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Macular degeneration (AMD)
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Macular degeneration (AMD)

Macular degeneration is a disease due to abnormal aging of the macula, a tiny area in the centre of the retina. This area is the origin of visual acuity, necessary for daily activities such as reading or driving a car.

There are two types of macular degeneration:

dry senile macular degeneration

This represents 85% to 90% of cases. Its progression is slow.

In this type of AMD, the deterioration of the retina is associated with the formation of tiny yellow deposits, know by the name drusens, under the macula. This phenomenon leads to a thinning and drying out of the macula. The degree of loss of central vision is directly related to the location and degree of retinal thinning caused by the drusens.

Wet senile macular degeneration:

This represents 10 to 15% of cases. It can cause rapid and serious deterioration of sight.

The term “wet” denotes the proliferation of new abnormal blood vessels on the macula, which deprives the retina of oxygen and nutrients. These blood vessels may bleed, cause leaks or an oedema of the macula.

In the case of AMD, it is important to note that it is only the central retina that is affected whereas the periphery of the retina remains intact. Therefore the eye loses the central field of vision but never becomes blind.

What are the symptoms?

The first symptoms of AMD, whether dry or wet, are generally a drop in close up vision and waviness of straight lines. Marks or black spots may also appear in the middle of the field of vision and colours may blur.

Who is affected?

AMD is, as its name indicates, related to age. AMD is the most widespread cause of irreversible, major loss of visual acuity in patients over 55 years of age.

What are the causes?

Macular degeneration is caused by the proliferation of new blood vessels on the central retina which deprives the eye of oxygen and nutrients. This phenomenon can sometimes occur fairly suddenly.

What is the evolution?

As we have already said, the progression of dry senile macular degeneration is slow. Whereas, wet senile macular degeneration may cause a rapid and serious deterioration of sight.

Nevertheless, it is important to state that, in all cases, lateral or peripheral vision is rarely affected and the eye will never become blind.

A certain percentage of dry forms of the disease develop into the wet form over time.

How is it diagnosed?

AMD symptoms can be verified using an Amsler grid comprising horizontal and vertical lines and a central fixation spot. When the patient sees black marks or a deformation/ waviness of lines, an urgent check of the retina is required.

In order to detect the appearance of new blood vessels, a fluoangiography must be carried out. Fluorescein is injected into an arm vein, and then, the doctor takes several photos of the retina. In some cases, it is useful to take an image of the choroid (the retinal layer): this is done by injecting indocyanine green into an arm vein.

The retina can also be visualised using OCT (Optical Coherence Tomography). This examination is totally painless.

How can it be prevented?

Some studies have shown that taking vitamin based medicines and other dietary supplements and anti-oxidants may slow the onset of AMD.

how to treat it?

    Introduction

    Intravitreal injections of anti-VEGF

    Laser photocoagulation treatment

    Photodynamic therapy treatment (PDT)

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