Macular degeneration

Age-related macular degeneration is a breakdown or tear of the macular in the eye.
The macula is a small zone in the retina, a light-sensitive tissue that covers the back of the eye.

The macula is the part of the retina that serves central vision and makes it possible to clearly see the small things in detail.

A few decades ago, the common names were based on the clinical appearance and age of the affected patient:

• Senile maculopathy
• Senile macular degeneration
• Discoid macular degeneration

The term “senile” is no longer used from the mid-80s.

Classification of macular degeneration

Macular degeneration is divided into:

• Dry (non-neovascular)
• Moist (neovascular)

Dry or atrophic macular degeneration (non-neovascular)

This is the initial phase of the disease, which can result from:

1. Aging and thinning of macular tissue
2. Pigment deposits in the macula
3. A combination of both phenomena

Dry macular degeneration is diagnosed when drusen (accumulation of extracellular material) accumulate in or around the macula.
These stains are thought to be deposits or remnants caused by dying tissue.
In dry macular degeneration, gradual central vision loss can occur, but this is usually not as severe as in wet macular degeneration.
However, dry macular degeneration can slowly progress into the advanced phase of geographical atrophy.
Geographical atrophy consists in the degeneration of the deeper retinal cells. These cells are part of the retinal pigment epithelium.
Geographical atrophy can lead to severe vision loss.

Wet or exudative macular degeneration (neovascular)

In about 10% of cases, dry degeneration develops into this more advanced form, in which new blood vessels form under the retina, from which blood and fluid also leak.

This loss causes permanent damage to the cells of the light-sensitive retina, which die and form blind angles in the area of central vision.

Choroidal neovascularization (CNV) is the process that causes wet macular degeneration and abnormal growth of blood vessels.
This happens because the body tries to form a network of blood vessels to bring more nutrients and oxygen to the retina.
However, instead of solving the problem, this process leads to scarring and loss of central vision.

Wet neovascularization is divided into two categories:

1. Occult. The growth of blood vessels under the retina is not as pronounced in wet macular degeneration occult CNV, the loss is less obvious, and in general, less severe vision loss is caused.
2. Classic. When the growth of blood vessels and scars is very clear and the contours seen under the retina are outlined, this type of wet AMD is known as classic CNV, which usually results in much more severe vision loss.

Risk factors

The risk of macular degeneration increases with age.

High risk factors include:

• Smoking. Recent research shows that smoking doubles the risk.
• Ethnicity. Caucasians are much more likely than people of African descent.
• Gender – a woman of 70 years is twice as likely as a man of the same age.
• Heredity – People with a family history of macular degeneration are at much higher risk.
• Drug side effects. Some cases of macular degeneration may be side effects from toxic drugs such as chloroquine (antimalarial medicine) or phenothiazine.
• Improper diet, because it favors the occurrence of diabetes and high blood pressure.
• Excessive sun exposure without filters or sunscreen.
• Heart disease: Cardiopathies cause changes in blood flow to the eyes.

Juvenile macular degeneration

Juvenile macular degeneration is a term used to designate certain inherited diseases of the eyes that affect children and adolescents, including Stargardt’s disease or Best’s disease. These rare diseases cause central vision loss, which can begin as early as childhood or adolescence.

Stargardt’s disease is characterized by yellow-white spots that appear inside and around the macula.
If the spots appear on the entire posterior section of the eye, one speaks of a fundus flavimaculatus. These deposits consist of a fatty substance that is formed during normal cell activity.

Best’s disease or vitelliform macular degeneration appears as an egg yolk, fluid-filled sac, like a cyst under the macula.
In the initial phase, the cyst resembles an “egg yolk” and there is no loss of visual acuity.
In some people, the cyst may burst, the fluid spreads on the macula, and the result is a deterioration of vision.

What are the symptoms of macular degeneration?

In the initial phase, macular degeneration does not have to cause symptoms and can go undetected until it progresses or affects both eyes.
The first sign of macular degeneration is usually a dark spot and blurred vision in the center of the field of vision.
This point may become larger or darker over time.

Symptoms of macular degeneration include:

• Dark and blurry districts in the center of the field of view
• Reduction of color perception
• Distortion of straight lines (metamorphopsia)

If any of these symptoms occur, you should consult an ophthalmologist as soon as possible.

Diagnosis of macular degeneration

The disease can be detected only by a thorough examination of the enlarged eye.
The ophthalmological examination may include the following examinations:

• Visual acuity test. A table is used to measure visual acuity over a certain distance.
• Eye examination for dilated eye. The ophthalmologist drips eye drops into the eyes to dilate the pupil. Thus, he can see the fundus better.
• Using a magnifying lens, he examines the retina and the optic nerve.
• OCT (optical coherence tomography), a non-invasive examination in which the retinal layers can be examined.
• Fluorescence angiography is an examination in which the ophthalmologist injects a colorant (fluorescein) into the arm vein. After a few seconds, the dye also flows through the blood vessels in the eyes.
• The ophthalmologist uses a special camera to take photos to evaluate the status of blood vessels.

Amsler grid
This is a graph that monitors the patient’s vision, as dry macular degeneration can turn into the more damaging form of wet macular degeneration.
To use the Amsler grid, you have to put on glasses and hold the grid 30 centimeters in front of your face in good light.

Covering
one eye You look directly at the center with the uncovered eye and focus the eye on it.
As you look at the center, you have to observe if all the lines of the grid are straight or if some lines appear distorted, blurry or dark.
The test is then repeated in the other eye.
If an area of the grid appears wavy, blurry or dark, you should consult the ophthalmologist.

Diet and nutrition for macular degeneration

Nutrition is very important for the treatment and prevention of this disorder because it is associated with:

• Diabetes
• Hypertension
• Arteriosclerosis

In general, two types of nutrition are recommended, which have already helped many patients:

1. The blood group diet according to Dr. Adamo/Mozzi is mainly based on proteins.
2. Vegan and raw food diets are recommended by Natural Medicine and Natural Hygiene.

A person who does not want to give up meat and fish can follow the blood type diet, otherwise you can opt for a vegan diet.

According to the blood type diet, a person can eat the foods that are suitable for his blood type, but then must avoid other foods.
Certain foods are harmful to all blood types and can promote diabetes and hypertension:

1. Cereal products (especially those containing gluten) because they stimulate insulin production and are converted into triglycerides in the liver.
2. Baked foods
3. Milk and dairy products, as the calcium contained therein is deposited as atherosclerotic plaques and forms calcifications.
4. Pork and salami

Some foods are only harmful to certain blood groups:

1. For blood type 0, these are fruit, tea, garlic and excessive consumption of nuts or seeds, etc.
2. People with blood type A should avoid red meat, mussels, crustaceans, potatoes, etc.
3. People of blood type B should better avoid tomatoes, cashews, hazelnuts, amaranth and avocado, etc.
4. People with blood type AB can get sick due to oil or sunflower seeds, artichokes, oranges, corn, etc.

Treatment of macular degeneration

There is currently no definitive treatment for macular degeneration, but some therapies can prevent or slow the progression of the disease.

Existing possibilities are:

Anti-angiogenic drugs. These drugs (Avastin, Eylea, Lucentis) block the development of new blood vessels and the leakage of blood from pathological blood vessels inside the eye, which leads to macular degeneration.
This treatment was an important step because it allowed many patients to restore the vision they had already lost.

Vitamins
A broad study by the National Eye Institute of the National Institutes of Health, called AREDS (Study of Age-Related Eye Diseases), has shown that for some people with moderate or advanced dry macular degeneration, the risk of vision loss can be reduced if their diet contains certain mineral salts and vitamins:

• Vitamin C
• Vitamin e
• Beta-carotene
• Zinc
• Copper

This study continues to explore whether adding more vitamins and minerals to supplements can improve outcomes.
The first addition was omega-3 fatty acids (fish oil) and the second was a combination of two carotenoids, lutein and zeaxanthin, which are found in green leafy vegetables and other fruits or vegetables.

The study showed:

• Beta-carotene does not reduce the risk of macular degeneration progression.
• The addition of omega-3 does not reduce the progression of the disease.
• The AREDS formula also helps with the addition of a small amount of zinc.
• Patients who also took lutein and zeaxanthin supplements, when these two substances were not present in sufficient amounts in their diet, had better outcomes.
• As a rule, those who had taken lutein and zeaxanthin instead of beta-carotene had benefits.

Laser therapy (photocoagulation). High-energy laser beams can be used to destroy pathological blood vessels that develop during macular degeneration.

Photodynamic laser therapy. This is a two-phase treatment that uses a photosensitive drug (Visudyne) to destroy diseased blood vessels.
The doctor injects the drug into the bloodstream, which is absorbed by the pathological blood vessels in the eye.
Then the doctor directs cold laser light at the eye to activate the drug and thus damages the pathological blood vessels.

Help for the visually impaired. These are devices that contain special lenses or electronic systems that produce magnified images of nearby objects. They help people with vision loss in macular degeneration to make better use of remaining vision.

Researchers are investigating new experimental treatments for macular degeneration.

Other therapies for macular degeneration

Submacular surgery is an operation to remove diseased blood vessels or blood.

Retinal
translocation Retinal translocation is a surgical procedure used to destroy pathological blood vessels located under the center of the macula. In this area, a laser beam cannot be positioned safely.

Rehabilitation of poor eyesight
In the case of vision problems, it is possible to significantly improve the quality of life by rehabilitating the visual impairment.
In the rehabilitation of visual impairment, the patient is taught how to make the most effective use of the remaining vision and learns various ways to perform everyday activities.

Rehabilitation services for poor vision include:

• Evaluation of visual impairment by an ophthalmologist or optician
• Prescription of aids
• Practical rehabilitation: reading, writing, shopping, cooking, lighting, etc.

Prevention of macular degeneration

The best ways to protect the eyes from premature macular degeneration currently seem to be:

• A healthy diet
• Exercise
• Wearing sunglasses that protect the eyes from damage caused by the sun’s UV rays and high-energy visible light (HEV).

• Loss of vision
• Red eyes
• Burning eyes