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Wednesday, April 11, 2012

Age related Macular Degeneration

Age related Macular Degeneration or AMD is a disease that affects older individuals and causes loss of central vision. In the western world it is the leading cause of irreversible severe visual loss in individuals over the age of 60 years. In India vision loss due to AMD and Diabetic Retinopathy (damage to inner part of the eye due to diabetes) are the major challenges for ophthalmologists.


AMD is a chronic slowly progressive degenerative condition which affects the central retina. The retina is the innermost layer of the eye and also the most sensitive layer responsible for transmitting the visual signals to the brain via the optic nerve. Since it affects the central retina it is the central vision which is lost and when both eyes are affected it is difficult to read, write, watch television, or recognize faces. This can cause a lot disability and distress.

A lot of research is going on to find out the exact reason why some people show degenerative changes while others don’t. Present research shows that metabolic activity in the cells produces a type of oxygen known as free radicals or unstable oxygen which can cause oxydative damage to the proteins and lipids in the cells. The retinal layer is prone to such damage due to two reason, the first being the high level of activity going on in these cells all the time and second being the high lipid content of these photoreceptor cells. The body produces free radical scavengers to counteract these oxidative processes but when the free radical exceeds the body's capacity to fight them the injurious process occurs.

The disease is very slowly progressing and since it is not associated with pain or redness of the eyes it can go undetected. The earliest symptoms would be dimness of vision especially for reding fine print and a black central spot called scotoma when reading or looking in the distance. The need for brighter light for reading may also be an indication.

Since the outcome of the disease if not detected and treated in time can be central blindness; awareness, prevention and screening are extremely important. Certain lifestyle changes started at an earlier age will a long way in keeping the retina healthy.

DIETERY HABITS

Incorporating dark leafy vegetables such as spinach. kale, turnip greens. These vegetables contain amino acids like lutein and zexanthin which are also the free radical fighting pigments found in the retina. Dry fruits in small quantities should be taken daily for the antioxidant and omega-3 fatty acids.

SUNGLASSES

More than fashion statement it is always a good idea to protect your eyes with god quality sunglasses and if possible a cap or a hat. The sunglasses should have good lenses with certified UV protection. The ultraviolet rays in sunlight are believed to be very damaging in nature to the retina.

SMOKING

Smoking has been proven by innumerable tests to affect the body's blood vessels so as to hamper circulation in all body parts including the retina. This adds to the damage caused by free radicals.

EXERCISE

Some form of cardiovascular exercise must be made part of the daily routine irrespective of whether one is thin or fat because exercise improves the efficiency of the circulatory system.

SCREENING

Annual routine eye check ups after the age of 40 are a must for early detection of age related aye diseases especially for those who have a family history of AMD or other eye disorders. Routine checking of vision both for far sight e.g. Looking at the television and near sight or reading with prescribed spectacles done covering one eye at a time is a good way to detect any problem at home. If when checking your vision like this any problem like a distortion or central dark spots are noticed a consultation with an eye doctor is mandatory.

During an eye examination with the doctor dilation of the pupil in the eye to get a good look at the retina will be done. If during the examination any anomaly is detected additional tests will be asked for such as:

-The Amber Grid Test

-Fundus Fluorescent Angiography and ICG

-OCT

Using these tests the eye doctor will be able to diagnose if the patient is suffering from AMD and to the severity of the disease. Once that has been done the line of treatment will be decided.

TREATMENT

The different modalities of treatment available based on the severity of the disease are: Antioxidant vitamins i.e. Vitamin C and E, BetaCarotene and minerals like Zinc and copper bilberry extract and Pycnogenol or grape seed extract taken as capsules slows down the progression of the disease. However these supplements should be taken only if necessary or if prescribed by the doctor.

If the disease is in a more advanced stage with development of abnormal blood vessels in the retina then injections of some drugs inside the eye may be required. These may have to be repeated at intervals to get the desired results.

In addition laser or surgery maybe required in certain forms of this disease.

Inspite of the different lines of treatment available and the continued research the outcome for advanced disease will be a stabilization in the vision loss but there is not treatment for recovering the vision that is already lost. therefore it cannot be emphasized enough that prevention and early detection as also early treatment are the key words for preventing blindness due to AMD.

Once the disease has affected one eye it is all the more necessary to take care of the other eye by regular eye checks, preventative measures and vision checking at home with the amber grid.

For those who have already lost vision due to the disease the only hope would be with Low Vision Aids.



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