What is macular degeneration?

In the middle of the retina lies the macula lutea or yellow spot, the place responsible for central vision (visual acuity).
Macular degeneration or yellow spot is a disorder of the eye in which the macula becomes damaged and no longer functions as it should; visual acuity will then deteriorate. In most cases, peripheral vision is spared.

The most important types of macular degeneration are juvenile macular degeneration and age-related macular degeneration. Juvenile macular degeneration occurs at a young age and is hereditary, but it is also relatively rare. Both eyes are usually affected.

Age-related macular degeneration starts at around 50 years of age. Heredity is not a factor. The two most common forms of age-related macular degeneration are the dry and wet forms:

foto OOGAANDOENING OCTDry macular degeneration, also known as atrophic degeneration, is the most common form of age-related macular degeneration (80%) with the least serious consequences. It is caused by the natural ageing process which leads to the thinning of macular tissue. Usually both eyes are affected and loss of visual acuity happens slowly. Peripheral vision remains unaffected.

Wet macular degeneration, also known as exudative or haemorrhagic macular degeneration is a more uncomfortable form and is fortunately less common (20%). Through a limited nutrient and oxygen supply to the retina, new blood vessels are formed under the yellow spot; these new vessels are fragile and do not function properly, leaking fluid, sometimes blood, into the macula and causing fluid accumulation (macular oedema) which distorts central vision. The subsequent and significant loss of visual acuity occurs very rapidly. The other eye might not be affected, but eventually both eyes will undergo the same process. In some cases, peripheral vision will also be affected.

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Macular degeneration: symptoms

The following symptoms are inherent to macular degeneration:

  • Decreased visual acuity: central vision degenerates (less focused or blurred vision when reading or watching TV); peripheral vision is usually unaffected. Clear, detailed vision disappears and a dark spot the middle of the field of vision appears. Macular degeneration can also lead to myopia and hypermetropia
  • Image distortion: straight lines might appear wavy
  • Visual difficulties: problems when reading, reduced night vision, visual hallucinations

Macular degeneration: causes

Although the actual cause of macular degeneration is not known, it is often put down to wear and tear. A number of factors can play a role:

  • Age and smoking are the leading risk factors
  • Heredity and genetic abnormalities
  • Diet: too many saturated fats, cholesterol and alcohol and insufficient antioxidants might be linked to macular degeneration development

Macular degeneration: treatment

There is no cure, for either the dry or wet forms. However, there is treatment that can stabilise this condition.
Early detection is very important in the case of macular degeneration so that treatment can be started as quickly as possible.

Diagnosis

  • Direct and indirect ophthalmoscopy (examination of the back of the eye)
  • Fluorescein angiography (examination of the retina using fluorescent dye)
  • Optical Coherence Tomography (OCT) (laser assisted examination of the retina)

Dry macular degeneration treatment

Addition of specific nutrients and supplements to the diet such as vitamins, antioxidants and certain oligo mineral elements.

Wet macular degeneration treatment

Currently, injections of vascular growth inhibitors are considered to be the best treatment for wet macular degeneration. These injections reduce the formation of new, abnormal blood vessels and thus prevent further vessel leakage. The medicine is injected into the vitreous cavity of the eye (intravitreal injection) and this injection must be performed several times. Interim checks are carried out via OCT.

Because macular degeneration often worsens without treatment, the objective of the above named treatment is purely for the maintenance of (and possible improvement of) visual acuity.

Other possible treatments are conventional (thermal) laser, Photo Dynamic Therapy (PDT), and ‘low vision’ optical aids (loupe, magnifying bar, sunglasses, better lighting etcetera).

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