Causes, symptoms, and treatment of age-related macular degeneration

What is the macula?

The term "macula" in the disease name refers to the central part of the retina, the part of the eye where light gathers. The retina is lined with photoreceptor cells, which are responsible for detecting light and color. The macula, in particular, is a crucial area of the retina where cells that distinguish the color and fine details of objects are concentrated. The macula is several millimeters in diameter and has a small depression in the center called the fovea. Light entering the eye is concentrated in the fovea.

The macula is the center of the retina, and when the macula functions normally, we can see fine details clearly.

• It appears distorted

  In many cases, a characteristic symptom that occurs in the early stages is distorted vision (metamorphopsia). This distortion is due to the macula, the central part of the retina, being distorted. The center of the field of vision, that is, what you are trying to look at, is distorted, but the peripheral areas appear normal.
  Other symptoms include difficulty seeing the center of the field of vision and blurring in the middle of the field of view.

• The center appears black.

  As the symptoms progress, the center of the eye may become black and invisible (central scotoma). In some cases, the ability to distinguish colors may also occur.

• decreased visual acuity

  As the condition progresses, vision deteriorates. If left untreated, vision can drop below 0.1. In some cases, vision can deteriorate suddenly. However, in most cases, there is no pain. Also, even if vision deteriorates in one eye, the other eye may still be able to see, so the symptoms may go unnoticed. The exudative type often progresses more rapidly. If left untreated for a long time, vision loss can occur.

• smoking
• Westernization of dietary habits
• A lifestyle lacking in green and yellow vegetables
• Obesity, high blood pressure, dyslipidemia
• UV rays
• Genetics

• Medical interview

  We will ask about when the symptoms started and what they are, as well as your smoking habits and any other illnesses you may have besides eye problems.

• Vision test

  Since vision loss is a symptom of age-related macular degeneration, we will check the degree of your vision.

• Amsler Test

  The patient looks at a grid-like diagram with each eye individually, checking for distortion, blurred vision, or black areas in the center. This is an essential test for diagnosing age-related macular degeneration.

• Fundus examination

  This examination involves dilating the pupil with eye drops to closely examine the condition of the retina. It also checks for macular hemorrhage, neovascularization, and atrophy.

• Fluorescein angiography

  This test involves injecting a fluorescent dye into a vein in the arm to image and examine the neovascularization (new blood vessel formation) in detail. Video recording may also be performed. It allows us to examine the location, shape, and activity of the new blood vessels.

• Optical coherence tomography (OCT scan)

  This is an examination that examines a cross-section of the macula. Newer machines now allow for a three-dimensional view of retinal swelling and choroidal neovascularization. Because it's a short, minimally invasive examination that doesn't require contrast agents, it can be performed frequently. It's used not only for diagnosis but also for monitoring the patient's progress.

• Drug therapy

  This is a new treatment that eliminates neovascularization by suppressing the activity of "vascular endothelial growth factor (VEGF)," which promotes the growth of choroidal neovascularization.
  Specifically, the procedure involves injecting a "VEGF inhibitor" into the eyeball. Since anesthesia is administered before the injection, there is virtually no pain. The eye and surrounding area are thoroughly disinfected, and the procedure is performed in a clean environment.

  Treatment can be done on an outpatient basis, but patients need to use antibiotic eye drops starting three days before the injection. They also need to use eye drops for two to three days after the injection.
  Initially, injections are administered 2-3 times every 4-6 weeks. After that, patients are monitored regularly, and if choroidal neovascularization recurs, injections are given again. This treatment may also be combined with photodynamic therapy.
  Since the condition may recur if the injections are stopped, it is important to continue patiently as instructed by your ophthalmologist.

• photodynamic therapy

  In many cases, it is used in combination with drug therapy.
  First, a drug that accumulates in neovascularization is administered intravenously. Then, a weak laser is applied to the area where the drug has accumulated to eliminate the neovascularization.

  The medication administered intravenously is sensitive to light, so exposure to strong light within 48 hours of treatment may cause complications such as photosensitivity; therefore, caution is necessary.
  Even after treatment, your condition will be checked every three months, and further treatment will be provided as needed.

• Laser photocoagulation

  This treatment uses a strong laser beam to burn away newly formed blood vessels. It is performed when new blood vessels are forming far from the fovea. This treatment can prevent the abnormality from spreading to the fovea.

• no smoking

  Quitting smoking is essential for preventing age-related macular degeneration. It has been clearly shown that smokers have a higher risk of developing age-related macular degeneration than non-smokers.

• Supplement intake

  It has been found that taking supplements containing vitamins such as vitamin C and vitamin E, as well as zinc, which protect retinal cells from the harmful effects of reactive oxygen species, can lower the risk of developing or progressing age-related macular degeneration.
  Furthermore, it is said that increasing the pigment in the macula is also important for protecting the macula. Taking supplements containing ingredients such as lutein and zeaxanthin may be beneficial.

• Eat green and yellow vegetables

  Green and yellow vegetables are rich in lutein and zeaxanthin, which are pigments found in the macula of the eye. It is also important to get vitamin C, vitamin E, and zinc from your diet. Vitamins are abundant in spinach, carrots, and pumpkins, while lutein is found in large quantities in spinach and broccoli.

• Protect from ultraviolet rays

  Ultraviolet rays can damage the retina. Wearing sunglasses with UV protection is a good idea. Darker colors make your pupils appear larger, so lighter tints are recommended.