Macular degeneration

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Symptoms

Among the most frequent symptoms of patients with macular degeneration are blurred grey or black spots in the visual field. Peripheral vision, however, stays sharp in one or both eyes. Such patients typically see deformed straight lines, blurred letters, deformed shapes, or sizes of various objects. Patients might also see colors that seem to be weakened. Because of the above-mentioned symptoms, reading, driving, watching TV or even distinguishing people’s faces is completely impossible.

Causes

Macular degeneration is an eye disorder caused by a yellow spot (macula) – a place on the retina where vision is the sharpest. Macular degeneration is the most frequent cause of blindness in people over 50. There are a wide range of factors that contribute to the development of this disorder. The main cause is probably cell damage caused by toxic substances from food or toxic substances in the environment that have accumulated in the retinal tissue. Hypertension and arteriosclerosis (hardening of the arteries) can contribute to macular degeneration as well because they influence the blood supply to the retina. Finally, risk factors include age, smoking, bad eating habits, hereditary factors, heart disease and extensive sun exposure.

Examination

The basic examination is done using the “Amsler’s Chart,” which is a 10-cm dark square divided into smaller 5-mm squares by white lines. The patient focuses with one eye on a central dot and observes whether the lines in the table twist or double.

Then an eye exam follows. First of all, you will be given special drugs in the form of drops to dilate your pupil (artificial mydriasis). Shortly after the exam (within a few hours) you might experience worse short distance vision or higher sensitivity to light due to the previous pupil dilatation. Therefore, we strongly recommend no driving immediately after the exam. However, the above-mentioned symptoms will disappear when the drug effects wear off.

You will also be examined by an ophthalmoscopy – directly or indirectly. In both cases, it is an exam which will not cause you any difficulties or discomfort. The direct ophthalmoscope is a device that is held in the doctor’s hand. Using a special light installed inside the ophthalmoscope, the doctor will look into your eyes. As far as indirect ophthalmoscopy is concerned, the doctor will wear a special binocular device with a light inside to exam your eyes. There is also a special form of indirect ophthalmological exam called biomicroscopy. This technique is used to examine the eye background, known as the retina. It is also a pain-free procedure done by using a slit lamp. In this case, the doctor holds an ophthalmoscopic lens in front of your eye.

Another modern imaging method is optical coherence tomography (OCT), which enables cross sections of the retina to be imaged, along with the thickness of retinal swelling and the type and depth of the damage. This procedure is performed using a special device and you will be asked to sit in front of it.

The examination of the eye blood vessels (vessels in the retina or iris) is done by fluorescent angiography, which allows the diagnosis to be confirmed and provides guidelines for the treatment. A cannula is inserted in one of the veins of your arm and a fluorescent dye is injected (fluorescein or indocyanine green dye) into the blood stream and travels into the eye vessels allowing the vessel system to be seen in detail in digital photography.

Conservative treatment

If macular degeneration is diagnosed in the early stage, the doctor can recommend food supplements containing the antioxidants lutein and zeaxanthin, which are naturally present in yellow pigment (macula pigment). These antioxidants absorb ultraviolet radiation (UV radiation) and protect cells against oxidative changes. However, the human organism is not able to produce these antioxidants. Furthermore, the level of these antioxidants in the human body decreases with age. Therefore, it is suitable to get them from food in order to prevent the development of macular degeneration brought about by an increase in age.

Surgery

Inner eye AVASTIN injection

A drug by the trade name Avastin (chemo-drug bevacizumab) was originally used in the treatment of tumors because it can bind tightly to VEGF protein (VEGF = vascular endothelial growth factor). Avastin functions to encourage blood vessel growth. However, if Avastin binds to the VEGF protein, its activity is blocked, interrupting new vessel growth. In ophthalmology, Avastin has been successfully used in the treatment of a damp form of senile macular degeneration and retinal swelling occurring as a result of inflammation or diabetic retinopathy. Before the doctor applies Avastin, the patient’s eye is anesthetized by anesthetic drops. Then about 0.1 ml of Avastin is injected into the vitreous body using a very thin needle. This procedure is repeated usually three times over a series of months.

Equipment/devices used 

Slit lamp

A slit lamp is a special binocular microscope which allows the inner eye to be seen and its parts examined in detail, mainly the cornea, the anterior eye chamber, the iris and the lens. For better visualization, it is sometimes necessary to apply drops to dilate the pupil. In our clinic, we use a device from the Alcon and Rodenstock companies containing an inner digital camera that enables high quality images or video to be fed directly into the doctor’s PC.

Ophthalmoscope 

An ophthalmoscope ("eye-mirror") is a piece of equipment used to exam the inner eye structures, mainly the eye background, choroid, retina and optic nerve. A direct ophthalmoscope is a handheld device with a source of light that penetrates the eye through the retina and allows the inner eye to be examined (the examined visual field is around 5–8°). An indirect ophthalmoscope, on the other hand, is a binocular device that constitutes a light attached to a headband, in addition to a small handheld lens. This device uses a specially modified light source and an accessory lens that is held in front of the patient’s eye. The lens induces real but inverted images of the observed structures (the examined visual field is around 45°). We use a device from the Heine Company in our clinic.

OCT device (Optic Coherent Tomography)

This is a modern diagnostic device used for a detailed and painless examination of the eye background, individual retina layers, nerve fibers and the optic nerve without taking a surgical sample abstract and without direct eye contact. Sometimes it is necessary to administer drops to dilate the pupil for better visualization. OCT is an optic device operated by a PC. It generates colorful cross-sectional images with a very high resolution of the individual structures and layers (in micrometers) of the examined tissues using infrared (IR) radiation with a short coherent wavelength. It even permits 3D images and spatial relevance of the examined eye to be evaluated. We use a device from the Carl Zeiss Company in our clinic.

Digital fundus camera

This device is used for digital images of the front and back eye segments, mainly of the retina and optic nerve. It maintains the real color scheme of the individual structures so that the doctor can observe disease development. We use a device from the Carl Zeiss Company in our clinic.

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