthy vision.

If this process is not stopped, then hemorrhages will lead to detachments and the formation of scar tissue, which threatens with an irreparable loss of central vision.

Causes and risk factors

Despite numerous studies devoted to AMD, the causes of this disease remain to date not fully elucidated. 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.

A significant part of the population has an innate 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 adversely affect natural defense mechanisms and therefore contribute to the development of AMD, the most significant are:

Race - AMD is most prevalent in Caucasians
Heredity - family history is an important risk factor in 20% of patients with AMD. A three-fold increase in the risk of developing AMD has been established if the disease occurs in relatives in the first generation
Cardiovascular disease plays a significant role in the development of AMD. It has been established that in atherosclerosis the risk of damage to the macular area increases by 3 times, and in the presence of hypertension - by 7 times.
Cigarette smoking is the only risk factor whose significance was confirmed in all studies. Stopping smoking reduces the risk of developing AMD.
Direct exposure to sunlight
Diet – The risk of AMD is higher in people who eat more saturated fat and cholesterol, and who are overweight.
bright iris
Cataracts, especially nuclear ones, are a risk factor for the development of AMD. Surgical removal of a cataract may contribute to the progression of the disease in patients with pre-existing changes in the macular zone.

Symptoms of Macular Retinal Degeneration

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

As the disease progresses, a person suffering from age-related macular degeneration complains of decreased visual acuity, difficulty in reading, especially in low light conditions. Also, patients may notice the loss of individual letters during cursory reading, the distortion of the shape of the objects in question.

Much less common is a complaint about a change in color perception. Unfortunately, more than half of patients do not notice a 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 already ineffective.

Early signs of vision loss from AMD are:

dark spots in central vision
fuzzy image
distortion of objects
deterioration in color perception
sharp deterioration of vision in low light and in the dark

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

An ophthalmologist can distinguish the manifestations of this disease even before the development of changes in the patient's vision and direct him to additional examinations.

Diagnostics

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

For 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 images are taken.

Stereoscopic images can also be used as baseline for dynamic monitoring of a number of patients with severe dry AMD and for patients in the process of 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 earliest stages of retinal degeneration.

Central vision with AMD gradually becomes fuzzy, blurred, dark spots appear in the center of the visual field, straight lines and objects begin to distort, color perception deteriorates. Peripheral vision is preserved.

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

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

Obligatory are the 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.

At the same time, its structure and thickness can be assessed and observed in dynamics, against the background of treatment. And fluorescein angiography allows assessing the state of the retinal vessels, the prevalence and activity of the dystrophic process, and determining indications or contraindications for treatment.

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

Treatment of dry and wet forms

It is impossible to completely cure AMD. However, the development of the disease can be slowed down, suspended, and sometimes even improved.

It is well known that the risk of AMD is reduced by a healthy diet containing fresh fruits rich in vitamins C and E, lutein and zeaxanthin, dark green vegetables and salad.

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

In large-scale studies, it has been found that a healthy diet and intake are biologically active additives to food containing specially selected micronutrients (vitamins, trace elements 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 as smoking increases your risk of developing AMD. Fight overweight and high blood pressure. Increase physical activity.

To protect the eyes from direct exposure sunlight Wear quality sunglasses with a reliable UV filter. Clinical studies have shown that the sooner preventive measures begin, the higher the chances of preserving 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 coagulation 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 causes blindness and low vision in older people. Age-related macular degeneration is a chronic degenerative disorder that most often affects people over the age of 50.

According to the official materials of the WHO Center for the Prevention of Avoidable Blindness, the prevalence of this pathology in the world is 300 per 100 thousand of the 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 and 30% over 75 have a loss of central vision 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 manifested by progressive deterioration of central vision and irreversible damage to the macular zone. 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 may begin to develop after 5-8 years.

Often, the patient does not immediately notice problems with vision, because at the initial stage, the better seeing eye takes over the entire visual load.

With a decrease in visual acuity; difficulties in reading and writing; the need for stronger lighting; the appearance of a fixed spot in front of the eye, as well as the distortion of the contours of objects, their color and contrast - you should immediately contact an ophthalmologist.

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

Despite tremendous progress in improving the methods of diagnosing AMD, its treatment remains a rather difficult problem. In the treatment of dry forms of AMD and at a high risk of developing the disease, it is recommended to conduct courses of antioxidant therapy in order to normalize metabolic processes in the retina.

It should be remembered that replacement therapy for the prevention and treatment of the dry form of AMD cannot be a course, its use is possible only on an ongoing basis. It should be used in people over 50 years of age, and in the presence of risk factors (smoking, overweight, aggravated anamnesis, cataract extraction), even earlier.

Treatment of wet AMD is aimed at suppressing the growth of abnormal vessels. To date, 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 retina of the eye, which leads to a gradual loss of central vision. The macula is an oval pigmented spot near the center of the retina that is responsible for visual acuity.

The retina itself is the layer that lines the back of the eye and contains light-sensitive cells. The retina transmits the images it perceives to the brain. AMD leads to irreversible loss of central vision, although peripheral vision is preserved.

Age-related macular degeneration is manifested by 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:

“Dry” (atrophic) AMD is more common. It is found in about 90% of people with this condition.
The remaining cases are the "wet" (exudative) form, often affecting patients who have previously been diagnosed with dry AMD.

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

This form of the disease is main reason visual disability (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.

At the same time, the risk of developing AMD increases threefold if this disease occurs in close relatives. An increased risk of 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 macular lesions increases with elevated level cholesterol in blood plasma, vascular atherosclerosis and high blood pressure.

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

The goal of macular degeneration treatment

Age-related macular degeneration is one of the most common causes of low vision and blindness in people over 50 years of age. This disease is associated with the development of pathological processes that affect photoreceptors, Bruch's membrane and the retinal pigment epithelium. Let's consider for what reasons it occurs and how macular degeneration of the retina is treated.

After about 45 years, age-related changes inevitably occur in the human body. The visual system is no exception. According to statistics, about 300 people per 100 thousand of the population annually turn to ophthalmologists with the problem of age-related macular degeneration (AMD). This is a serious disease that, in the absence of timely professional treatment, inevitably provokes the appearance of complete blindness. It is most often seen in older people. Pathology occurs due to a slowdown in the metabolism in the structure of the retina, due to which the cells in its central part (macula) are affected, where the light beam is focused. The disease can be localized only in one eye, but in severe cases there is a bilateral lesion of the organs of vision. It should be noted that degenerative disorders in the work of the macular zone of the retina lead to low vision and complete blindness. Therefore, it is important to obtain a qualified medical care.

Age-related macular degeneration: dry form

The macula, or yellow spot, is the central part of the retina, consisting of several layers: photoreceptors, pigment epithelium and Bruch's membrane, which acts as a partition between the upper layers and blood vessels (choriocapillaries). Over time, metabolic processes in the human body slow down. This leads to the accumulation of waste products of cells in the macula. As a result, special seals are formed in the layers of the macula - drusen. The presence of many such small formations is a sign of the early dry form of AMD. At this stage, there is practically no deterioration in vision, especially if the pathology is localized on one side. This is due to the fact that a healthy eye compensates for the work of the visual system due to more intensive functioning. Over time, age-related macular degeneration (dry form) progresses to an advanced stage. At the same time, an increase in the size of drusen and their number is observed. In addition, destructive processes begin to occur in photosensitive cells and tissues surrounding the macula. This leads to a significant decrease in visual acuity and contrast sensitivity of the eyes. Also, in many patients, in the center of the visual field, first a blurry, and then dark spot. In this regard, straight lines are perceived as partially broken, and the picture is greatly distorted, for example, a straight doorway may appear skewed. In addition, at the advanced stage of the dry form of AMD, hypersensitivity eye to light, impaired spatial vision and difficulty in distinguishing colors. All of the above symptoms impose restrictions on the performance of any work that requires good visibility near and far. If untreated, the dry form of AMD progresses rapidly and becomes wet.

Dry form of AMD: stages

Early stage. It is often asymptomatic and does not cause a decrease in visual acuity. At this stage, seals (drusen) form in the structural layers of the macula.

advanced stage. It is characterized by an increase in the size and number of drusen. At this stage, blurring and a sharp decrease in visual acuity, as well as other uncomfortable symptoms, are observed.

Progressive stage. It is characterized by the transformation of pathology into a wet form.

Age-related macular degeneration (wet form)

The most aggressive and serious is the wet (exudative) form of AMD, characterized by the formation of new abnormal blood vessels in the macula. As drusen accumulate in the structure of the macula, the retina begins to develop inflammatory processes accompanied by the production of the VEGF protein. It promotes angiogenesis, the growth of new blood vessels that are abnormal to macular tissues. Over time, they grow through the Bruch's membrane and are introduced into the structure of the macular tissue of the retina. Further, blood and fluid (plasma) begin to flow through the pathological vessels, which leads to the formation of bubbles. Age-related macular degeneration (wet form) is dangerous because these deposits stagnate and accumulate between the Bruch's membrane and the photoreceptor layer, thereby affecting vulnerable nerves. If you do not receive medical attention in a timely manner, the process of formation of scar tissue and detachments in the macula region will begin. This threatens with irreparable loss of vision. It should be noted that the wet form of the disease is less common than the dry form, in 1-2 cases out of 10. However, it is the most dangerous because it progresses quite quickly.

Diagnosis of AMD

Macular degeneration - serious illness which can cause total blindness. Therefore, at the age of 45 to 50 years, it is recommended to undergo an ophthalmological examination at least once every 2-3 years, and after 60 years - at least once a year. Modern computerized methods of diagnosing the retina make it possible to detect the disease at the earliest stage of the dry form of AMD. For this, as a rule, the method of optical coherence tomography (OCT) is used. With its help, a specialist can obtain detailed information about the changes taking place in the tissue structures of the macula.

If symptoms of the disease appear, such as a blurry spot in the center of the visual field, you can test for AMD at home. This will require an Amsler table, which can be easily found on the Internet. This test is designed to detect pathologies of the macula, as well as to assess the dynamics of the treatment of a previously diagnosed disease of the central part of the retina. The table must be placed at a distance of 30 cm and cover one eye with your hand. Then you should focus on the bold dot, which is in the center of the checkered page. In the presence of AMD, the cells around the focal point will begin to distort. Ophthalmologists recommend that these deformations be noted on a sheet (draw) and taken with you to the appointment. This can be useful in the diagnostic process.

Many are interested in what factors influence the development of AMD. Doctors are currently identifying several causes that increase the risk of the onset and aggressive progression of this disease.

Factors affecting the appearance of macular degeneration:

Sex sign. In women, the risk of developing the disease is 2 times higher;
Age. HMP is often diagnosed in people over the age of 50;
Obesity (overweight);
Smoking;
chronic diseases(atherosclerosis, hypertension, diabetes mellitus);
Negative professional factors (ionizing radiation);
Bad ecology.

Treatment of AMD (age-related macular degeneration)

Currently, the treatment of macular degeneration is carried out quite effectively. Previously, laser coagulation was used to stop the growth of pathological vessels in the macula. It allowed to partially remove the abnormal tissue, but did not affect the cause of its appearance, namely, the production of the VEGF protein. Therefore, this procedure was only a temporary measure. In the early 2000s, a revolutionary way to combat AMD was developed, which was based on the destruction of the VEGF protein using special medical preparations. It has proven its effectiveness, therefore it is successfully used to this day, allowing millions of people around the world to avoid the onset of blindness. However, it should be noted that at the most advanced stage of the disease, this method of treatment is no longer effective. Anti-VEGF therapy cannot help with the appearance of scar tissue in the macular area. In such a situation, loss of vision is inevitable. In other cases, injections can reduce the progression of AMD and restore clarity of vision. The control of angiogenesis with these drugs reduces swelling and prevents further damage to the macula, which stabilizes visual function.

Macular Degeneration Treatment: Anti-VEGF Therapy

The drug "Lucentis". This substance includes ranibizumab molecules. The action of this drug is aimed at reducing excessive stimulation of the growth of pathological vessels in AMD. It reduces macular edema of the retina, prevents the germination of pathological vessels, new hemorrhages and significantly reduces the area of localization of the pathology.

Aela. This drug contains aflibercept, an active substance whose molecules fuse with pathological cells and destroy them. It is used only in the wet form of the disease.

These drugs counteract the development of new pathological vessels in the center of the retina. For the most effective impact, the injection is made directly into the vitreous body of the eye. The procedure takes a few minutes and does not require special preparation. It is performed under sterile conditions by an experienced ophthalmologist. As it penetrates active substances in the macular tissue, the level of VEGF protein activity decreases, as a result of which the pathological vessels begin to disintegrate. With several injections, the abnormal fluid also resolves. The course of treatment is carried out under the strict supervision of an ophthalmologist. It is strictly forbidden to try to use these drugs on your own. This can lead to irreparable consequences, up to complete blindness.

Disease prevention

In order to prevent the occurrence of AMD, it is recommended to systematically undergo an ophthalmological examination, especially after 45 years. Also, experts advise protecting your eyes from excessive exposure to ultraviolet radiation (use sunglasses). It has been proven that people who spend a lot of time in the sun are 4 times more likely to be diagnosed with macular degeneration. Ophthalmologists strongly advise giving up cigarettes. It has been proven that smoking significantly increases the risk of developing and progressing AMD (by about 5 times). In addition, doctors recommend limiting the use fatty foods and control the level of cholesterol (its increased content disrupts the blood circulation of the eyes). Foods that are good for vision should be introduced into the diet: blueberries, lettuce, cabbage, spinach, fish, eggs, grapefruit and others. In autumn and winter, it is advisable to take vitamin complexes. In general, experts advise leading an active lifestyle, spending more time outdoors, and reducing visual stress as much as possible.

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and pigment epithelium. AMD in ophthalmology in different periods was designated by different terms: central involutional macular degeneration, senile, Kunt-Junius dystrophy, age-related maculopathy and others. Currently, there is a consensus that these are manifestations of the same pathology.

Age-related macular degeneration is the main cause poor eyesight and blindness in patients over 50 years of age in Europe and the USA, and in Southeast Asia. The number of people who have lost their sight increases with age. In our country, this pathology occurs in 15 people out of 1000. average age patients ranges from 55-80 years.

Age-related macular degeneration (AMD) is characterized by bilateral lesions, central localization of the pathological process, long-term slow course, and steady progression. The disease can be asymptomatic for a long time, patients seek qualified help late, which leads to loss of vision and disability. In the structure of disability according to AMD, 21% are people of working age.

Risk factors for AMD

Age (over 50 years);
ethnicity and race;
heredity;
white skin color;
arterial hypertension;
smoking;
oxidative stress;
low content of carotenoids in the yellow spot;
lack of antioxidants, vitamins, microelements;
high level of solar radiation.

Diabetes mellitus, atherosclerosis are also clearly associated with the development of age-related macular degeneration. carotid arteries, malnutrition, overweight, impaired carbohydrate and lipid metabolism. Women over the age of 60 suffer from this pathology twice as often as men.

Types of age-related macular degeneration

There are "dry" and "wet" forms of the disease, which depend on the stage of the disease.

"Dry" AMD, or non-exudative, accounts for about 90% of cases and is characterized by slow progression. The “wet” or exudative form occurs in 10% of cases, is accompanied by the development of choroidal neovascularization and rapid loss of vision.

In the development of AMD, the ischemic factor (trophic disorders) is of decisive importance. The disease can develop in two ways:

The first option is characterized by druze formation. Drusen are defined in both eyes symmetrically as yellowish thickenings located under the retinal pigment epithelium. Their size, shape and quantity, as well as the degree of prominence and combination with other changes in the pigment epithelium, vary. With a significant size and an increase in the number of drusen, choroidal neovascularization develops. Characterized by active production of endothelial vascular growth factor, which is a powerful stimulator of angiogenesis. Newly formed vessels may extend under the pigment epithelium, causing retinal retinal lesions. This is followed by perforation of the pigment epithelium and detachment of the neuroepithelium. A choroidal neovascular membrane is formed, followed by a fibrous scar.
The second variant is characterized by extensive geographic atrophy of the macular pigment epithelium, with choroidal neovascularization developing only in the later stages.

Symptoms of age-related macular degeneration (AMD)

The "dry" form of AMD, in which hard and soft drusen are formed, is usually accompanied by minor functional disorders. Visual acuity in patients usually remains quite high. The presence of drusen is considered as a risk factor for the development of neovascularization.

The "wet" form of AMD is characterized by rapid progression and almost always occurs in patients with an already existing "dry" form. The symptoms of the "wet" form are as follows:

a sharp decrease in visual acuity;
blurred vision;
weakening the contrast of the image;
difficulty reading with the ineffectiveness of spectacle correction;
the curvature of the lines when reading or the loss of individual letters;
metamorphopsia (distortion of objects);
(appearance of dark spots before the eyes).

Over 90% of all cases total loss vision in AMD is associated with the exudative ("wet") form of the disease, which is characterized by abnormal growth of newly formed vessels originating in the choroid and growing through defects in the Bruch's membrane under the layer of the retinal pigment epithelium, neuroepithelium. This situation is defined in ophthalmology as the formation of a neovascular membrane.

Blood plasma seeps through the wall of new vessels, deposits of cholesterol and lipids accumulate under the retina of the eye. Rupture of newly formed vessels can lead to hemorrhages, which can reach significant volumes. All this leads to a violation of the trophism of the retina, the development of fibrosis. The retina over the zone of fibrosis (scar) undergoes gross changes and is no longer able to perform its functions.

AMD never leads to complete blindness. Initially lost, an absolute scotoma (dark spot) appears in the central part of the visual field. Since the pathological process affects the macula (the central part of the retina), it remains preserved. At the end of the process, visual acuity is most often not more than 0.1, and the patient sees only with peripheral vision.

The disease in all patients proceeds individually, but when the neovascular chorioretinal membrane is formed, the time factor plays a key role. Early diagnosis and initiation of treatment during this period helps to avoid vision loss and achieve stable remission.

Diagnosis of AMD

Macular degeneration can be detected even before development clinical symptoms. Only a timely ophthalmological examination allows you to diagnose the pathology in time. To determine the disease, they are used as traditional diagnostic methods( , ), as well as computerized and automated - computer, visocontrastometry, fluorescent, color stereophotography, which make it possible to diagnose macular pathology with high quality. With an already verified diagnosis of AMD, self-monitoring of patients using the Amsler grid is highly informative. This test allows you to identify symptoms of macular edema due to choroidal neovascularization.

Treatment of age-related macular degeneration (AMD)

In the treatment of AMD, the main principles are timely onset, pathogenetic approach, differentiation depending on the stage of pathology, duration (sometimes treatment is carried out throughout life), and complexity (medication, surgery, laser treatment).

Drug therapy for AMD includes the use of antioxidant drugs, vitamin-mineral complexes, which include zeaxanthin, lutein, anthocyanins, vitamins A, C, E, selenium, zinc, copper and other necessary components, as well as angiogenesis inhibitors and peptide bioregulators.

Laser treatment of AMD involves laser coagulation, photodynamic therapy. Surgical treatment of AMD includes methods such as the retinal pigment epithelium, with the removal of SNM.

The method of intravitreal administration of kenalog due to its simplicity and accessibility, which is carried out with macular edema of various etiologies, including "wet" AMD, has become very common. This method It is highly effective, significantly reduces the edematous component, but is associated with a risk of complications.

In recent years, a new progressive method of treating AMD has been practiced - the use of drugs that inhibit the production of vascular endothelial growth factor. These drugs show the best results in terms of preserving vision and are the method of choice.

Video about the disease

Prevention of AMD

All patients with a burdened history of AMD, as well as those from risk groups, should undergo a comprehensive ophthalmological examination every 2-4 years. If there are complaints characteristic of this pathology (decrease in visual acuity, loss of letters, metamorphopsia, and others), you should immediately contact an ophthalmologist.

Moscow clinics

Below are the TOP-3 ophthalmological clinics in Moscow, where you can undergo the diagnosis and treatment of age-related macular degeneration.

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 a disease 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 connected with the brain (it 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 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, one has 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, 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 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 the symptoms of the disease.
Wrong nutrition.
Exposure to direct sunlight without protective goggles.

Pathology often develops in people with a burdened hereditary history (the 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

Surgical treatment of retinal degeneration

One drug therapy 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 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 in the absence of contraindications, transplantation of the pigment epithelium, vitrectomy (in case of hemorrhage into the vitreous body of the eye) are performed.

Prevention of age-related retinal degeneration

TO preventive measures include: dieting, weight loss. With vascular lesions, smoking cessation is recommended. Also avoid direct sunlight for people with light color eye. In addition, prevention includes the use of vitamins to strengthen vision and trace elements.

retinal dystrophy - This is a disease in which dystrophic changes occur in the macula. Photoreceptors-cones 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)- malnutrition.

The development of retinal dystrophy is associated with atherosclerotic changes in the vessels of the choriocapillary layer. eyeball. Circulatory disorders in the choriocapillaries, which, in fact, are the only source of nutrition for the macular area against the background of age-related changes in the retina of the eye, can serve as an impetus for the development of a 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 violation is associated with genetically determined sclerosis of vessels related to the macula.

Of great importance in the development of retinal dystrophy is the level of macular pigmentation. Macular pigment is the only retinal antioxidant that neutralizes the action of free radicals and limits blue light, which is phototoxic to the retina.

Numerous studies in recent years have revealed the hereditary nature of retinal dystrophy. Children of parents with this disease are at high risk of developing the disease. If you have been diagnosed with this, warn your children and grandchildren. They could inherit the features of the structure of the macula, which increase the risk of the disease.

With age-related macular degeneration, mainly central and color vision is disturbed, therefore, the first signs of the disease are a decrease in visual acuity, a violation of color perception. As a result, there are difficulties in reading, writing, working at a computer, watching television, driving a car, etc. Peripheral vision in age-related macular degeneration does not change, due to which the patient freely orients himself in space and copes with everyday everyday tasks. The patient needs a brighter light when reading, writing and painstaking work. Very often, people do not notice the deterioration of vision for a long time - after all, with one normal seeing eye, you can read and do small work.

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

The older the person, 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 40 years, 2% of people can get 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 (40 years and older);
gender (women get sick more often than men, in a ratio of 3:1);
genetic predisposition (the presence of the disease in relatives);
white skin color and blue iris;
cardiovascular diseases (arterial hypertension, atherosclerosis of cerebral vessels);
unbalanced diet;
high blood cholesterol;
overweight, obesity;
smoking;
frequent and prolonged stress;
deficiency of vitamins and antioxidants in food;
low content of carotenoids in the macula;
irradiation of the eye with the ultraviolet part of the spectrum of sunlight;
bad ecology.

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

There are two forms of age-related macular degeneration: dry and wet.

"Dry" form of AMD with the formation of "hard" and "soft" drusen, it usually proceeds with minor functional and visible impairments. Most patients have a fairly high visual acuity (0.5 and above).

Drusen should be considered as an "ocular" risk factor for the development of neovascularization in AMD.

Formation of the neovascular membrane

"Wet" AMDprogresses much faster than dry AMD, and almost always manifests itself in those people who already suffer from the "dry" form of AMD.

Symptoms wet form AMD:

Decreased visual acuity (decrease in visual acuity may be gradual in patients with a "dry" form and sharp - in the case of "wet").
Difficulty reading, the inability to improve vision with spectacle correction.
Blurred vision, reduced image contrast.
Loss of individual letters or distortion of individual lines when reading.
Distortion of objects (metamorphopsia).
The appearance of a dark spot in front of the eye (scotoma).

More than 90% of cases of blindness from AMD are associated with the development of the so-called "wet" orexudative form diseases. exudative formAMD is characterized by abnormal, pathological growthnewly formed vessels, which, originating from the choriocapillary layer of the choroid, grow through defects in the Bruch's membrane under the retinal pigment epithelium and / or neuroepithelium. Ophthalmologists classify this situation as the formationsubretinal(i.e. located under the retina)neovascular membrane.

Blood plasma begins to seep through the wall of newly formed vessels that are part of the subretinal neovascular membrane, lipid and cholesterol deposits accumulate under the retina. Very often, as a result of rupture of newly formed vessels, hemorrhages occur (usually local, but in rare cases quite significant in volume). These processes lead to malnutrition of the retina, stimulate the development of fibrosis (replacement by connective tissue). The outcome of the exudative form of AMD is the formation of a subretinal scar. Above the area of the scar, the retina undergoes such gross changes that it becomes unable to perform its functions.

Age-related macular degeneration never leads to complete blindness. The patient gradually loses central vision, a dark spot appears in the central part of the visual field (absolute scotoma). The peripheral visual field is preserved because the process affects only the central region of the retina (macula). Visual acuity at the end of the process usually does not exceed 0.1 (one line), the patient sees "sideways", "lateral vision".

This is how the patient sees the terminal stage of the process when age-related macular degeneration.

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

TREATMENT

Usual for modern ophthalmology methods of treatment of exudative form of AMD include laser coagulation, photodynamic therapy (PDT), transpupillary thermotherapy (TTT), and removal of the subretinal neovascular membrane through surgery.

Due to the severity of the problem of AMD in recent years, the use of drugs that inhibit endothelial vascular growth factor (VEGF), allows you to count on the successful treatment of patients. The names of these drugs are: Avastin, Lucentis, Macugen.

Avastin(Avastin) inhibits the binding of endothelial vascular tissue growth factor to its Flt-1, KDR receptors on the surface of endothelial cells, which leads to a decrease in vascularization and inhibition of membrane growth.

The anatomical effect of Avastin administration includes thinning of the retina in the macula and stabilization of the subretinal neovascular membrane. Fluorescein angiography shows a decrease in fluorescein extravasation.

Injection of the drug into the vitreous cavity almost completely eliminates the risk of systemic side effects due to the microdosage required for acupressure (the dose is 400-500 times less than that used for injection into a vein), and at the same time gives the doctor the opportunity to create the desired concentration of the substance in the desired area. 1.25 mg of Avastin is injected into the vitreous cavity with an interval of three to four weeks. The maximum effect is usually observed after the first Avastin injections.

With the beginning of the use of this drug, there has been a positive shift in the treatment of the exudative form of age-related macular degeneration.

Avastin causes a significant increase in visual acuity in a third or more of patients, and in half of all patients visual acuity stabilizes.

Lucentis® (Lucentis, ranibizumab) is an antigen-binding fragment of a mouse anti-VEGF antibody obtained by genetic engineering (recombinant preparation). Being a highly specific part of the antibody to VEGF, the Lucentis drug molecule has a low molecular weight and is able to penetrate through all layers of the retina to the target (blocks the receptors of newly formed vessels that make up the subretinal neovascular membrane).
Based on positive results clinical trials, in June 2006, Lucentis was approved in the United States for the treatment of choroidal neovascularization associated with neovascular (wet) AMD. Then it was approved for use in EU countries. In Russia it is allowed and registered on 06/16/2008. (registration number LSR-004567/08) for the treatment of neovascular (wet) AMD. Then, by the Decision of the Ministry of Health and Social Development of the Russian Federation of February 28, 2011. No. 31-3-400730 approved the use of the drug for the treatment of diabetic macular edema (DME).
The goal of treatment is to prevent further deterioration of visual acuity. Although many patients experience improved visual acuity, Lucentis cannot repair parts of the retina that have already died as a result of the disease. Also, Lucentis cannot prevent the recurrence of the disease and further deterioration of visual acuity as a result of relapse.

For prevention and treatment early stages age-related macular degeneration, priority is given to compliance healthy eating, reducing the consumption of foods with high cholesterol levels 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 in 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 into the tissues of the eye. Lutein enters the body with food, and zeaxanthin is formed directly in the retina from lutein.

YOU SHOULD KNOW IT!

Sources of lutein and zeaxanthin are 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.

Given the "rejuvenation" of this disease, Special attention should be addressed for its prevention, which includes:

a mandatory course of oral intake of lutein, zeaxanthin and anthocyanosides;
quitting smoking and cholesterol-rich foods;
protection from direct exposure to sunlight (sunglasses, headgear, awning, etc.);
use of contact lenses that protect the eyes from ultraviolet radiation;
correction of arterial hypertension;
regular examinations of the retina to detect signs of disease progression (at least once a year);
self-monitoring of visual disturbances using the Amsler grid and, if necessary, contacting an ophthalmologist.

AMSLERA test (test for the definition of macular degeneration)

The easiest and fastest method of checking the central field of vision(the time for its implementation is 10-15 seconds). Do it regularly (even daily) to assess vision and possible appearance early symptoms of age-related macular degeneration.

Put on glasses or contact lenses(if you usually wear them).
Place the net in front of you at a distance of 20-30 cm.
Cover 1 eye.
Focusing on the center point, without taking your eyes off the center point, evaluate the rest of the grid.

Are all grid lines straight and even?
Are all the squares of the grid the same size?
Are there areas where the pattern is distorted, fogged, discolored?

Repeat the test for the other eye.

Evaluation of results:

Normally, when performing the Amsler test, the visible image should be the same in both eyes, the lines should be even, without distortion, spots and curvature, which corresponds to the norm. If changes are found, contact an ophthalmologist, because. this may indicate pathological processes in the central parts of the retina (macular degeneration).

Remember that the Amsler test does not replace the mandatory regular visits to the ophthalmologist for patients over 50 years of age.