As the name suggests, age-related macular degeneration are changes in the macular area that become more frequent with age. The disease is the most common cause of blindness in developed countries and may be the first factor limiting a healthy and active older person.
The macula is the central area of the eye’s retina, from which information about light is transmitted to the brain and is perceived there as central vision. It is anatomically adapted to gather the most accurate information possible. We would not find such light-blocking structures as capillaries in the macula centre, but the highest photoreceptors are here.
Symptoms are Noticeable Only at a Late Stage
According to Lina Krėpštė, an ophthalmologist and a microsurgeon at the Lirema Eye Clinic, the early or even moderate stage of age-related macular degeneration is often asymptomatic.
“When examining eyes, a patient may have complaints about impaired vision, but this is rarely seen in everyday life. Symptoms are felt when eternal macular degeneration develops into a late stage. There are several forms – nonexudative (dry) and exudative (wet),” says L. Krėpštė.
In the case of the dry late form, atrophy of the macula develops, and when it reaches the centre itself, the vision disappears. Atrophy develops slowly, and until it comes to the centre, a person can go unnoticed. Sight is compensated by either eye movements or the help of the other eye. However, if atrophy is detected in both eyes, within 1.5 years, two out of three people lose the opportunity to drive, and over 6 years, 16 percent of people lose sight altogether.
Because most of the factors contributing to the onset of macular degeneration are systemic (genetic predisposition, age, circulatory status, smoking, malnutrition), the degeneration is often reciprocal (i.e., occurs in both eyes) but not necessarily in the same form or stage. Visual impairment can appear differently in both eyes.
The Number of Patients is Increasing
Age-related macular degeneration is the most common cause of irreversible vision loss in developed countries and is therefore extremely dangerous and the most widespread on the European continent. Degeneration is also more common in people of European origin on other continents.
“In Europe, early or moderate form of age-related macular degeneration was detected in 25.3% and late-stage in 2.4% of patients over 60. The proportion of people with this disease increases with age. One in 10 people aged 60-64 and one in 3-4 patients older than 75 years are diagnosed with this disease”, says L. Krėpštė.
According to the expert, late-onset macular degeneration, which causes visual impairment and even blindness, is more likely to affect the elderly. One in 15 patients aged 75 or older is diagnosed with late-stage macular degeneration.
“As the population ages, the importance of this disease will only increase. There are currently 67 million people in Europe. It is estimated that the number of patients will jump by another 15% in 30 years,” the microsurgeon shares.
As life expectancy increases in developed countries, so does the quality of working life when older people do not stop working, driving or being active. Older adults often have even more time for hobbies, usually take on new activities, and impaired vision should not stop it. To preserve youth, health, and working-age for longer, the prevention of age-related macular degeneration is essential for each individual and society as a whole.
You Can Protect Yourself by Adjusting Your Lifestyle
According to L. Krėpštė, many factors determine the development of age-related macular degeneration and its cumulative effect with age. Some factors, such as age or genetic predisposition, are not adjusted, but others are subject to change, such as:
- Smoking. Studies show that after quitting this harmful habit, the risk of getting sick is equal to non-smokers after 10 years.
- UV exposure. We have a lifelong focus on eye protection from harmful sunlight and the everyday use of sunglasses. This is especially important after cataract surgery. A natural lens provides better protection against UV rays than the most expensive artificial lens implanted during cataract surgery. Ophthalmologists can name more than one case in which age-related macular degeneration develops in an operated eye after many years. The macula is seen intact in the eye that has not been altered.
- The poor condition of the cardiovascular system. Arterial hypertension and dyslipidaemia are associated with an increased risk of late-onset macular degeneration, so it is crucial to detect, treat and prevent these diseases as early as possible.
- Higher body mass index. Higher weight increases the risk of age-related macular degeneration on average. This is especially important for people with diabetes, as diabetes has also been identified as a risk factor in some studies.
“Extensive studies have shown the effect of certain supplements that reduce the number of patients in whom the disease progresses in moderate macular degeneration. Adequate nutrition, close to the well-known Mediterranean diet, is also beneficial, especially for those with a genetic predisposition,” advises the microsurgeon.
Promising Research
Much research is being done in the field of macular degeneration, but so far, there is no guaranteed way to prevent the disease. Age-related macular degeneration is not yet curable.
“The dry form of the disease is progressing slowly, and a cure is still being sought. It is gratifying that various solutions are being researched and tried, from supplements, eye injections to genetic modification. There are currently 15 studies in the world. It is to be expected that a breakthrough will occur during any research, as happened with the wet form of age-related macular degeneration,” L. Krėpštė shares joyful tendencies.
The treatment of wet age-related macular degeneration is quite effective. Although it is not curable, many patients are stabilised and are not doomed to sudden blindness as before.
“This form is treated with injections into the vitreous. The preparations inhibit the growth of new incomplete blood vessels, the entry of fluid into the retinal layers, promote the regression of neonatal blood vessels, and the reabsorption of bruises. In this way, suddenly impaired vision improves or even recovers,” says the microsurgeon.
Unfortunately, the main disadvantage of this treatment is the intensive and lengthy treatment process, with injections depending on the product and sparsing every 1-2 months. The treatment and monitoring of the patient are continued for at least several years.
According to the doctor, much further research looks for drugs that work differently or last longer. An internal eye implant has also been developed, which can be supplemented with an appropriate preparation, done less frequently and without puncture in the eye.
Not Treating the Disease in Time Can Result in Vision Loss
Ophthalmologists usually have the equipment needed to assess the fundus and can diagnose the disease.
“It is important to contact your doctor immediately if you experience any symptoms. This rule applies to all eye diseases, disorders or complaints without exception. Waiting for it to pass on its own can be risky. If the disease is diagnosed and degeneration of the macular spot is wet, more detailed visual examinations are needed,” warns L. Krėpštė.
Optical coherence tomography shows retinal layers and microscopic changes in them. Although it sounds very scientific and gives the doctor a lot of information, the examination is not complicated for the patient, does not require special preparation and takes only a few minutes to look directly at the device. Unfortunately, not every eye doctor has the equipment needed for this test.
“Assessing the urgency of the disease, the huge and growing number of patients and the intensity of research, we can expect an optimistic scenario – that treatment, and perhaps prevention, will become even more effective shortly,” the doctor concludes.