Synonyms
AMD (age-related macular degeneration), in a broader sense also maculopathy. english: macular degeneration
Definition macular degeneration
The term macular degeneration describes diseases that affect the retinal center. The center of the retina is also called yellow spot (macula) and represents the place of sharpest vision. Degeneration often leads to considerable and irreversible disturbances of the central visual acuity.
One distinguishes a juvenile (juvenile) from an age-related (senile) form of macular degeneration. At the age-related macular degeneration a distinction is made between a dry and a wet (exudative) form. In the dry form the degeneration of the pigment layer of the retina is in the foreground while in the wet form the ingrowth of pathological vessels is added.
These tend to bleed into the retina and then leave behind so-called fibrovascular membranes. Dry macular degenerationMostly the affected persons notice grey shadows in the central field of vision, exactly where they look. The visual acuity is very impaired, often so much that it is hardly possible to read.
Distortions of looked at objects are also possible. This can be checked with a special map on which a net with grid lines is recorded (test map according to Amsler). The grid lines then appear curved. Also the color perception can be disturbed.
How is macular degeneration diagnosed?
Indications of a macular degeneration are first of all the symptoms described above. The ophthalmologist can examine the ocular fundus within the scope of an eye test with special devices. In case of a degeneration of the retina often pigment shifts and so-called drusen are visible.
Druzes are yellowish-white, small foci that are numerously distributed over the central retina. In the case of wet macular degeneration there is an accumulation of fluid under the retina which can be characterized as a grey-brown, round bulge of the retina. This can be determined very well with a dye – vascular imaging (fluorescence angiography).
Test whether you suffer from macular degeneration. Zum Amsler Gitter TestA restoration of full vision is not possible in most cases of macular degeneration. Changes in age can no longer be reversed!
In many cases the disease process cannot be stopped completely but only slowed down. As treatment options there are different options available which range from surgical to medical measures. To the surgical options of macular degeneration belong: Here one tries to obliterate the pathological new formations of vessels with an argon-green laser.
This can prevent bleeding, but the disease can progress elsewhere. A further disadvantage of laser treatment are field of vision failures also called scotomas. Here, the patient is injected a dye into the arm vein, which accumulates mainly in the newly formed vessels in the retina.
These can now be sclerosed using a non-thermal diode laser. In case of very advanced macular degeneration or macular degeneration that is not accessible to laser treatment or photodynamic therapy, the pathological vessel neoplasms can also be surgically removed. An improvement of visual acuity is usually not expected.
However, a stabilization occurs and the visual acuity does not further deteriorate. In this relatively new surgical method, the entire retina is detached and rotated by about 30 degrees, so that the center of the sharpest vision (macula) comes to rest on a different part of the pigment cell layer. As a result, the macula is once again attached to intact pigment cells.
However, the twisting of the retina must be compensated with an eye muscle operation. As a drug option, there is the possibility of treatment with substances that inhibit the formation of new blood vessels. For example, ranibizumab, pegaptanib and bevacizumab (Avastin) may be considered.
The substances are injected directly into the eye and the injections must be repeated regularly, as the effect only lasts for a certain period of time. Further therapy attempts of macular degeneration aim to support the still existing vision. Here, for example, magnifying vision aids such as illuminated reading magnifiers, magnifying glasses, screen readers and video magnifiers are used.In some university hospitals, patients are also treated in so-called “low vision clinics”, which specialize in the treatment of severe visual impairment up to blindness.
Furthermore, care should not be limited to the technical component, but must aim to motivate patients to lead an active life despite their disability.
- Laser coagulation:
- Photodynamic therapy:
- Subretinal surgery:
- Retinal rotation:
Macular degenerations can be acquired or inherited. The most frequent form however is the age-related macular degeneration (AMD).
The exact cause is not yet finally clarified. But it is assumed that both environmental influences as well as hereditary factors play a role. There is much evidence that an accumulation of metabolic products is responsible for the destruction of the cells of the retinal center.
This is particularly true for AMD and is the result of an overload of the pigment layer cells of the retina, which is due to aging processes. Other very probable causes include smoking, arteriosclerosis, high blood pressure and high light exposure of the retina. Currently there are no treatment methods that can cure macular degeneration completely.
The course of the disease can at most be slowed down and in few cases stopped. Proven preventive measures are not known. Nevertheless patients with retinal degeneration should be advised to stop smoking or to have a too high blood pressure correctly adjusted. The earlier a developing macular degeneration is detected the more effective a therapy can be started.
