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Age-Related Macular Degeneration (AMD)

The Age-Related Macular Degeneration is a degenerative disease of the retina, and more particularly the macula. The macula is the central part of the retina deputed to defined vision and color. In most developed countries, AMD is the leading cause of severe visual impairment in people over the age of 55.

The AMD is a unilateral onset and it is doubtful that affects both eyes.

 

 

NORMAL FUNDUS

 

As said, the macula is responsible for the defined vision of details and allows you to appreciate the most subtle color shades. When the macula undergoes degenerative phenomena, however, the vision is also seriously compromised so much so that in the most advanced cases you may experience the perception of a black spot in the center of the visual field, while the device still allows us to perceive the world around them but in ways less precise and with colors less alive.

There are two forms of AMD:

  • Atrophic or dry
  • Exudative or wet

The two forms are united by an early stage whose hallmark is made up of small yellowish deposits (Drusen) in the macular area. From this stage, the disease can progress to the shape or the exudative or atrophic not evolve at all.

 

 

The dry or atrophic AMD, has a slow progression and the late stage is characterized by the death of cells in the retina at the macular level due to atrophy (lack of food) causing loss of central vision. Vision loss is usually gradual and depends on the extent of macular injury level.

 

  DRY AMD 

 

 

The moist exudative AMD, is the most aggressive form of the disease, and it can also develop from the dry form. In this form, the intake of nourishment and reduction of oxygen causes the formation of pathologic blood vessels, said neovascular membranes, which penetrate into the retina. These new vessels have structurally altered and walls are permeable, so they come out fluids and blood with even severe central vision.

  WET DMLE

Symptoms

The symptoms are variable and are related to the progress of the pathology. These consist mainly of:

  • Distorted vision, for example, the straight lines of the jamb of a door appear wavy (metamorphopsia)
  • distorted or blurred vision especially in the center of the images
  • impaired vision, objects may appear distorted in shape and / or size, the colors may appear blurred or inaccurate
  • Appearance of dark or empty area in the center of vision (scotoma)
  • Request more light for reading than in the past and may be missing individual letters or parts of words

 

CENTRAL SCOTOMA

 

 

METAMORPHOPSIE

          

 

THE CAUSES

It is difficult to define the causes leading to the AMD, in fact this is a disease considered to be multifactorial. One could make a long list certain, in any case, not be exhaustive.

You can list, however, the risk factors currently considered the most important, distinguishing between modifiable and non-modifiable.

Among the non-modifiable we can put:

  • Age – All studies agree that the prevalence, incidence and progression of disease will grow significantly with increasing age.
  • Genetics – The first-degree relatives of a person with AMD have a three times greater risk of developing the same disease than the general population. This indicates that genetic components play an important role in the pathogenesis of AMD.
  • Gender – Some scientific studies have shown statistically significant differences in the risk of AMD in both sexes to the disadvantage of women, where the disease occurs more frequently.
  • Ethnic – The prevalence of AMD is greater in the white population compared to the black, especially as regards the wet form.

Among the modifiable risk factors we can list:

  • Smoking- this is considered one of the main risk factors. The incidence of AMD can vary both in relation to the years in which the subject has smoked that in relation to the amount of cigarettes smoked. Probably the smoke acts by amplifying the risk of AMD by increasing oxidative stress and stimulating the formation of new vessels.
  • Alcohol – alcohol abuse can lead to increased risk of AMD also significant.
  • Diet – an unbalanced diet, high in animal fat and low in vegetables can lead to increased aggression by oxidizing substances and a reduction of those deputies substances to arrest the negative action, substances known also as antioxidants, as well as bringing a possible increase in weight.
  • Obesity, the obese subjects have shown an increased risk of developing AMD compared to normal weight.
  • Sedentary Life – sedentary lifestyle has been linked to a higher risk of developing AMD.
  • Exposure to light – sunlight is considered one of the greatest risk factors for AMD, the light has a powerful photo-oxidant activities and directly affects the macula given the role it plays, so you need to protect yourself in the hours more at risk with good quality sunglasses.

As first thing to do, follow up the problem with your ophthalmologist, he/she will advise you about the best path to be taken together to better address the disease.

Undergo eye exams on a regular basis is the most effective way to keep the disease under control. You just know that, paradoxically, the wet form, the most serious, is that for which there are medical therapies useful to slow down the evolution, such as intravitreal injections, so the regularity of checkups is fundamental to be able to promptly implement.

By his/her side, the patient can make use of simple self-diagnostic systems, to ensure that any symptom which suggests a deterioration, can take it to the eye regardless of the deadline set with him. An example is the Amsler test that is very useful to track the development of macular already diagnosed and simple execution.

 

The best solution passes through prevention, which entails the reduction of modifiable risk factors:

  • stop smoking,
  • minimize the use of alcohol (it should be stressed that red wine, in moderate doses, has been shown to be a protective factor)
  • implement a diet rich in fruits and vegetables such as limiting the frequent intake of red meat and cold cuts, preferring white meat and fish,
  • reduce body weight and make adequate physical activity, which allow to counteract age,
  • use hat and sunglasses since childhood when you are to perform work or recreational activities in full sun.

To all this must be added the importance of using products specifically formulated to base of antioxidant substances, which are capable of exerting a protective effect against the free radicals and therefore useful to protect the retina from oxidative damage, and photo-oxidative thus improving the metabolism.