Macular degeneration. Age-related macular degeneration. What are the risk factors and causes of AMD?

The concept of “stress test” in cardiology includes assessment of the functional reserve and state of the cardiovascular system when performing various types of activities. Why should stress diagnostics be carried out? The fact is that at rest the cardiovascular system can be in a state of compensation without signs of its disturbances. That is why a standard resting electrocardiogram (standard ECG) may not detect signs of damage to certain parts of the heart, which does not exclude the presence of certain nosological forms in the patient.

Similarly, echocardiography may not visualize certain signs (patterns) of myocardial contractility disorders (local or global). Therefore, to identify certain patterns, tests with physical activity (stress tests) were introduced into medical practice.

Currently, stress tests with dosed physical activity are widely used in medical practice.

Dosed physical activity is that load, the power of which can be changed according to the specific tasks of the researcher. Dosing physical activity has become possible thanks to the advent of special devices that allow you to change the intensity of physical activity in certain standard values. These include bicycle ergometers and treadmills.

Bicycle ergometer - allows you to dose physical activity, expressed in Watts (W). There are 2 types of bicycle ergometers: with electromagnetic and belt load dosing mechanisms.

Treadmill - allows you to dose physical activity by changing the speed of movement and the angle of inclination of the moving belt. The load during treadmillergometry is dosed in metabolic equivalents (MET), which reflects the body's energy expenditure when performing work, with 1 MET = 1.2 cal/min or 3.5-4.0 ml of oxygen consumed per minute per 1 kg of body weight.

Bicycle ergometers and treadmills provide the so-called isotonic load, i.e. that load, which involves the use of a large group of muscles.

What can be diagnosed using stress tests?

1. Coronary insufficiency - initially in cardiology, exercise testing was used precisely for these purposes. Stress tests are the most informative of non-invasive techniques in the diagnosis of coronary heart disease (CHD). The sensitivity of this technique reaches 98%, and specificity - 100%. Indeed, IHD is nothing more than a discrepancy between the myocardial oxygen demand and its delivery. At rest, this discrepancy can be compensated due to the body’s low energy expenditure, as a result of which sinus rhythm without signs of myocardial ischemia can be recorded on the resting ECG. When performing any type of activity, the body's energy expenditure increases, and as a result, the load on the myocardium increases and its need for oxygen increases. When the need for oxygen does not match its delivery, myocardial ischemia occurs, which is manifested by certain patterns on the ECG. Depending on the degree of damage to the vascular bed, this discrepancy may manifest itself under loads of varying intensity. Therefore, the use of a stepwise protocol for dosing physical activity allows one to assess the severity of vascular damage, and the use of certain ECG leads allows one to localize it anatomically.

Arterial hypertension - until now, arterial hypertension was diagnosed according to one main criterion, namely a persistent increase in blood pressure (BP). The severity of arterial hypertension (AH) was assessed by the presence of certain changes in “target organs” - the heart (left ventricular hypertrophy), brain (hypertensive encephalopathy), and kidneys (hypertensive nephropathy). However, the presence of normal resting blood pressure values ​​in a patient does not exclude hypertension. In addition, most patients with hypertension receive antihypertensive therapy and there are problems in determining the severity of the disease. In this regard, stress tests have a high diagnostic value, since when performing work, the load not only on the heart, but also on the entire cardiovascular system increases, which is manifested by an increase in heart rate (HR) and blood pressure levels. If, when performing work of a certain intensity, an excessive increase in blood pressure occurs, then this serves as a “diagnostic key” when diagnosing hypertension. Depending on the intensity of the load at which the pathological increase in blood pressure occurred, the severity of hypertension can be assessed.

Heart (myocardial) failure is also well verified during stress tests. When performing work of a certain intensity, patients with heart failure (HF) experience depletion of the functional reserve, which is subjectively expressed in the appearance of severe shortness of breath. Using gas analysis of exhaled air on special gas analyzer attachments, it is possible to objectify the appearance of myocardial dysfunction, which increases the diagnostic value of stress tests in the diagnosis of HF.

Arterial insufficiency of the vessels of the lower extremities is currently underused due to the fact that stress tests have recently been used to assess this criterion. By analogy with coronary insufficiency, as the intensity of the load increases, the need for oxygen in working muscles increases. If there is a discrepancy between the need for oxygen and its delivery (which occurs with obliterating atherosclerosis of the vessels of the lower extremities), then subjective complaints of pain in the legs arise. Recently, it has become possible to objectify ischemia of the lower extremities, which allows for a more accurate diagnosis even before the appearance of the patient’s subjective complaints. Depending on the intensity of the load at which arterial insufficiency manifested itself, the severity of the disease can be assessed.

So, we looked at the diagnostic capabilities of stress tests. Thus, based on them, patients are sent to verify the diagnosis or determine the severity of the verified disease.

Stress tests are a serious diagnostic study, so it is necessary to take into account contraindications to their conduct.

ABSOLUTE CONTRAINDICATIONS.

  • * Congestive heart failure
  • *Recent (current) myocardial infarction
  • * Unstable or progressive angina
  • * Dissecting aneurysm
  • * Polytopic extrasystole
  • * Severe aortic stenosis
  • * Recent (current) thromboembolism
  • * Recent (current) thrombophlebitis
  • *Acute infectious disease

RELATIVE CONTRAINDICATIONS.

  • * Frequent (1:10 or more) ventricular extrasystole
  • * Untreated severe arterial or pulmonary hypertension
  • * Ventricular aneurysm
  • *Moderate aortic stenosis
  • * Metabolic diseases that are difficult to treat (diabetes, thyrotoxicosis, etc.)

So, for carrying out stress tests, the protocol of isotonic load with a continuous stepwise increase in its level has become most widespread.

What is the best way to conduct a stress test? In Western countries, treadmill ergometry has become widespread, while in Europe bicycle ergometry (VEM) is used. From a physiological point of view, treadmillergometry is the most suitable, however, due to the high cost of equipment, VEM is common in our country.

For stress tests, regardless of the method of dosing the load, there are general principles:

Load uniformity - the load from stage to stage should not be dosed chaotically, but should increase evenly in order to ensure proper adaptation of the cardiovascular system at each stage, which will allow for accurate diagnosis.

Fixed duration of each stage. Throughout the world, the generally accepted duration of the load step is 3 minutes.

You need to start the test with a minimum load - for VEM this is a value equal to 20-40 W, and for treadmillergometry - 1.8-2.0 MET.

After the stress test has been carried out, it is necessary to begin evaluating the data obtained, which includes:

  • * assessment of coronary insufficiency with determination of functional class
  • * assessment of exercise tolerance
  • * recommendations for correction of therapy and motor regimen

ASSESSMENT OF CORONARY INSUFFICIENCY

In total, the sample is assessed according to three criteria: positive, negative and doubtful.

A positive test is performed if ECG signs of myocardial ischemia occur during the study. When signs of myocardial ischemia appear without an attack of angina (anginal pain), silent myocardial ischemia is indicated.

A negative test is performed based on the absence of ischemia criteria, provided that the required level of load is achieved (submaximal heart rate or load corresponding to 10 METs or more).

A questionable sample is placed if:

  • 1. the patient had an attack of angina, but no ischemic changes were detected on the ECG;
  • 2. the required level of load has not been achieved (submaximal heart rate or load

If a positive test is performed, then it is necessary to determine the functional class and topical localization of ischemia.

It should be noted that today the international metabolic scale is used to assess the functional class. The use of a metabolic scale makes it possible to fairly accurately determine the functional class, while with the traditional assessment of the functional class in our country based on the threshold load power criterion (in Watts), we received a discrepancy between the severity of the disease and the objective condition of the patient, determined by coronary angiography. This is due to the fact that the MET value (metabolic equivalent load) depends on many factors (age, weight, gender), while the Watt value is “stationary” and depends only on the degree of fitness of the body.

For example, the same load of 60 W for a 55-year-old man with a body weight of 90 kg “costs” 3.0 MET, and with a lower weight of 40 years - 5.0 MET. If this critical load provoked myocardial ischemia (according to ECG data), then in the first patient it corresponds to functional class 3, and in the second it corresponds to functional class 2.

When blood pressure rises to any level above the threshold value of 190/100 mm Hg, a hypertensive response to physical activity is indicated.

If rhythm and/or conduction disturbances occur during the test, it is also necessary to indicate in the conclusion a description of the level of load at which they appeared and their nature.

POSSIBILITIES OF LOAD TESTING IN PATIENTS WITH ARTERIAL HYPERTENSION

Currently, arterial hypertension has a large share in the structure of diseases of the cardiovascular system. Most patients take antihypertensive therapy and are in the so-called “normotensive zone,” which significantly complicates the determination of the degree of hypertension, since normal blood pressure values ​​in patients with hypertension are not criteria for “cure.” In patients with hypertension, a false impression is created that they do not have hypertension, which is the reason for refusing to take antihypertensive drugs.

In a comprehensive assessment of the severity of hypertension, load tests that simulate loads of varying power are of great importance. This makes it possible to assess the relationship between blood pressure and load in this group of patients, which is important when assessing work capacity.

We have conducted studies of the response to physical activity in patients with arterial hypertension. A “peak” blood pressure value was detected, i.e. the blood pressure value achieved at the peak of physical activity. If the value of the “peak” blood pressure level corresponded to 190/100 mm Hg. and more, a hypertensive reaction to physical activity was diagnosed. Depending on the level of load at which the peak level of blood pressure was reached, i.e. the metabolic “cost” of the load (in MET), the functional class of the hypertensive response was determined.

Thus, the connection between an increase in blood pressure above the threshold value (“hypertensive reaction”) and physical activity makes it possible to establish the “functional class” of hypertension and helps to resolve the issue of adjusting antihypertensive drugs, as well as expert questions regarding the patients’ ability to work.

ASSESSMENT OF PHYSICAL ACTIVITY TOLERANCE

If the duration of the last stage is less than three minutes, then performance is calculated using the formula:

W =Wstart + (Wlast- Wstart)t/3

W - general performance;

Wstart - power of the previous load stage;

Wlast - power of the last load stage;

t - operating time at the last stage.

For survivors of myocardial infarction and patients with coronary artery disease, exercise tolerance is assessed as “high” if W > 100 W; “average” - at W = 50-100 W; “low” if W< 50 Вт.

According to physical activity tolerance, recommendations on motor mode are given.

If coronary insufficiency is detected during a stress test, then recommendations are given for correcting antianginal therapy and performing coronary angiography.

If a hypertensive reaction to physical activity occurs, it is necessary to indicate the correction of antihypertensive therapy and repeat the stress test to assess its adequacy.

If during the stress test complaints such as dizziness and pain in the calf muscles arise, then it is necessary to recommend a Doppler examination of the vessels of the brain and lower extremities, since this indirectly indicates cerebral circulatory insufficiency and arterial insufficiency of the lower extremities.

HOLTER MONITORING

The method of long-term ECG recording, proposed in 1961 by Norman Holter, is now firmly established in cardiological practice. Indeed, a standard ECG allows recording only fragments from several seconds to several minutes, while the study is carried out at rest, as a result of which signs of myocardial ischemia and various arrhythmias may not appear on the ECG. The method of long-term ECG recording (Holter-ECG), which abroad is called “outpatient ECG monitoring,” does not have these shortcomings. Indeed, as the name implies, ECG registration can be carried out in the patient’s usual “domestic” conditions, while maintaining normal daily activity. It is this fact that makes it possible to identify the genesis of changes in the ECG with the patient’s complaints: during the Holter ECG registration, the patient keeps a diary of daily activity, where he indicates at what time and what load was performed, notes all the complaints that bothered him during the entire registration period .

Our department uses the Hoter system “Custo-Med”, Germany. ECG recording is carried out on the solid-state memory of the sensor (in contrast to “cassette” recording methods, which produced a large number of hardware artifacts). The device is attached using a special case to the patient’s belt. Disposable sticky electrodes are used. The device runs on an alkaline battery. The procedure is safe for the patient and does not interfere with the patient’s normal activities.

Areas of application of Holter ECG monitoring:

1. Diagnosis of rhythm and conduction disorders - the most common indication. Using the Holter method, you can determine the type of arrhythmia, its circadian activity (day, morning, night), and also determine the possible factors of its provocation (physical activity, food intake, emotional stress, etc.).

Indications:

  • 1) The patient complains of frequent heartbeats;
  • 2) Extrasystole (to identify their total number per day and circadian activity, connections with various types of activities);
  • 3) Ventricular preexcitation syndrome (WPW syndrome) - both manifest and latent forms;
  • 4) Sinus node dysfunction (to exclude sick sinus syndrome) - with a heart rate at rest of 50 per minute or less;
  • 5) Syncope conditions - subject to 100% ECG monitoring to exclude their arrhythmogenic nature.
  • 6) Transient and permanent form of atrial fibrillation.
  • 2. Coronary heart disease is the method of choice in diagnosing coronary artery disease. If the patient complains of pain in the heart area - for their differential diagnosis and verification of coronary artery disease. To verify IHD, it is recommended that the patient be given loads of varying intensity per day, especially those in which he experiences subjective complaints with mandatory registration in the patient’s diary.
  • 1) Angina pectoris - used, as a rule, in patients who cannot perform stress tests (lack of training, joint disease, thrombophlebitis, etc.).
  • 2) Vasospastic angina (Prinzmetal’s angina) is a 100% indication for daily ECG recording. Vasospastic angina usually occurs in young patients, predominantly men. An attack of angina is associated not with atherosclerotic lesions of the coronary vessels, but with their spasm (“angina pectoris on unchanged coronaries”). As a rule, an attack of angina is not associated with physical activity and occurs in the early morning hours, accompanied by ST segment elevation on the ECG (ECG changes according to the type of injury) - lasts several seconds, sometimes minutes. After the attack, the ECG returns to its original level (“sinus rhythm”).
  • 3) Post-infarction period.

Let us consider some features of the conclusions based on the results of Holter ECG monitoring.

So, the long-term recording method allows you to estimate:

  • 1) Pacemaker activity of the sinus node (normally not impaired).
  • 2) Ectopic activity of the myocardium (normally not expressed).
  • 3) Paroxysmal rhythm disturbances.
  • 4) Conduction disorders (transient blockade, etc.).
  • 5) ST segment fluctuations - when diagnosing coronary artery disease. Normally, no significant fluctuations in the ST segment are recorded on the 24-hour ECG.

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Suddenly, the straight lines in your notebook that are familiar to you seem crooked? And the floor, which was previously covered with perfectly parallel parquet bars, suddenly became not so perfect, although everything should be fine with it? Unfortunately, there is a sick chance that age-related macular degeneration of the retina has overtaken you. What kind of disease is this, what consequences it can lead to, and whether there are effective methods of treatment and prevention, this article will tell you.

This is a deformation that occurs in the very center of the retina in the macula, due to a physical disorder. This is a fairly common eye disease in people over 40 years of age. In rare cases, younger people are also affected by this retinal disease. AMD is becoming the most common cause of complete loss of vision in people, as it affects the main visual part of the eye, the macula. The macula, in turn, is responsible for central vision and its acuity, on which the clarity of vision of objects depends. Today, scientists have identified two different types of AMD - dry macular degeneration and wet age-related degeneration. The most common is the first type of AMD and affects up to 90% of people who suffer from age-related macular degeneration.

Dry age-related macular degeneration

Dry macular degeneration is a deformation of the center of the retina that leads to damage to the macula. Small deposits of yellowish drusen are formed - remnants of the axon transport system of degenerating retinal ganglion cells, which accumulate under the macula. Their large accumulation leads to damage to various cells that are involved in vision. Ultimately, such damage leads to complete destruction of cells. Due to destroyed cells, the macula begins to function only partially and this leads to a gradual decrease in visual acuity.

Wet age-related macular degeneration

Wet macular degeneration is a deformation of the center of the retina that leads to damage to the macula. Due to the formation of small deposits of the axon transport system that remain under the macula, damage to the ocular blood vessels occurs. As a result, blood vessels are formed not in the same areas, but in places of the macula where they should not be. This growth causes damage to the macula and can reduce visual acuity in a fairly short period of time.

Reasons for development

Until today, scientists who study eye diseases can identify three main reasons for the development of AMD:

Age

Unfortunately, our body and body tend to age. This implies that processes in the body do not function as efficiently with age, muscles gradually atrophy, the body’s ability to absorb nutrients is lost, etc. Age is one of the main causes of retinal deformation, since with age, eye tissue tends to wear out. According to a study by ophthalmologists, the risk of developing AMD at 50 years of age is 4%, but on average, each subsequent year of life the percentage increases by one. Therefore, by the age of 80, almost half of people are at risk of developing AMD.

Floor

As practice shows, women are more predisposed to developing AMD. According to experts, women suffer from this disease almost twice as often as men.

Heredity

Heredity refers to the transfer of genetic information. But it is important to realize that both the parents’ strengths and weaknesses are passed on. If there are people in the family who have suffered from AMD, this means that immunity to this disease is weakened and there is a predisposition to this disease. Therefore, if your parents suffer from age-related modular degeneration in old age, then your chances of being exposed to this disease increase significantly. As practice shows, having direct relatives with AMD increases your likelihood of developing this disease by 10-30%.

It is also worth understanding that the above three reasons are not the only reasons for the development of AMD. This disease is most likely to develop in people who lead an unhealthy lifestyle. There are several factors that increase the chance of developing AMD:

  • Smoking. In addition to all the diseases for which smoking acts as a catalyst, this bad habit directly affects the macula and leads to its degeneration. Especially if a person smokes for many years and in large quantities, then the chance of getting macular degeneration increases significantly;
  • Nutrition. An unbalanced diet is one of the key reasons for the development of AMD. A lack of lutein (an oxygen-containing pigment), which is found in highest concentration in yellow and orange fruits and vegetables, leads to a decrease in carotenoids, which accumulate in the eye tissues. This, in turn, causes the development of retinal deformation;
  • Excess weight;
  • Solar radiation;
  • High blood pressure.

Symptoms

AMD is considered a rather insidious disease, since it is impossible to detect this eye disease in the early stages. In the early stages, AMD can only be detected by examining the eyes with the pupils dilated to detect a collection of drusen under the macula. Despite this, age-related macular degeneration is a progressive form of the disease and leads to damage to cells that are involved in vision and its processes. Such lesions do not go away without leaving a trace and lead to the appearance of visible symptoms:

  • Formation of dark or shadowed spots in the central vision area;
  • Loss of image clarity, blurriness, both near and far;
  • Distortion and deformation of the primary shape of objects;
  • Deterioration in the ability to perceive color;
  • A sharp deterioration in visual acuity in low light conditions.

People who spend a lot of time reading may try to notice AMD in the earlier stages, as they have difficulty reading, especially if there is not enough light around them. There may also be a lack of different letters if a person reads fluently. As practice shows, most people cannot notice changes in vision if the deformation affects only one eye. Therefore, symptoms often become noticeable only in the later stages of the disease, when the pathology also affects the second eye, and in this case, treatment may not give the desired result.

A series of examinations to make an accurate diagnosis

To make an accurate diagnosis of AMD, the patient needs to undergo a series of examinations that will help the attending physician determine the extent of the disease and which treatment methods will be most effective. Mandatory examinations include:

  • Determination of visual acuity. Determination in digital value of the eye’s ability to perceive two points that are located at a certain distance from each other. Visual acuity can be measured using relative units, which are determined by a special instrument. If a routine procedure is used, then a table is used in which the numerical values ​​of visual acuity are entered.
  • Fundus ophthalmoscopy. This method is widely used in fundus examination and a number of procedures that are aimed at studying the transparency of the eye media in order to detect eye diseases. Ophthalmoscopy of the fundus of the eye allows you to accurately determine the condition of the blood vessels, the color of the fundus, and also assess the place where the optic nerve exits the retina.
  • Optical coherence tomography. OCT allows highly accurate examination of the posterior part of the eye, its retina and optic nerve. Thanks to tomography, it becomes possible to obtain a virtual intravital section of the retina. This section allows the specialist to most carefully examine the structure of the retina and its thickness. Further virtual sections will make it possible to determine the effectiveness of treatment and the dynamics of recovery. This highly informative research method allows the procedure to be completed in 1-2 minutes and is completely safe, without causing any discomfort to the patient.
  • Fluorescein angiography of the fundus. FA is the latest informative diagnostic method for intravital examination of the vessels of the retina, optic nerve and choroid. This method allows you to study and evaluate the condition of the blood vessels that surround the eyeball, the condition of muscle tissue and the optic nerve. Thanks to FA, it is possible to determine whether retinal dystrophy has developed, its degree and the distribution of lesions throughout the eyeball.

Treatment

Unfortunately, today it is not possible to cure macular degeneration of the retina. But, timely intervention from doctors and the latest technologies, as well as a certain course of therapy, will stop the progression of the disease. Also, thanks to a correct diagnosis and an effective course of treatment, it is possible to partially restore the functions of the eye. Depending on the form of the disease (dry or wet), treatment methods may differ.

Treatment of dry macular degeneration

Despite the fact that methods for diagnosing AMD have improved significantly over time, treatment of this disease remains a rather labor-intensive process. The dry form of AMD or its high risk of development requires therapeutic methods of treatment. The goal of this therapy is aimed at normalizing metabolic processes in the retina and its blood supply.

According to research, taking antioxidants—substances that inhibit oxidation—may have a beneficial effect on eye health in patients with AMD. The most effective use of this drug was found in patients who have intermediate or late stages of age-related macular degeneration in at least one eye. Therapeutic measures based on a combination of various antioxidants (zinc and copper) can eradicate the development of late-stage AMD by 30%, and reduce the possibility of vision loss by 20%.

It is necessary to take into account that the form of replacement therapy for preventive measures and treatment of the dry form of AMD cannot be a course. This type of therapy involves its constant use. People over 50 years of age can use replacement therapy. If a person abuses bad habits (tobacco smoking, alcohol, excess weight), then this type of therapy is recommended to be used even earlier.

Treatment of wet macular degeneration

Treatments for wet AMD are based on suppressing the growth of blood vessels that are considered abnormal (vessels that have grown out of place and disrupt the proper structure of the eye). Today, the most effective treatment for wet AMD is the intravitreal administration of drugs that block the proliferation of blood vessels.

Intravitreal drug administration is a method of introducing a drug into the eye cavity. In simple terms, this is an injection directly into the eye, which is performed under absolutely sterile conditions, which prevents the introduction of foreign microorganisms into the vitreous body. This method of drug administration makes it possible to maintain the concentration of the drug exactly in the center of the lesion.

In addition to the treatment methods described above, today there are two more methods of treating AMD: laser treatment, which involves laser correction, and photodynamic therapy, which is based on the intravenous administration of special substances (photosensitizers).

Are there therapeutic glasses or therapeutic exercises?

Unfortunately, in cases where a decrease in visual acuity appears due to damage to the retina by age-related macular degeneration, glasses with therapeutic properties are not provided. Exercises that can partially restore visual acuity also do not exist for AMD. The fact is that eye gymnastics involves warming up muscle tissue and stretching it. All exercises are aimed at restoring the tone of the eye muscles, which help with focusing the eye. But AMD involves damage directly to the retina, so any eye gymnastics will be powerless.

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Age-related macular degeneration is a chronic disease that causes deterioration of central vision. The pathological process is based on damage to the macula, the central part of the retina. The macula contains a huge number of light-sensitive cells that provide sharp and detailed central vision. The macula is located in the posterior part of the retina and is the most sensitive part.

What it is?

Experts distinguish between dry and wet forms of AMD. The first type is quite common and is associated with the appearance of deposits on the retina. The wet form is formed due to the sweating of blood and fluid from the blood vessels.

Age-related macular degeneration significantly impairs quality of life. Patients have deteriorating vision in the central part of the visual field, and this area is responsible for many processes, including reading, recognizing faces, driving a car, and sewing.

Most often, degenerative changes in the macula appear after the age of fifty, although there are cases when the disease occurs in young patients. AMD can develop slowly, with vision remaining unchanged for a long period of time. In other cases, the pathology progresses rapidly and causes significant visual impairment in one or both eyes.

There are wet and dry forms of AMD

Provoking factors

The exact causes of degenerative changes in the macula are still not fully understood, but they occur as the eye ages. This ultimately leads to thinning and destruction of the central part of the retina.

Experts identify the following etiological theories of the occurrence of AMD:

  • abnormal growth of blood vessels. Fluid leaking from abnormal vessels interferes with the normal functioning of the retina and leads to clouding of the macula. As a result, the objects you look at appear bent and misshapen;
  • accumulation of fluid in the back of the eye. This causes epithelial detachment, which appears as a blister under the macula.

The dry form of age-related macular degeneration can progress and become the wet type. Experts make no guarantees as to whether such rebirth is possible or when it will happen. For some people, vision loss progresses so much that it leads to blindness.


Smoking is a provoking factor in the occurrence of the pathological process of the macula

Risks of age-related macular degeneration under the influence of the following factors:

  • smoking. According to research, this bad habit doubles the risk of AMD;
  • genetic predisposition;
  • cardiovascular disorders;
  • overweight;
  • race. Europeans are more likely to be diagnosed with AMD;
  • age indicators;
  • poor nutrition;
  • inflammatory processes;
  • elevated cholesterol levels;
  • surgery for lens opacity;
  • prolonged exposure to an intense light source.

Experts assure that a healthy lifestyle significantly reduces the likelihood of a pathological process. Doctors recommend quitting smoking, engaging in moderate exercise, and monitoring blood pressure and cholesterol levels. An important role is played by the diet, which should include greens, vegetables, and fish.

Symptoms

Macular degeneration is characterized by the following symptoms:

  • the need for brighter light for reading and working with small objects;
  • poor adaptation in low light conditions;
  • vagueness of the text;
  • feeling that colors have become faded;
  • poor face recognition;
  • the appearance of haze before the eyes;
  • rapid deterioration of vision;
  • the appearance of a blind spot in the field of vision;
  • straight lines appear curved;
  • visual hallucinations. People or geometric shapes may appear.


Visual hallucinations may occur with macular degeneration

Why is macular degeneration dangerous?

As you know, the eyes are a paired organ, so the healthy organ of vision takes on the function of the affected one. For a long time, manifestations of degeneration may remain undetected. It is also worth noting the fact that with macular degeneration there may be no pain, so the patient may think that everything is normal.

The disease threatens complete blindness and loss of ability to work. Irreversible consequences can develop in just a few weeks. That is why you should contact an ophthalmologist for diagnosis as soon as possible.

The diagnosis is made on the basis of anamnestic data, visual acuity studies, angiogram and CT scan. The doctor will definitely examine the fundus of the eye.


Macular degeneration occurs when cells in the macula are destroyed.

Living with macular degeneration

If you are diagnosed with age-related macular degeneration, it means you will have to make lifestyle changes. This also applies to nutrition. Consider all these recommendations:

  • eat fruits and vegetables. The antioxidants it contains are extremely important for eye health. Doctors recommend introducing spinach, beans, broccoli, and kale into your diet. These vegetables contain not only antioxidants, but also lutein and zeaxanthin, which are so necessary in the fight against macular degeneration;
  • eat fats. We are talking about healthy unsaturated fats, which are, for example, found in olive oil. At the same time, you should limit your intake of saturated fats. They are found in butter, fast foods;
  • replace flour with whole grain products;
  • eat fish. Omega-3 fatty acids included in the product reduce the risk of vision loss.

The following tips will help you adapt to changes in vision:

  • try to select glasses as accurately as possible;
  • use a magnifying glass to work with small objects;
  • On electronic devices, select the desired font size and image contrast. There are special computer programs designed for the visually impaired. You can install a program with which the text will be produced in mp3 format;
  • brighten your home;
  • If you are allowed to drive, do so with great care;
  • Don’t isolate yourself, seek help from your loved ones. You may need the help of a psychologist or psychotherapist.


Spend more time with your family, loved ones will provide invaluable support

Wet macular degeneration

The pathological process is based on the growth of pathological vessels under the macula on the posterior side of the retina. These abnormal blood vessels are fragile enough to allow blood and fluid to leak through them, elevating the macula from its natural position. The wet form develops quickly and is characterized by rapid deterioration of vision.

Important! In ninety percent of cases, it is wet macular degeneration that causes blindness.

Treatment of age-related macular degeneration includes conservative therapy. Patients are prescribed dedystrophic drugs, antioxidants and immunomodulators. Also useful for retinal degeneration are lutein and zeaxanthin. Although they cannot restore vision, they are quite capable of stopping the progression of the pathological process.

Currently, methods are used whose effectiveness has been clinically proven:

  • photodynamic therapy. This is a relatively new treatment method. Abnormal vessels are exposed to photochemical effects. Using a weak laser effect, a special substance is activated, which is first administered intravenously. As a result, abnormal blood vessels are blocked and swelling is relieved;
  • angiogenesis inhibitors: Avastin, Eilia, Lucentis. These drugs quickly relieve swelling and return normal vision. The products are injected directly into the eye using a very thin needle. This procedure is absolutely painless.


With wet AMD, fluid and blood leak from pathological vessels

Dry macular degeneration

It is characterized by atrophic changes, which result in thinning of the macular tissue. First, the pathological process affects one eye, after which the second organ of vision is also involved.

A characteristic symptom of the dry form is the formation of drusen. They are deposits under the retina. Drusen themselves do not cause vision impairment.

The disease occurs in three main stages:

  • Early stage. It is characterized by the appearance of several small drusen. As a rule, there are no clinical manifestations.
  • Intermediate stage. There are a large number of medium-sized drusen and a few large ones. There may be no symptoms. In some cases, clouding of the central part of the visual field appears. A person needs more time to go into a dark room and brighter lighting to read.
  • Late stage. Large drusen appear. Macular cells are destroyed. Significant deterioration of vision.

Treatment for dry macular degeneration includes the following:

  • timeliness of treatment measures;
  • impact on the mechanism of development of the pathological process;
  • comparative analysis of AMD with other pathologies;
  • lifelong treatment, including lifestyle changes;
  • the use of medication, laser and surgical treatment.

Summary

Age-related macular degeneration is a serious pathological process that most often occurs in people after fifty years of age. The disease threatens irreversible changes, including loss of vision. Macular degeneration can be dry or wet. Depending on the form of the disease, appropriate treatment is selected. Early diagnosis, timely treatment and following medical recommendations will help prevent the development of dangerous complications and restore vision.

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