Macular degeneration: symptoms and therapy

Macular degeneration: symptoms and therapy

The macula, or “yellow spot”, is the point of sharpest vision on the eye’s retina. The progressive demise of the sensory cells located there is the leading cause of severe visual impairments in industrialized countries. Since macular degeneration occurs predominantly in older people over 50, it is also called age-related or senile macular degeneration, or AMD for short. On the other hand, the juvenile form is sporadic, inherited, and known as Stargardt syndrome. What are the symptoms of age-related macular degeneration, what are the causes, and how can it be treated?

Causes of Macular Degeneration

Age-related macular degeneration is one of the most common causes of visual acuity loss in old age. The disease usually begins after age 50 and can lead to significant visual impairment in the late stages. This affects the central field of vision. Macular degeneration does not lead to complete blindness since the sense of space, i.e. orientation in space, is retained.

Macular degeneration primarily damages the macula, i.e. the part of the retina with which we can see the sharpest. This area of ​​the eye is also known as the “macula lutea”, i.e. “yellow spot”. This is where the cells (photoreceptors) are most densely packed, which react sensitively to light and enable sharp vision at different light intensities – in good light conditions, these are the so-called rods, and in poor light conditions, the cones.

The body regularly regenerates rods and cones. The old photoreceptors are disassembled and degraded. The waste products are stored in the retinal cells if this metabolic process is disturbed. Deposits accumulate between the retinal layer and the choroid. As part of the ageing process of the eye, more and more waste products accumulate. This can trigger age-related macular degeneration. Everyday activities such as reading or driving then become increasingly difficult.

forms of macular degeneration

There are two types of age-related macular degeneration. You can find out what these are below.

Dry macular degeneration

In the case of dry macular degeneration, more prominent associations, so-called drusen, have formed from the deposits. These soft drusen interfere with blood circulation and thus the supply of nutrients and oxygen to the eye. As a result, the photoreceptors in the eye’s macula gradually die off.


Wet macular degeneration

If drusen develops between the retinal layer and the choroid and there is a lack of oxygen, the body can form new blood vessels in response. These can also grow under the retina. Because the vessel walls are often unstable, liquid can also leak.

Both processes ensure that the retina is lifted and scar tissue forms under the retina. The light-sensitive sensory cells are further damaged. Wet macular degeneration is less joint than dry macular degeneration and is caused by it.

Macular degeneration: Symptoms

Blurred vision is characteristic of macular degeneration. This occurs when you want to focus on an object or a living being.

The first symptoms of age-related macular degeneration are, for example:

  • When letters blur or disappear while reading
  • when straight lines suddenly appear curved (distorted, wavy) – particularly pronounced in lattice shapes such as tile patterns
  • If a blurred spot appears in the centre of the field of vision while vision is preserved in the outer areas

Usually, the disease process begins in only one eye. However, there is a high probability that the second eye will also be affected later. A wet macular degeneration is characterized by a much faster deterioration than the slowly progressing dry macular degeneration.

Self-test and diagnosis of macular degeneration

To determine whether you have typical signs of macular degeneration, you can conduct a few simple tests if the symptoms are mild. Because the healthy eye often compensates for the changes in vision in the diseased eye, you should occasionally cover the right and left eye alternately to be able to perceive changes in the vision of the individual eyes even earlier.

You can quickly examine more precisely whether symptoms of AMD are present using the so-called Amsler grid test: the grid is held in bright light at a distance of 30 to 40 centimetres in front of the eye. Glasses or contact lenses should be removed or removed for the test. Cover one eye with one hand while the other eye fixes the dot in the middle.

If the lines around the fixed point are crooked and distorted, seek medical attention immediately. As part of this, the exact complaints are first queried.

If there is a suspicion of macular degeneration, this can be confirmed with a fundus reflection ( ophthalmoscopy) and the display of the retinal vessels using fluorescence angiography. In the ocular fundus mirroring, the inside of the eye is viewed using a magnifying glass. Changes such as drusen or bleeding are noticeable in the case of macular degeneration.

In fluorescein angiography, a fluorescent dye is injected into the bloodstream. If it gets into the blood vessels of the retina and choroid, it can be made visible for about five to six minutes. This makes it easier to identify newly formed blood vessels.

Another method that can be used to detect macular degeneration is what is known as optical coherence tomography (OCT). The eye is scanned with a special laser to detect the thickening of the retina or accumulations of leaked fluid.


Dry macular degeneration: Therapy

Although there is currently no cure for macular degeneration, the progression of the disease can be slowed. The course of the disease also varies significantly from person to person, so deterioration in dry macular degeneration can drag on for a long time or even stop temporarily.

The treatment options for dry macular degeneration are much more limited than wet macular degeneration. The administration of specific preparations with vitamins C and E, the minerals zinc and copper, and the high-dose use of the carotenoid lutein are suspected of slowing down the course of the disease. The studies carried out to date on the effectiveness of this therapy referred to the presence of dry macular degeneration in one eye with at least one large druse.

However, since taking these preparations is associated with side effects and the composition and concentration of the individual components must also be individually adjusted, a personal benefit-risk assessment should always be carried out in consultation with the doctor treating you. Under no circumstances should you take the preparations to treat macular degeneration on your own.

Treatment of wet macular degeneration

Wet macular degeneration can also be treated with a combination of dietary supplements. In contrast to dry macular degeneration, many other sufficiently studied treatment options are available for this form.

The same applies here: complete healing is not possible. However, the therapy serves to destroy existing, newly formed blood vessels. As a result, visual acuity can improve again as part of the treatment.

This includes:

  • Injections: Drugs used to treat wet macular degeneration are anti-VEGFs, also known as VEGF inhibitors. The abbreviation stands for “Vascular Endothelial Growth Factor”. VEGF inhibitors inhibit the formation of new blood vessels. They are injected directly into the eye. The cost of these injections is usually covered by health insurance.
  • Photodynamic therapy: A non-toxic dye is injected into the affected person. This dye is activated in the vessels of the eyes using a cold laser beam. It becomes visible in the newly created blood vessels. These are destroyed with the laser.
  • Laser treatment: Laser therapy uses a hot laser beam to destroy the newly formed blood vessels. However, this can lead to scarring in the surrounding tissue.
  • Surgery In some cases, surgical removal of the blood vessels in the eye may be necessary. Other surgical procedures, such as transplanting feeding cells under the retina, are still being explored.

Risk Factors and Prevention

Smoking is one of the most critical risk factors that can contribute to the development of macular degeneration, as it impairs blood flow in the vessels. There are also initial indications that macular degeneration could be hereditary, as it often runs in families.

In addition to not smoking, a balanced diet can help prevent macular degeneration because specific vitamins and minerals can positively affect cellular health.

In addition, preventive care is essential. Early detection is critical in the case of wet AMD with its rapid progression. Anyone over 40 should, therefore, be checked by an ophthalmologist every year or at least every two years.


Prevent macular degeneration with sunglasses.

Wearing sunglasses can also prevent the development of macular degeneration. Since UV light promotes the formation of oxygen radicals, which in turn can damage the cells in the eyes, sunglasses should be worn in solid or prolonged exposure to the sun.

The following tips should be observed when handling sunglasses:

  • CE-marked sunglasses comply with European safety standards.
  • Glasses should have broad-spectrum UV 400 protection.
  • The tint of the sunglasses says nothing about UV protection.
  • Hold the glasses in front of a straight line. If the lenses are of poor quality, they will bulge or appear distorted.
  • Minor scratches in the glass tyre of the eye. Wear only intact glasses.

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