Tuesday, April 25, 2017

MACULAR DEGENERATION: understanding, symptom, Cause, diagnosis, Treatment and complication

Understanding Macular Degeneration

Macular degeneration (AMD / ARMD) is a decrease in central vision, your ability to look straight ahead. The macula is a small area in the middle of the inner lining of the retina of the eye with the largest number of stem cells and cones. This area plays an important role for humans to be able to see well in light and dark time. Sighted vision ( peripheral vision ) does not have the same number of cells as the macula resulting in unfocused or non-sharp vision .
MACULAR DEGENERATION: understanding, symptom, Cause, diagnosis, Treatment and complication
Makula helps humans to be more independent and alert to things or circumstances around themselves. This condition affects the ability to read, drive, write, or recognize a person's face, but has no effect on the sight of the sides or surroundings. Furthermore, this condition develops gradually depending on its severity.
Macular degeneration is the most common cause of vision impairment in developed countries. In Asia alone, about 6 out of 100 people are found to suffer from macular degeneration.

The Cause of Macular Degeneration

The cause of macular degeneration is not yet known with certainty but its symptoms always develop as age increases.
There are two main types of macular degeneration (AMD) with different causes, namely wet and dry macular degeneration. Dry AMD is the most common type and new possibilities are detected when the patient performs an eye exam. However, despite causing more severe conditions, wet AMD is more manageable.
Degeneration of dry macula / dry AMD.
Dry AMD begins with the build-up of residual substances under the retina called drusen. The more drilling buildup will affect the vision. In advanced stages, this can lead to degeneration and depletion of cells located in the outer layer of the retina ( retinal pigment epithelium / RPE ). RPE is a cell that nourishes and maintains stem cells and cones in the inner lining of the retina.
Degeneration of wet macula / AMD wet.
Besides being caused by decreased RPE conditions, this condition is also caused by the growth of new fragile blood vessels from small blood vessels located behind the macular layer. These fragile blood vessels tend to leak easily and secrete blood and fluids that can damage stem cells and cones, and cause scarring in the macula. Wet AMD may interfere with central vision in faster time than dry AMD, ie within weeks to months. Even if there is bleeding, vision may disappear abruptly within hours or days.
In addition to female gender and age above 50 years, other risk factors that can trigger the development of macular degeneration, among others:
  • Caucasian (White)
  • Heavy smokers
  • Obese people
  • Patients with heart disease
  • Patients with high blood pressure
  • Have a family member with AMD
  • Ultraviolet light A and B coming from the sun

Symptoms of Macular Degeneration

Macular degeneration is a progressive disease whose condition will worsen over time even though the patient is less likely to feel pain. Symptoms of AMD will be more easily known if the disease has attacked both eyes. AMD that attacks one eye is not easy to feel because it is still helped by other normal eyes.
The first major symptom of AMD is the worsening of central vision despite the use of glasses. Patients also find it difficult to recognize the writing, images, faces and facial expressions of others.
Dry AMD takes 5-10 years before it reaches severe levels, while wet AMD sufferers may lose sight faster. In addition to the initial symptoms, symptoms that may be experienced by patients with dry AMD are:
  • The colors look less bright.
  • Difficulty adapting to the dim light.
  • Vague or unclear visions.
While wet AMD sufferers may experience the following additional symptoms:
  • The existence of blind spots ( blind spots ) in the field of vision that will increase in line with the addition of macular cells that degenerate.
  • Visual hallucinations in severe AMD sufferers, when the patient sees different images ranging from simple to complex images, generally pictures of children and animals.
  • Visual distortion of lines (Straight lines will look wavy)

Diagnosis of Macular Degeneration

Macular degeneration is commonly known unintentionally when the patient performs an eye exam. If the patient has symptoms of AMD, then the general practitioner will immediately give a referral to the ophthalmologist.
The patient's vision will be examined by being asked to see some images that have vertical or horizontal lines. If the patient finds a missing or distorted line, then the doctor will proceed by examining the back of the eye using a special microscope. The physician may photograph the retina of the eye to see if there are changes that resemble dry or wet AMD conditions.
Other tests that may be used are ocular coherence tomography and fluorescein angiography if the patient is proven to have wet AMD.
Ocular coherence tomography , this test is performed using special light rays to scan the retina and see more detailed macular disorders. This test helps determine the type of AMD suffered and monitors ongoing treatments.
Fluorescein angiography , this test is done by injecting colored ink to the blood vessels in the hands to find out if there is a leakage of blood vessels in patients diagnosed with wet AMD. The leaky blood vessels can be known from the ink that appears in the macula area, as well as knowing the severity of leakage and AMD in patients.

Treatment of Macular Degeneration

AMD treatment aims to maximize the quality of vision of patients, although it is not known for certain whether this treatment can help prevent or slow the progression of the disease, especially for dry AMD. Dry AMD causes a gradual loss of vision for the sufferer over a period of 5-10 years although it does not affect side vision.
Here are some types of treatments available for dry and wet AMD.
Dry AMD is a type of AMD that can not be cured, but its development can be slowed if the disease is successfully diagnosed earlier. Dry AMD can be slowed by performing the following steps
  • Supplements and vitamins that contain antioxidants, zinc, vitamin E, and vitamin C can be consumed in accordance with the physical condition and health of the patient. Talk to your doctor about a safe and appropriate dose.
  • How to eat healthy. Consumption of foods containing many antioxidants, such as spinach, broccoli, and nuts in sufficient quantities. Foods that contain zinc are also good for AMD sufferers, such as beef, lamb, milk, cheese, yogurt, and whole grain bread. Other foods that can be consumed are olive oil, salmon, tuna, and walnuts.
  • Adjust dry AMD treatment with other treatments that are being experienced by patients, such as heart disease and high blood pressure.
  • Keep your weight proportional to your height
  • Quit smoking
Some other dry AMD therapies, namely:
  • Rehabilitation of vision. This rehabilitation helps dry AMD sufferers to adapt to changes in their declining central / center vision. In addition to ophthalmologists, rehabilitation is done with the help of a vision rehabilitation specialist or other trained personnel experienced in this field.
  • Installation of telescopic lenses. This surgical treatment is generally selected for patients with dry AMD who both eyes are infected. Installation of telescopic lenses is expected to improve the ability to see, but only on one eye only. This lens can enlarge the area of view of the patient, as well as near and far vision which will be useful when recognizing road signs.
In the case of wet AMD, a possible treatment is the administration of an anti-vascular endothelial growth factor (VEGF ) to stop or inhibit vision loss. This drug will block the formation of new blood vessels in the macula area.
Anti VEGF is injected directly into the eyeball and can be done every four weeks for two years. This drug aims to keep eyesight from declining in some cases. In other cases, this procedure can also be used to help improve the eyesight of the patient. Although there are also patients who do not respond to this type of treatment, but can respond to other types of treatment, namely:
  • Laser therapy. This therapy is difficult because it can cause scarring of the macula and loss of vision.
  • Photodynamic therapy. This therapy is done by injecting a special medicine into the blood vessels. Furthermore, this drug will bind new blood vessels that grow in the macula. After that the laser will be fired at the blood vessels to inhibit the development of wet AMD.
Another therapy that is usually given to patients with dry or wet AMD who are in the final stage is the  intraocular lens system. This therapy uses several layers of mini lenses in sequence to deflect the reflected image on the macula to other parts of the retina that are still functioning. These lenses will make the image more clear and large in the area and the patient will need vision rehab to adapt to this situation.
Although some of the cases that use this therapy show good results, but this therapy also has the possibility of serious complications, including increased pressure in the eye area or even damage to the eye. Another thing that could be an obstacle is the high maintenance costs because the lens must be tailored to each patient's condition.
Some of the following tips can be done by AMD sufferers to adjust themselves and the environment with changes in vision conditions experienced.
  • Use a magnifying glass.
  • Use an electronic reading tool that has a sound system.
  • Change the look and settings on the computer, for example by adding a sound system and adjusting the screen with greater contrast or changing the font size.
  • Choose a brighter light.
  • Use tools specifically designed for people with visual impairments, such as a clock that makes a sound.
  • Use public transport or ask for help from family members to drive or arrange day-to-day transportation for AMD sufferers.
  • Purchase a book with a larger display of letters or numbers.

Prevention of Macular Degeneration

Perform the following steps to reduce the risk of developing wet and dry AMD.
  • Stopping smoking.
  • Protecting eyes from ultraviolet light using solar glasses can help slow the progression of this condition.
  • Regular eye tests can detect early eye disorder symptoms so that they can be treated early.
  • Start a healthy eating habit with a balanced diet and according to the condition of the body. Expand foods containing antioxidants, fish, fruits, and vegetables.
  • Get extra nutrition by taking supplements containing vitamins A, C, E, zinc, and copper. A sufficient and appropriate supplement can help reduce the risk of vision loss.

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