Macular degeneration, also called age-related macular degeneration/degeneration (AMD), is a group of diseases that have different etiologies but have a similar effect on the macula (part of the retina) and, therefore, on central vision.

What do all these terms mean? The retina is the inner layer in the eyeball, which consists of receptors and nerve cells, which collect and transmit light impulses from the eye along the optic nerve to the brain for decoding, which is the basis of our vision.

Central vision is the central part of the space we see. It is central vision that provides us with the ability to distinguish the shape and color of objects, as well as small details.

The macula (macula) is the central part of the retina, responsible for detailed and color vision, which we use when reading, writing, threading a needle, and recognizing faces. It is a highly specialized part nervous system and the eyes, in which photoreceptors perceive light impulses, and neurons interpret and transmit these signals in a clearly organized and compact manner. This macula allows people to have high visual acuity (1.0 or, as they say, “one” or more), and an eagle from a great height to find a small rodent on the ground.

Reasons for the development of macular degeneration

One of the main reasons for the development of macular degeneration is a degenerative change in the retinal vessels, as a result of which they cease to perform their functions, which leads to oxygen starvation retinal tissue.

The most big factor risk is age. Although AMD occurs in middle age, research shows that people over 60 years of age are undoubtedly to a greater extent are at higher risk than other age groups. For example, a large study found that about 2 percent of middle-aged people are at risk of developing AMD, but that risk increases to nearly 30 percent in those over 75 years of age.

Other risk factors include:
. Smoking. It is generally accepted that smoking increases the risk of developing AMD.
. Obesity. Studies have shown a connection between obesity and the progression of early and intermediate stages of AMD to late AMD.
. Race. White people have a much greater risk of vision loss due to AMD than African Americans.
. Burdened heredity. Those who have immediate family members with age-related macular degeneration are at greater risk of developing this pathology.
. Floor. Women appear to be at greater risk than men.
. Gene mutations. AMD is now widely recognized as a late-onset, genetically inherited disease. In particular, the greatest risk of developing of this disease present when there are changes in three specific genes, namely:
. CFH gene (chromosome 1);
. genes BF (complement factor B) and C2 (complement component 2) (chromosome 6);
. LOC gene (chromosome 10).

The American Academy of Ophthalmology notes that findings regarding AMD and risk factors have been inconsistent and dependent on study methodology. The only risk factors associated with the development of the disease, such as age and smoking, are consistently substantiated in studies.

Types of Age-Related Macular Degeneration

“Dry” (non-exudative) form of macular degeneration. “Dry” macular degeneration occurs in 90% of cases. It is caused by progressive atrophy of the macular zone of the retina, caused by thinning of the macular tissue as a result of age-related changes, deposition of pigment in it, or a combination of these two factors. The “dry” form of AMD often first affects one eye, but, as a rule, over time the other eye is also involved in the pathological process. There may be loss of vision in one eye with a seeming absence of pathology in the other. There is currently no way to predict whether both eyes will be affected.

In approximately 10-20% of patients, “dry” AMD gradually progresses to the “wet” form. One of the most common early signs of dry AMD is drusen.

Drusen are yellow deposits under the retina that are common in people over 60 years of age. An ophthalmologist can detect them by performing a comprehensive eye examination with a dilated pupil.

Drusen themselves do not usually cause vision loss. Currently, scientists are unclear about the relationship between drusen and AMD. Increasing the size or number of drusen is known to increase the risk of developing either late-stage dry or wet age-related macular degeneration. These changes can cause severe vision loss.

The “dry” form of AMD has three stages.

Early stage. People with early-stage AMD have several small to medium-sized drusen. At this stage there are no symptoms or signs of vision impairment.

Intermediate stage. In the retina of patients with intermediate stage AMD, multiple medium-sized drusen or one or several large ones are detected. There is also loss of the retinal pigment epithelium (RPE) and surrounding layers of the retina (atrophy). Some patients see a blurry spot in the center of their field of vision. You may need more lighting to read and perform other tasks.

Late stage. In addition to the presence of drusen, people with late-stage dry age-related macular degeneration have destruction of light-sensitive cells and supporting tissue in the central region of the retina. This may result in a blurry spot appearing in the center of the field of view. Over time, this spot may enlarge and become darker, occupying an increasingly larger area of ​​central vision. The result is difficulty reading or recognizing faces even at very short distances.

“Wet” macular degeneration (exudative, neovascular). Wet AMD occurs when abnormal blood vessels begin to grow behind the retina under the macula. They are very fragile and often allow blood and fluid to pass through, which lifts the macula from its normal place at the back of the eye. This condition soon leads to pathological changes in this area of ​​the retina. “Wet” macular degeneration progresses much faster than “dry” macular degeneration, leading to a sharp deterioration in vision. With “wet” AMD, central vision loss occurs very quickly.

This form is also known as late. It does not have stages like “dry” age-related macular degeneration. Despite the fact that only 10% of all patients with AMD have the “wet” form, it accounts for 90% of cases of blindness from this disease. But it should be noted that in this case we are talking about the so-called practical blindness, i.e., a significant decrease in visual functions, and not a complete loss of vision (when there is even no light perception).

Choroidal neovascularization (CNV) is a process underlying the development of “wet” AMD and abnormal growth blood vessels. This is a mistaken way the body tries to create a new network of blood vessels in order to improve the supply of nutrients and oxygen to the retina. Instead, the process causes scarring, sometimes leading to severe loss of central vision. A dark spot appears in the central part of the visual field (absolute scotoma). The peripheral field of vision is preserved because the process affects only the central region of the retina (macula). But visual acuity decreases sharply, since the patient can eventually see only with peripheral vision. The lack of central vision deprives him of the ability to distinguish the shape and color of objects, as well as small details.

Wet macular degeneration can be divided into two categories according to the form of CNV accompanying each of them:
Hidden. New blood vessels grow less prominently under the retina, and leakage through their walls is less obvious. The occult form of choroidal neovascularization usually results in less severe vision loss.
Classical. The growing blood vessels and scarring observed under the retina have very clearly defined contours. This type of wet AMD, characterized by the presence of classic CNV, typically results in more severe vision loss.

Symptoms of Macular Degeneration

Symptoms of AMD. Neither the “wet” nor the “dry” forms of AMD cause pain.

For the “dry” form of AMD the most common early sign is blurred vision. It is caused by light-sensitive cells in the macula slowly being destroyed, gradually causing central vision in the affected eye to become blurry. The fewer cells in the macula are able to perform their function, the more difficulty a person has in recognizing faces, and the more lighting may be required for reading and performing other tasks.

If the loss of these light-sensitive cells becomes significant, a small, but growing, dark spot may appear in the middle of the visual field. Gradually, in the affected eye, as the function of the macula decreases, central vision is also lost.

Classic early symptom "wet" form of AMD is the curvature of straight lines. This is the result of the fact that fluid sweating from the blood vessels collects under the macula and lifts it, thereby distorting the image of objects visible to the eye. A small dark spot can also appear in the “wet” form of AMD, eventually leading to loss of central vision.

Diagnostics

The initial examination includes measuring visual acuity and examining the retina. During the latter, the ophthalmologist identifies certain signs of macular degeneration. The scope of examinations may include the following methods.

Fluorescein angiography (FA). This examination helps determine the location of the blood vessels and whether they are damaged, and whether laser treatment could potentially be beneficial in this case. Importantly, this method determines whether leakage from the blood vessels (the “wet” form of macular degeneration), if identified, can be treated with laser or injections. .

Indocyanine green angiography (ICGA). This examination uses various intravenous dyes, after which the retina is photographed in infrared light. The method helps to identify the signs and type of “wet” form of macular degeneration, which are not visualized by fluorescein angiography. .

Optical coherence tomography (OCT). This is a non-invasive examination method that allows you to obtain images of cross-sections of the retina in natural conditions. Its use is especially useful for precise definition the involved layers of the retina, as well as the presence of inflammation or edema in the macular area. .

Determination of visual fields (perimetry) helps to accurately track the location of areas of the retina with complete loss or decrease in their function. This important technique requires mutual understanding and cooperation between patient and physician. .

Amsler grid (Amsler test). During the initial examination, you will be asked to look at a special grid known as an Amsler grid. It consists of vertical and horizontal lines with a dot in the middle.

If you have macular degeneration, it is likely that some lines will appear faded, broken, or distorted. Telling your ophthalmologist exactly what these lines are will give them a better idea of ​​the extent of damage to the macula.

Treatment of macular degeneration

Treatment of the “dry” form of AMD. Once the dry form of age-related macular degeneration reaches an advanced stage, no known treatment can prevent vision loss. However, treatment can delay and possibly prevent progression from the intermediate stage to the advanced stage, where vision loss occurs.

Due to the lack of effective treatment methods, prevention is the main direction in the treatment of this form of macular degeneration. There is now evidence that patients with early and intermediate AMD should take adequate dietary intake of antioxidants, including vitamins A, E and zinc. The judgment is based on the hypothesis that one of the links in the pathogenesis of the disease is oxidative processes in tissues ().

The Women's Antioxidant and Folic Acid Cardiovascular Study found a reduction in the risk of developing AMD in patients taking a combination of folic acid (2.5 mg/day), vitamin B6 (50 mg/day) and B12 (1 mg/day) in comparison with placebo().

In 2001, an extensive AREDS study was completed to determine the effectiveness of taking high doses antioxidants at different stages of AMD (). It turned out that daily intake of 500.0 mg of vitamin C, 400 IU. vitamin E, 15 mg of beta-carotene (equivalent to 25,000 IU of vitamin A), 80 mg of zinc oxide and 2 mg of copper oxide inhibit the development and progression of AMD at certain stages of the disease (see table). As you can see, there are no strict indications for the use of these drugs for early stages"dry" form of AMD.

A little later, another large study AREDS 2 () was conducted. In it, all patients took supplements according to the regimen from AREDS (see above), but individual groups were additionally prescribed various combinations of lutein at a dose of 10 mg per day, zeaxanthin 2 mg per day and omega-3 fatty acids, as well as placebo. Based on the results, it was concluded that adding the above substances to the regimen does not reduce the risk of progression to the late stage of AMD. However, lutein and zeaxanthin can successfully replace beta-carotene, which increases the risk of lung cancer in former smokers.

It would be logical to assume that taking vitamins and antioxidants according to the regimen proposed in AREDS, which helps patients at certain stages of AMD, should also have a preventive effect in their relatives ( genetic predisposition?), who do not yet have vision problems. However, a seven-year observation period did not show any benefit from their use, and it is suggested that the use of the AREDS regimen should be considered only for those who have more than two risk factors for the development of AMD.

Thus, the relatives of patients suffering from AMD, as well as those who are at risk of its occurrence, can be offered the following to prevent the development and progression of the disease:
. to give up smoking;
. protecting your eyes from ultraviolet radiation with sunglasses and/or wearing wide-brimmed hats in clear sunny weather;
. a well-balanced diet rich in natural antioxidants;
. eating freshly cooked fish (1-2 times a week), green leafy vegetables (for example, spinach, cabbage) daily;
. use of additives with folic acid(2.5 mg/day), vitamins B6 (50 mg/day) and B12 (1 mg/day).

Treatment of the “wet” form of AMD can be performed using laser surgery, photodynamic therapy and intraocular injections. However, none of them cure the disease, which, like vision loss, can progress despite treatment.

Intraocular injections.
Vascular endothelial growth factor blockers. Abnormally high levels of specific growth factor (VEGF) are detected in patients with “wet” AMD and contribute to the proliferation of abnormal blood vessels. Currently, first-line drugs are substances that block vascular endothelial growth factor (anti-VEGF). Ophthalmologists now have a number of drugs in this group in their arsenal: pegaptanib (Macugen), ranibizumab (Lucentis), bevacizumab (Avastin), aflibercept (Eylea). Behind last years Many studies have been conducted, including comparative ones, confirming their effectiveness. The disadvantages of this treatment are the high cost of drugs, the need for repeated injections and the fading of the effect if treatment is refused, intravitreal (directly in vitreous) method of administration.

Let us briefly list the results of studies on the effectiveness of VEGF inhibitors.
The VISION study (,) found that 70% of patients with pegaptanib administered once every 6 weeks for a year did not experience a deterioration of more than 3 lines on the visual acuity table. The effect is similar to the results of PDT therapy.

The MARINA study showed improvement or stabilization of vision in 95% of patients who received 0.3 or 0.5 mg of ranibizumab monthly for two years. It is also important that 34% of those receiving 0.5 mg of the drug had an increase in visual acuity of at least 15 characters according to the LogMAR table (approximately corresponding to 3 lines according to the Sivtsev table) of the table for checking visual acuity, which remained unchanged for two years ().

The ANCHOR trial compared the results of ranibizumab and verteporfin (see PDT). Monthly administration of 0.5 mg of the former improved or stabilized vision in 96% of patients, while verteporfin did so only in 64%. Visual acuity in the first case increased in 40% and only in 6% in the second ().

There are long-term observations (more than 4 years) after the administration of ranibizumab (HORIZON (), SEVEN-UP ()). It is noted that with a decrease in the frequency of use of the drug after a year (the first year was administered monthly), a deterioration in the achieved result was often observed.

However, with appropriate monitoring of patients, it is possible to achieve the results obtained in the MARINA and ANCHOR studies by reducing the frequency of drug administration. Thus, ranibizumab can be used as needed after several mandatory injections at the beginning of the course (PrONTO () and SUSTAIN () studies). It is also possible to prescribe the drug according to the “treatment and extension” scheme, when initially the drug is administered three times with a monthly interval, which, in the absence of progression, is increased each time by 2 weeks (13). The results of using the drugs according to these regimens were similar:
administration of 0.5 or 2.0 mg of aflibercept monthly = 3 monthly injections of 2.0 mg of aflibercept and then 2.0 mg every 2 months = monthly administration of 0.5 mg of ranibizumab. In addition, monthly administration of 2.0 mg aflibercept was associated with a greater improvement in visual acuity compared with ranibizumab.

Statins. Despite the connection between blood lipid levels and the presence of AMD, the use of statins (drugs that normalize their levels) is controversial due to the lack of sufficient evidence.

Laser treatment.
Before the advent of VEGF blockers, the main treatment method for the “wet” form of AMD was thermal laser destruction of newly formed vessels. The MPS study, conducted back in the eighties of the last century, noted high risks of a significant decrease in visual acuity with laser exposure to the central region of the retina, even in comparison with observation. Only 13-26% of all patients with the “wet” form of AMD were good candidates for this treatment, and in more than half of the cases, activity of previous newly formed vessels or the appearance of new ones was noted within two years. Currently, laser coagulation is rarely used to treat AMD.

Photodynamic therapy (PDT). In order to avoid damage to properly functioning retinal structures during laser exposure, special photosensitizing substances can be used - verteporfin (Visudin), photolon. They are introduced into the bloodstream and accumulate in pathological newly formed vessels. Using laser radiation of a specific wavelength this substance activates, releasing oxygen and free radicals. This leads to the destruction of newly formed blood vessels and, as a result, to a slowdown in the rate of vision loss.

The TAP study showed that 53% of patients did not lose more than 15 LogMAR lines of vision over 2 years (approximately 3 lines on the Sivtsev table), and 16% showed an improvement of one or more lines (20). Over the next 5 years, almost half of the patients experienced a decrease in visual acuity.

Combined treatment. Despite the fact that the results of the introduction of VEGF blockers are promising, in practice there are periodically cases with unsatisfactory results. Currently, there is no clear opinion about the effectiveness of the combined use of various treatment methods. Some studies have shown that the combined use of PDT and anti-VEGF drugs reduces the number of required injections with similar visual acuity (,). Others (DENALI (), MONT BLANC ()) did not demonstrate greater effectiveness of combination treatment compared to monotherapy.

In people with macular degeneration, the macula, the area responsible for central vision, is damaged. The disease leads to the destruction of the retinal nerve cells 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 activities. daily work. Treatment of macular degeneration of the retina can slow down the progression of the disease, but does not cure it.

Causes

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. Scientific research has shown that 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 research have shown that age-related macular degeneration is more likely to occur in people who consume a lot of saturated fatty acids and cholesterol (these substances are found in animal products, some vegetable oils, confectionery). 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 the development of the 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 of the retina. 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 a sharp deterioration in vision.

Dry

Yellow pigment accumulates in the macula area, which over time damages the light-sensitive cones. Initially, the disease affects one eye, later the second one is also 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 proliferation of 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 degenerative changes in the 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:

1. 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.
2. Intermediate. During the examination, drusen of medium and large sizes or geographic atrophy of the macula that does not affect the central fossa are detected. At this stage, patients notice the appearance of a fuzzy spot in front of their eyes. Visual acuity begins to gradually decrease.
3. 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 before 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 at the dispensary and explains that he will have to come for routine examinations once a year. Regular visits to an 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 of the vitreous body. 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 whole line additional techniques research. With their help, you can determine the form and stage of the disease.

Methods used to diagnose macular degeneration:

Conservative treatment

On initial stages Macular degeneration of the retina is treated conservatively. Antioxidants are used to combat pathology. visual pigments, carotenoids and certain trace elements (zinc, copper). 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 drugs in the treatment of macular degeneration are:

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

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

Treatment of macular degeneration of the retina cannot be done without a balanced diet. The patient should eat more green vegetables, carrots, fresh fruits, and berries. Sprouted grains and legumes are very useful in this regard. But the rich broths, fatty varieties It is better to exclude meat, fried, salted and smoked foods 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 proliferation of small vessels and the destruction of the macular region of the retina.

Intravitreal administration of anti-VEGF drugs

Since in the final 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 introduction medicinal product patients soon notice improved 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 pass full course 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 surgery, the doctor carefully moves the macular area of ​​the retina to the desired location. 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 should take vitamin and mineral complexes for preventive purposes. Regular visits to an ophthalmologist are also required. At this age, it is necessary to attend preventive examinations at least once a year.

Useful video about macular degeneration of the retina

Retinal dystrophy is a disease in which dystrophic changes occur in the macula. The cone photoreceptors 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) - nutritional disorder.

The structure of the eye.

The development of retinal dystrophy is associated with atherosclerotic changes in the vessels of the choriocapillaris layer eyeball. Impaired blood circulation in the choriocapillaris, which, in fact, are the only source of nutrition for the macular area against the background of age-related changes in the retina, can serve as an impetus for the development of the degenerative 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 disorder is associated with genetically determined sclerosis of the vessels related to the macula.
The level of macular pigmentation is of great importance in the development of retinal dystrophy. Macular pigment is the only retinal antioxidant that neutralizes the effects of free radicals and limits blue light, which is phototoxic to the retina.

Fundus: 1.- yellow spot; 2-disc optic nerve; 3- artery; 4 - vein.

Numerous studies in recent years have revealed the hereditary nature of retinal dystrophy. Children of parents suffering from this disease have high risk development of the disease. If you are diagnosed with this, warn your children and grandchildren. They could have inherited structural features of the macula that increase the risk of developing the disease.

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

The older a person is, 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 50 years, 2% of people may develop 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 (50 years and older);

gender (women get sick more often than men in a ratio of 3:1);

genetic predisposition (presence of the disease in relatives);

White color skin and blue iris

cardiovascular diseases(arterial hypertension, cerebral atherosclerosis);

unbalanced diet;

high blood cholesterol levels;

overweight, obesity;

smoking;

frequent and prolonged stress;

deficiency of vitamins and antioxidants in food;

low content carotenoids in the macula;

exposure of the eye to the ultraviolet part of the spectrum sunlight;

bad ecology.

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

There are two forms of age-related macular degeneration: dry and wet. The dry form of the disease occurs in approximately 90% of patients. Over the course of 5-6 years, it develops first in one eye and then moves to the other eye. Dystrophic changes appear in the macular region of the retina in the form of small focal dispigmentation and light yellow spots of round or oval shape. There is no sharp decrease in vision, but objects in front of the eyes may become distorted.

Retinal dystrophy (central macular degeneration)

Note:

If you have the dry form of age-related macular degeneration, you should be examined by an ophthalmologist at least once a year. An ophthalmologist must examine the retina of both eyes with a dilated pupil.

Although only 10% of people have wet macular degeneration, 90% of severe vision loss occurs from this form of the disease.

Vision loss occurs because new blood vessels begin to grow into the retina towards the macula. These newly formed vessels have incomplete defective walls through which blood begins to leak. Vision decreases sharply.

One of the symptoms of the wet form of age-related macular degeneration is the feeling of distortion of objects in front of the affected eye. Straight lines begin to appear wavy to the patient. This optical effect occurs because swelling occurs in the macular area. In this case, central vision decreases very quickly and a visual field defect appears in front of the eye in the form of a dark spot.

This is how objects look with retinal dystrophy.

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

Often patients with age-related macular degeneration with concomitant cardiovascular and neurological diseases Consultations with a cardiologist and neurologist are required.

TREATMENT. To prevent and treat the early stages of age-related macular degeneration, adherence to healthy eating, reducing the consumption of foods with high level cholesterol 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 of 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 the eye tissue. 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. seaweed and the petals of many yellow flowers.

Considering the “rejuvenation” of this disease, special attention should be paid to its prevention, which includes:

a mandatory course of oral administration of lutein, zeaxanthin and anthocyanosides;

quitting smoking and cholesterol-rich foods;

protection from direct impact sun rays(sunglasses, hat, awning, etc.);

use of contact lenses to protect the eyes from ultraviolet radiation;

correction of arterial hypertension;

regular retinal examinations to identify signs of disease progression (at least once a year);

self-monitoring of visual impairments using Amsler grids and, if necessary, contact an ophthalmologist.

Amsler test.

The test is quite simple: look at the point in the center of the Amsler grid. If the lines near the dot appear fuzzy, there is a possibility of AMD. If your doctor suspects you have wet AMD, you will likely have to undergo a fluorescein angiography procedure. The essence of the survey is as follows. A dye is injected into a vein in your forearm and eventually reaches the retina of your eye. A special device allows you to trace the entire path of paint through the blood vessels of the retina.

This procedure helps the ophthalmologist determine whether damaged blood vessels can be treated with laser. If the vessel walls are too thin and there is a risk of severe bleeding, your doctor may recommend optical devices instead of laser surgery. If your vision deteriorates, optics can help you restore the functions of your eye, but will not be able to fully compensate for the loss of vision.

Amsler grid .

"LUTEIN FORTE"

For complex treatment of AMD, glaucoma, cataracts, complicated myopia and postoperative period, with the goal of a speedy recovery.

All components included in the drug provide effective protection and enhance the overall antioxidant effect, which helps to improve and stabilize visual functions.

Peculiarities psychological state patients with age-related macular degeneration.

An unfavorable prognosis for visual impairment is often accompanied by changes in the psychological state of patients.

To avoid unfavorable psychological changes in the patient’s condition, he needs to receive as many positive emotions as possible.

This is facilitated by the normalization of the psychological climate in the family; breathing exercises and walks in the fresh air; work on a personal plot or dacha (caring for plants, animals, birds); eating fresh vegetables and berries containing vitamins, minerals, antioxidants (spinach, carrots, celery, zucchini, Jerusalem artichoke, blueberries, lingonberries, black currants, rose hips, rowan, etc.).

What is AMD?

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 vision.

Age-related macular degeneration is the leading cause of irreversible vision loss and blindness among people aged 50 years and older in the developed world. Because people in this group represent a growing proportion of the population, vision loss from macular degeneration is a growing problem.

According to WHO, the share of the population of the older age group in economically developed countries is about 20%, and by 2050. will probably increase to 33%. Accordingly, due to the expected increase in life expectancy, the steady increase in atherosclerosis and concomitant pathologies, the problem of AMD remains the most pressing. In addition, in recent years there has been a clear trend toward “rejuvenation” of this disease.

The cause of decreased vision is degeneration of the macula, the most important area of ​​the retina, responsible for the sharpness and acuity of central vision necessary for reading or driving a car, while peripheral vision is practically unaffected. The socio-medical significance of this disease is due precisely to the rapid loss of central vision and loss of general performance. The severity of the process and loss of central vision depends on the form of AMD.

Dry and wet forms of AMD

Intense metabolism in the retina leads to the formation of free radicals and other reactive oxygen species, which can cause the development of degenerative processes when the antioxidant system (AOS) is insufficient. Then, in the retina, especially in the macula and paramacular region, under the influence of oxygen and light, non-cleavable 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. Subsequently, scarring processes occur, accompanied by loss of large quantity retinal photoreceptors.

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

The dry form of AMD is more common than the wet form and is detected in 85% of all cases of AMD. Yellowish spots known as drusen are diagnosed in the macular area. The gradual loss of central vision limits patients' ability to see fine details, but it is not as severe as in the wet form. However, dry AMD can slowly progress over several years to the late stage of geographic atrophy (GA), a gradual degradation of retinal cells that can also lead to severe vision loss.

Doesn't exist today radical treatment dry form of AMD, although some are currently in clinical trials. A huge number of clinical studies have proven that certain nutrients Supplements such as beta-carotene (vitamin A), vitamins C and E may help prevent or slow the progression of dry macular degeneration. Research shows that taking large doses Certain eye supplements and vitamins may reduce the risk of developing early-stage AMD by 25%. Eye doctors It is also recommended that patients with dry AMD wear sunglasses with UV protection.

The wet form of AMD is present in approximately 10-15% of cases. The disease progresses quickly and often results in significant loss of central vision, with dry AMD progressing to more advanced and damaging forms of the eye disease. In wet AMD, the process of new blood vessels growing (neovascularization) begins. The wall of such vessels is defective and allows blood cells and fluid to pass through, which 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.

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 to ensure the required amount of nutrients and oxygen reaches the retina. Instead of this process, scarring occurs, resulting in severe loss of central vision.

Causes and risk factors for developing AMD

Despite numerous studies on AMD, the causes of this disease remain unclear to date. 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 person. A significant portion of the population has a congenital 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 negatively affect natural protective mechanisms and therefore contribute to the development of AMD, the most significant are:

• Race - the highest prevalence of AMD is observed in Caucasians
• Heredity - family history is important factor risk in 20% of patients with AMD. A threefold increase in the risk of developing AMD has been established if the disease occurs in relatives in the first generation
• Cardiovascular diseases play a significant role in the development of AMD. It has been established that with atherosclerosis, the risk of damage to the macular area increases 3 times, and in the presence hypertension– 7 times.
• Cigarette smoking is the only risk factor whose significance was confirmed in all studies. Quitting 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.
• Light iris
• Cataracts, especially nuclear ones, are a risk factor for the development of AMD. Cataract surgery may contribute to the progression of the disease in patients with existing changes in the macular area.

Symptoms of AMD

Age-related macular degeneration usually causes slow, painless, and irreversible vision loss. IN in rare cases, vision loss can be dramatic.

Early signs of vision loss from AMD include:

• appearance of dark spots in central vision
• blurred image
• distortion of objects
• deterioration in color perception
• sharp deterioration of vision in poor lighting and darkness

The most basic 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 symptoms of AMD may see that some lines appear blurred or wavy and appear in the field of vision. dark spots.

An ophthalmologist can distinguish the manifestations of this disease even before changes in the patient’s vision develop and refer him for additional examinations.

Diagnosis of AMD

Diagnosis of AMD is based on medical history, patient complaints, assessment of visual functions and data from examination of the retina using various methods. Currently one of the most informative methods When identifying retinal pathology, fluorescein angiography of the fundus of the eye (FAGD) is recognized. To conduct FAGD, various models of cameras and special contrast agents-fluorescein or indocyanine green, which is injected into the patient's vein, and then a series of fundus photographs are taken.

Stereoscopic images can also be used as a baseline for dynamic monitoring of a number of patients with severe dry AMD and patients during 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.

Treatment of dry and wet forms of AMD

Despite enormous strides in improving diagnostic methods for AMD, its treatment remains a rather difficult problem. In the treatment of dry forms of AMD and with a high risk of developing the disease for the purpose of normalization metabolic processes courses of antioxidant therapy are recommended in the retina.

According to the AREDS study, beneficial effect benefit from antioxidant supplementation was achieved in those participants who had intermediate or late stage AMD in at least one eye. Combination therapy antioxidants, zinc and copper over 5 years reduced the incidence of late-stage AMD by 25%, and the risk of loss of visual acuity by 3 or more lines by 19%.

It should be remembered that replacement therapy for the prevention and treatment of the dry form of AMD cannot be a course 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, severe medical history, cataract extraction), then even earlier.

Treatment of wet AMD is aimed at suppressing the growth of abnormal blood vessels. Today, there are a number of drugs and techniques registered in Russia that can stop or reduce the manifestations of abnormal neovascularization, which has improved vision in a significant number of people with wet AMD.

For more information, read our article “Treating Age-Related Maular Degeneration.”

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Age-related macular degeneration as a threat to vision loss among pensioners

Time cannot be stopped, just as aging of the human body cannot be avoided. As you age, many problems begin to arise. Including vision problems.

Let's remember a little about the structure of our eye. The macula has a second name - the yellow spot. This is the very center of the retina where the beam of light is focused. It provides central vision as well as color perception of the visual image. Damage to the macula that occurs in patients of the older age group indicates the onset of a pathology such as age-related macular degeneration (abbreviated as AMD).

With macular degeneration, the diameter of the blood vessels supplying the retina decreases. As a result, its tissues cease to fully receive the necessary substances. Dystrophic changes develop in one or both (left and right) eyes. AMD is often the cause of disability and disability.

Of course, when we talk about age-related macular degeneration, we understand that the main cause of this disease is precisely age-related degenerative changes in the retina. But in some patients the disease develops, while in others it does not; in some it progresses rapidly, while in others it progresses extremely slowly. The reasons for this situation are not fully understood, but histology helps to understand the mechanism of development pathological process and identify a number of risk factors:

• Genetic predisposition and heredity (inheritance occurs as an autosomal dominant, an autosomal recessive, or by linkage to the X chromosome).
• Smoking. It significantly increases the risk of developing AMD.
• Arterial hypertension.
• Diabetes.
• Myopia or farsightedness.
• Prolonged exposure to sunlight on eyes not protected by sunglasses.
• Excess weight bodies. Scientific research points to a link between obesity and the progression of AMD.
• Poor nutrition, as a result of which the patient’s body does not receive enough nutrients necessary for the proper functioning of the visual apparatus (in particular carotenoids).
• Race. Whites age-related changes vision are more common than African Americans.
• Vegetative-vascular dystonia or, in short, VSD.
• It should also be noted gender – in the fairer sex this disease is diagnosed more often.
• Eye pathologies. For example, chronic blepharitis or endocrine ophthalmopathy (pseudotumorous or thyrotoxic form).
• Previous eye injuries.

Age-related macular degeneration is more often diagnosed in women and whites.

Classification of macular degeneration

Ophthalmologists classify pathology according to the forms of AMD:

1. Dry (other names - non-exudative, atrophic). Develops slowly.
2. Wet (other names: exudative, neovascular). It is developing rapidly.
3. Scar. Last stage AMD. It is developing rapidly.

Atrophic form

The dry form of AMD is observed in 85% of cases than other forms of pathology. As a person ages, metabolism changes. This results in yellowish spots called drusen in the macula area. These are the foci of atrophy. Drusen are divided into hard and soft. Hard – small and clearly defined; soft - large, with blurry edges, can merge with each other. The patient loses visual acuity gradually. This is one of the differences between this form of pathology and others. Cases have been recorded when the dry form gradually passed into the last - scar stage.

The dry form of AMD is also called non-exudative or atrophic.

Neovascular form

Ophthalmologists diagnose this type pathology in only 10-15% of cases. The wet form of AMD is the result of progression of the atrophic form. The disease develops rapidly. In most cases, central vision is almost completely lost. As drusen (arising in the dry form) increase in size and thicken, the process of formation of new vessels develops on the retina. It is this process, also called neoangiogenesis, that distinguishes the wet form. As a result, the body tries to compensate erroneously malnutrition retina of the eye, sending an additional volume of oxygen and substances necessary for functioning.

As the pathology progresses, blood cells and fluid penetrate through the walls of new vessels, accumulating in the area under the retina. Swelling develops and hemorrhages appear. As a result, retinal cells that are particularly sensitive to light are constantly damaged and die. This creates blind spots in central vision.

Classified into:

1. Classic, affecting the subretinal neovascular membrane (SNM).
2. Hidden, also called occult.
3. Mixed.

The wet form is also called exudative or neovascular.

Scar form

When vessels grow under the pigment epithelium, retinal detachment is possible, followed by detachment of the neuroepithelium and the formation of scar tissue (transition to the scar stage).

This is the final stage of age-related macular degeneration. Vision loss is irreversible.

Symptoms

Symptoms directly indicate the form of the disease. In most cases, the disease is asymptomatic.

Symptoms:

1. As a result of the gradual appearance and further increase of drusen, vision deteriorates. In the dry form it is insignificant and gradual, and in the wet and cicatricial form it is rapid.
2. Floaters begin to flash before the eyes (especially typical for the dry form).
3. The pigment layer suffers the most, which is why the perception of the shades and brightness of the picture and its contrast decreases.
4. Hemorrhages arising from edema, which are noticeable to others, indicate the wet form of the disease.
5. Fields of vision disappear.
6. The picture we see becomes blurred.
7. Surrounding objects are distorted, straight lines are bent.

The development of the dry form is asymptomatic at first.

Development of the dry form:

1. On initial stages no symptoms.
2. Central vision gradually deteriorates.
3. Then most of the image becomes cloudy.
4. Over time, the affected area enlarges and darkens, resulting in the formation of a scotoma.
5. Peripheral vision remains intact.

The special features of the second and third forms are as follows:

1. 100% vision loss occurs quickly.
2. It is possible to preserve peripheral vision in very rare cases.

In the final cicatricial form of AMD, the degree of vision loss reaches 100%.

How is diagnosis done?

Despite the possibility of long-term asymptomatic progression of the disease, age-related macular degeneration can be diagnosed thanks to modern eye examinations. People over 50 years of age should have regular eye exams. This will identify pathology at an early stage and prevent vision loss.

The dry form can smoothly transform into the most dangerous form - the scar form. Therefore, you need to visit the ophthalmologist regularly.

With a long process of development of pathology, patients coming to the ophthalmologist most often complain of the appearance of a “spot” in front of the eyes, reminiscent of fog. Gradually the defect increases in size.

Diagnostic methods:

• taking anamnesis;
• visometry;
• ophthalmoscopy (examining the fundus of the eye);
• optical coherence retinotomography;
• visocontrastometry;
• fluorescein angiography;
• computer perimetry;
• color stereo photography.

These methods allow for timely and high-quality diagnosis of the macular region of the retina.

Based on the diagnostic results obtained, a course of treatment is prescribed.

When AMD of the eye is detected, the doctor must explain to the patient what it is, prescribe a course of treatment and teach self-diagnosis (relevant for the dry form of the pathology).

Self-diagnosis

For those patients who have already been diagnosed with age-related macular degeneration of the retina, good method Diagnosis of disease progression is the Amsler grid test. This method allows you to determine even the initial signs of macular edema due to the formation of new vessels on the retina.

The Amsler grid is a 40 x 40 cm grid with square cells with a dot in the middle. When diagnosing, the test distance to the Amlser grid is about 50 cm. One eye must be covered with the palm of your hand, and the other eye must be looked at the grid.

If pathology is present, the patient may see non-existent “holes” or “dark spots”, or distortions in the mesh. With this development of events, it is necessary to urgently undergo examination by an ophthalmologist.

Self-examination using the Amsler grid can be performed even every day.

Self-diagnosis allows you to monitor the development of AMD.

Treatment of eye AMD

Treatment of dry form

The dry form is more treatable than the wet form. It has a more favorable course.

Damage in this form of the disease is irreversible. Reducing the risk of transition to the wet form is achieved by drug therapy, which includes the following:

1. Antioxidants.
2. Vitamin and mineral complexes.
3. Taurina.
4. Lutein/beto-carotene/vitamin A/zeaxanthin (one of the drugs or their complex is prescribed depending on the clinical picture course of the disease) in a volume of 10mg/15mg/28000IU/2mg.
5. Anthocyanosides.
6. Vitamins C and E in the amount of 500 mg and 400 IU, respectively, daily.
7. Copper and zinc in the amount of 2 mg and 80 mg, respectively.
8. Selenium and other trace elements.
9. Gingko biloba.

You should visit your doctor regularly to monitor the progress of the disease.

For dry AMD, treatment is based on taking vitamin complexes.

To improve blood circulation in the retina, patients are recommended to take antiplatelet agents and vasodilators.

It is worth noting that conservative medicine, which consists of prescribing dedystrophic drugs, immunomodulators and antioxidants (tablets, injections or drops), is ineffective. When taking these drugs, patients most often ignore the need to visit an ophthalmologist for monitoring. In this regard, the risk of the disease progressing to a more severe stage increases.

Treatment of the wet form

Not long ago the only effective method Treatment of the wet form of AMD remained laser coagulation - destruction (destruction) of newly formed vessels using a laser. However, this method did not eliminate the cause of the formation of new vessels. In addition, healthy tissue can also be damaged during this procedure.

A less aggressive version of wet laser therapy is photodynamic therapy using the drug Visudin. It is administered intravenously and the retina is irradiated with a laser. The drug has a tropism only for pathological vessels of the retina, is able to accumulate in them and be activated when exposed to a laser beam. Blood clots form in bleeding pathological vessels, and the vessels become “sealed.” With this procedure, there is virtually no risk of damage to healthy tissue.

Visudin is used to treat wet AMD with photodynamic therapy.

But today, VEGF therapy, developed in the early 2000s, is considered a more progressive method. The second name is “Targeted Therapy”. Treatment of eye AMD in this case allows not only to stop the progression of the process, but also to partially restore the patient’s vision. However, this statement is only true if irreversible scar changes have not yet begun.

With VEGF therapy, special drugs are injected into the vitreous body of the eye to stop the formation of blood vessels. The drugs used for these injections are Lucentis, Macugen, Avastin and Eylea.

The following risks are possible with this type of therapy: increased intraocular pressure, retinal detachment, eye infection, temporary visual disturbance, hemorrhage.

From surgical methods For the treatment of AMD, the following types of operations should be noted:

• pigment epithelium transplantation;
• removal of subretinal neovascular membranes with the formation of scleral folds;
• removal of subretinal hemorrhages.

Lucentis is used to treat wet AMD with VEGF therapy.

Additional measures

For patients who have lost visual acuity, glasses are prescribed. Plus lenses are installed for nearsighted people, and minus lenses for farsighted people. It is recommended to have an anti-reflective coating to protect your eyes from such negative impact, such as glare from a monitor or TV, increased strain on the eyes when reading or other work.

Treatment with folk remedies

Use one or the other folk method Treatment is permissible only after consultation with your doctor. Unfortunately, traditional medicine cannot cure AMD, but it can improve well-being, prevent the development of the disease and relieve symptoms.

1. Soak washed oat grains in a half-liter jar for 4 hours. Drain the water and pour the oats into the pan. Pour in 3 liters of water and cook over medium heat after boiling for 30 minutes. The resulting broth is filtered and stored in the refrigerator. Take warmed up to 5 times a day in a glass. It is recommended to add ground currants, blueberries, chokeberries and honey to the decoction.
2. 1 tablespoon of pharmaceutical calendula is poured into a glass of boiling water and left for 15 minutes. Let it stand. Then strain and take 3 times a day, ¼ cup. You can also apply this infusion to your eyes, 2 drops per eye. Take up to 6 months. Then take a break.
3. Everyone knows about the benefits of aloe and mumiyo. They can also help with AMD. You need to dissolve 50 g of mumiyo in 100 ml of aloe juice. Insist. There are two options for using this infusion. The first is to drink 10 ml 2 times a day. The second is to use as eye drops: 1k. in each eye. After 10 days of taking it, take a break.
4. Onion peels (2 parts), rose hips (2 parts) and pine needles (5 parts) need to be chopped. Pour 1 tablespoon of the mixture into 1 liter of water and boil for 2-3 minutes. Take 1.5 liters daily.
5. A tablespoon of cumin is poured into 250 ml of water. Boil over low heat for 2-3 minutes. Add 1 tsp. cornflower flowers, mix and set aside for 5 minutes. Use 1-2 drops in each eye 2 times a day.
6. Grind the celandine. 1 tsp pour 100 ml of water. Heat on fire for 10 seconds. Let it brew. The infusion is filtered and stored in the refrigerator. Apply 3 drops in each eye 3 times. in a day. Course – 1 month.
7. Take 1 part goat milk and 1 part boiled water. Use the resulting mixture as drops - 1 drop in each eye. After instillation, you need to cover your eyes with a dark bandage or special glasses and lie down for 30 minutes. Course – 1 week.
8. Add 1 tsp to 1/3 cup of chopped nettle. chopped lilies of the valley and add ½ tsp. soda Mix. Place in a dark and dry place for 9 hours. Make compresses from the resulting mass.
9. Treatment with leeches is a separate, but very useful area traditional medicine.

Traditional medicine can be used as an addition to basic treatment.

It is necessary to consume a sufficient amount of foods rich in carotenoids, fresh vegetables, fruits, and herbs.

You should also limit the intake of animal fats from food, which provoke atherosclerotic changes in the retina.

Foods rich in carotenoids:

• carrot;
• pumpkin;
• potato;
• melon;
• spinach;
• cabbage;
• zucchini;
• citrus;
• tomatoes;
• Bell pepper;
• corn;
• apricots;
• peaches;
• persimmon.

Foods with antioxidants:

• Red Ribes;
• blueberry;
• cranberry.

Prevention of AMD

Measures to prevent senile disease - AMD include:

• diet (limiting animal fats; sufficient amounts of fresh vegetables and fruits);
• weight loss;
• level control blood pressure;
• wearing sunglasses (especially for patients with light eyes);
• refusal bad habits(smoking);
• taking vitamin complexes;
• playing sports; but from professional sports; for example, triathlon, you will have to refuse.

And, of course, regular examination by an ophthalmologist is necessary.

Nov 28, 2017 Anastasia Tabalina