In macular degeneration, the retina at the back of the eye or eyes is damaged. This impairs sharp vision and, in the worst case, can lead to blindness. The treatment of macular degeneration depends on the form of the disease. Macular degeneration itself cannot be cured. In most cases, it is anage-related development, known as age-related macular degeneration (AMD). However, it can also be caused by other factors, such as inflammation.
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Age-related macular degeneration (AMD) is a disease of the eye that can lead to severe visual impairment. The sensory cells of the macula in the center of the eye, which specialize in colour vision, lose their function. This part of the eye is responsible for sharp vision.
In macular degeneration, this area is severely impaired. The outer edge of the visual field usually remains intact.
Visual field in macular degeneration
People over the age of sixty are usually affected. Age-related macular degeneration is the most common cause of severe visual impairment in old age. It can also lead to blindness.
The reason for this is the diminishing function of the pigment layer.
The main symptoms are
Those affected often notice the first signs of macular degeneration when reading. The disease occurs in dry and wet forms.
Age-related macular degeneration of the eye iscaused by deposits under the retina. The whitish or yellowish accumulations are called drusen. They are an early manifestation of age-related macular degeneration.
As the disease progresses, the layer under the retina (pigment layer) thins out. The next layer (vascular layer) is also affected. Later, the photoreceptors die, which severely impairs vision.
Dry age-related macular degeneration is the most common variant: around eight out of ten cases are affected by this form. The visual impairment is not very pronounced over a long period of time. However, those affected notice that their vision is impaired.
Dry macular degeneration can stop temporarily or for a longer period of time. However, if those affected perceive a dark spot, then the central field of vision is affected due to macular degeneration.
Dry age-related macular degeneration can be divided into three stages:
The wet variant is the rare form of age-related macular degeneration. It arises from dry age-related macular degeneration. The visual impairment occurs in ten to fifteen percent of all cases.
It has a rapid progression and the loss of central vision occurs earlier than in the dry variant. What is special is that those affected do not see straight lines, but curves. In the advanced stage of the disease, the central field of vision appears as a dark spot.
The disease causes edema to form under the retina. As the membrane breaks, blood vessels grow from the choroid into the retina.
These blood vessels are also called choroidal neovascularizations. The messenger substance VEGF (vascular endothelial growth factor) is responsible for the growth of new vessels in the retina. However, these do not prove to be stable and cause bleeding as a result of their rupture, which damages the macula.
The ophthalmologist recognizes newly formed vessels and hemorrhages in the macula, which are symptoms of macular degeneration.
The basis for the ophthalmologist's diagnosis is the medical history, in which the ophthalmologist and patient take a medical history. In general, people over the age of 60 should undergo an appropriate preventive examination. The ophthalmologist has various examination procedures to determine the disease.
When determining visual acuity, the ophthalmologist uses visual test charts. The patient reads numbers and digits in different sizes.
The phoropter is a special device through which the patient looks while reading. This makes it possible to determine the visual acuity at distance and near as well as the necessary corrective lenses.
To identify signs of age-related macular degeneration, the ophthalmologist examines the condition of the eye. He uses the slit lamp to do this. This allows him to examine the structures of the eye: from the eyelids to the cornea and the lens.
Several procedures are available to examine the retina:
The ophthalmologist examines the retina by reflecting the fundus of the eye. With this examination, the doctor can detect changes in the eye, including the macula.
Drawn diagram of the eye with iris, cornea, lens, retina and its blood vessels, macula
Optical coherence tomography (OCT) is the most important procedure in AMD diagnostics. The ophthalmologist determines the thickness of the retina.
It becomes thinner in the dry form of the disease and thicker in the wet form. The examination is painless, the patient sits in front of the device and looks at a luminous dot.
The doctor administers drops to the patient to dilate the pupil. The doctor looks at the retina to detect changes in the eye caused by age-related macular degeneration. Changes include cysts or fluid in the retina.
Another method for examining the back of the eye is fluorescein angiography. A dye is injected into the patient's arm vein.
After just 20 seconds, the blood vessels at the back of the eye change color. Leaking or diseased vessels, such as those in wet macular degeneration, can thus become visible.
The ophthalmologist takes photographs of the blood vessels and retina. The patient is given eye drops that dilate the pupil. Their vision may be impaired for up to 12 hours.
The Amsler grid test, which you can also carry out at home, is suitable for detecting age-related macular degeneration. This graphic in the form of a grid is also available on the Internet.
Amsler grid test
How to carry out the Amsler grid test:
The results of the test differ depending on whether it is the dry or wet variant.
This is what the Amsler grid with macular degeneration might look like
In the case of dry macular degeneration, treatment consists of lifestyle adjustments, as there are no specific effective treatment methods.
Important measures include
For the treatment of the wet form of age-related macular degeneration, therapies are available that slow down or stop the disease. A complete cure is not yet possible.
One effective method of inhibiting the formation of new blood vessels in wet macular degeneration is anti-VEGF therapy. The so-called VEGF inhibitors reduce the growth of unstable vessels in the retina and seal off diseased blood vessels. As new hemorrhages and fluid deposits no longer occur, the oedema can "dry out".
This therapy can slow down the progression of age-related macular degeneration and can also improve vision.
The ophthalmologist injects the medication directly into the vitreous body. This allows the drug to work where it is supposed to. Beforehand, the doctor anaesthetizes the eye locally so that the patient does not feel any pain.
Initially, three doses are administered at monthly intervals. The doctor then decides how to continue the treatment.
In photodynamic therapy (PDT), the patient receives an injection with the active ingredient verteporfin every three to four months. This medication is then distributed throughout the bloodstream.
The ophthalmologist irradiates the newly formed blood vessels on the retina with a fine laser beam. This hits the blood vessels filled with Verteporfin.
This contact produces a toxin that leads to the destruction of the diseased blood vessels. During treatment, the active substance must be dosed in such a way that it does not damage the retina. Whether photodynamic therapy is suitable for a patient depends on the type of neovascularization.
This surgical procedure is suitable for patients with major hemorrhages under the retina. The surgeon removes the vitreous body of the eye in order to aspirate the blood from the retina after making an incision.
In the next step, he replaces the previously removed vitreous body and replaces it with an artificial one made of silicone oil. There is a risk of additional bleeding during and after the operation. Doctors therefore carefully weigh up whether to use this method beforehand.
In order to detect age-related macular degeneration at an early stage, you should have regular check-ups with your ophthalmologist.
As the disease initially occurs without symptoms or pain, those affected often do not notice it.
Glaucoma screening should be carried out regularly from the age of 40.
Screening for age-related macular degeneration should be carried out from the age of 60.
You should also refrain from smoking. Smoking is a significant risk factor for vascular diseases, which can also occur in the eye.
Another important element is a healthy diet. Fruit and leafy green vegetables should be an important part of this. The so-called Mediterranean diet is highly recommended. Vegetable oils, plenty of fish and little meat form the basis of this diet.
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