MACULAR DEGENERATION ASSOCIATED WITH AGE

What is macular degeneration?

Age-related macular degeneration (AMD) is a disease of the retina in which various degenerative changes occur in the central part of the retina, called the macula. The cells in this area are responsible for fine vision, for details; Thanks to it we can read and distinguish faces. These changes can therefore lead to poor central vision, preventing activities such as reading or driving.  It is called associated with age because it appears in people over 50 but it is not the same as normal aging of the retina by age.

A person with AMD may therefore notice alterations in the central vision, difficulty in reading and recognition of faces and / or distortion of images (metamorphopsia). However, in the early stages the vision can be completely normal.

How many types of AMD exist?

In patients with AMD, the deterioration of the macula occurs progressively and can be differentiated at the time of diagnosis according to the severity between early or early AMD, intermediate AMD or late AMD.

There is another classification, very useful in view of the need or not for rapid treatment, which is the differentiation between the dry form and the wet form:

  • The dry form is the most common and accounts for about 85 percent of people with the disease. Early, intermediate and most late forms of AMD belong to this form. Visual loss is slow and some patients can maintain good visions for a long time. It is called dry because “there is no liquid.” At some point it can become wet.
  • The wet form affects the remaining 10-15 percent and constitutes a part of the late AMD. The evolution is rapid and can cause serious vision problems. It is caused by the formation of new blood vessels under the macula (neo-vessels). These blood vessels are abnormal, bleed easily and can leak fluid under or inside the retina. If this persists for a while, irreversible scars form, which leads to visual impairment due to loss of central vision, preventing us from activities such as reading or driving.

How many types of AMD exist?

First there’s preventive treatment. Although we know a non-modifiable genetic base, several studies show evidence that a good diet, a little regular exercise and no smoking reduces the incidence and progression of this disease, although it does not eliminate it.

In cases of intermediate AMD, daily intake of antioxidant drugs is recommended, which has been shown to reduce progress to advanced forms.

For the wet form we have treatments to slow the evolution and avoid visual impairment. Immediate detection and treatment is the key. It is a method that has revolutionized the treatment of wet AMD in recent years such as the injection of drugs that inhibit the growth of new blood vessels: antiangiogenic drugs, such as Lucentis or Eylea. These drugs should be administered by the ophthalmologist according to different guidelines, by intravitreous injections.

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    Imagen 2

    Forma seca de la DMAE

    Forma húmeda de la DMAE / Forma cicatricial avanzada e irreversible

    DIABETIC RETINOPATHY

    What do they consist of and what symptoms do they produce?

    People with diabetes may have an eye disease called diabetic retinopathy. This disease occurs because high blood sugar levels eventually cause damage to the blood vessels of the retina. These damaged blood vessels do not work well, dilate (forming microaneurysms) and allow fluid to escape into the retina or below (diabetic macular edema) and cause bleeding and deposits (exudates). They can also close and prevent blood flow (retinal ischemia). Ischemia or lack of irrigation in the retina causes the secretion of angiogenic factors, that is, they generate new blood vessels but these are abnormal (we call them neovases), bleed easily causing vitreous hemorrhages and cause scarring and can even detach the retina. All these changes left to its evolution can make you lose vision.

    Do I have to have surgery of my macular problem?

    The changes in the retina occur progressively, at the beginning they are slight and gradually they can move forward.

     

     

    At the beginning of this process, if the central part of the retina is not affected, they may not cause visual problems, but it is important to detect those initial changes in order to act in time.

    If the central part of the retina is affected (macular edema) you will notice alterations in the central vision: blurred vision and difficulty reading. In advanced cases, if vitreous hemorrhage or retinal detachment occurs, vision loss can be very severe and abrupt. The detection in the initial stages of this problem is very important because we have various treatments to be applied before irreversible damage to the retina is caused.

    Therefore, all diabetics should be checked once a year even if they have no apparent visual problems. In case you already have any sign of retinopathy, depending on the severity of it, you should start some treatment or make more frequent reviews.

    What does the surgery consist of?

    Once the problem appears, your treatment will be different depending on the severity. These are some of the treatment options:

    • Medical control of diabetes

    Controlling your blood sugar can help stop vision loss. Follow the diet recommended by your nutritionist. Take the medications prescribed by your doctor. In some cases, good sugar control can even return some vision. Controlling blood pressure, cholesterol and getting some exercise can be of great help.

    • Medication

    The anti-VEGF or antiangiogenic (Eylea and Lucentis) help to improve the damage of the vessel walls and reduce macular edema. These drugs should be administered by the ophthalmologist according to different guidelines, by intravitreal injection.

    Another option to reduce macular edema is treatment with corticosteroids. They are usually given in the form of injections or implants that last longer.

    Your ophthalmologist will recommend the treatment plan appropriate to the severity of your retinopathy.

    • Laser surgery

    Laser surgery is used in diabetics to help seal blood vessels that suffer loss of fluid, improve oxygenation of the retina, make abnormal vessels disappear and stop vision loss. In most cases, it is necessary to perform more than one treatment and combine it with the previous ones.

    • Vitrectomy

    In advanced cases, if you have persistent vitreous hemorrhage, retinal traction or retinal detachment, it may be insufficient with previous treatments and you may need treatment with retinal surgery or vitrectomy. This operation involves removing the vitreous gel, cleaning the blood and improving the oxygenation of the retina, removing the scar tissue, repairing the detachment if there is one and sometimes completing the laser treatment.