At present, China's elderly population over the age of 60 has exceeded 200 million, accounting for about 14.9% of the total population. Patients over the age of 50 are reminded that regular eye examinations are required, mainly so that the three main blind diseases in the elderly can be detected early, including cataracts, glaucoma, and macular disease. Here, we will guide everyone to further understand the "macular degeneration".
1. What is the cause of vision loss in the elderly?
The most common eye diseases in the elderly are senile cataracts, followed by elderly macular degeneration, macular membrane or macular hiats and recesses, which can lead to serious loss of vision.
2. The structure of the eye?
Describe the eye as a camera, the cornea is the lens cover, the lens is the lens, and the imaging is the retina, which is equivalent to the film of the camera. The lens of the elderly gradually becomes cloudy from transparent to cataracts. Light enters the eyeball from front to back, and the structure facing the retina is the macula, which is the most important place for us to produce vision, responsible for fine vision, including reading and distinguishing colors. Lesions of the macula can affect vision.
Fig. 1: Normal eyeball structure.
3. How to self-test whether I have macular degeneration?
Block one eye to see if there are dark spots in the center of the field of vision. Look for a wall line, the edge of a door frame, or a notebook with a line to see if the straight line is curved? Ophthalmology has a special checklist - Amsler table, when the patient looks at the grid on the checklist, the straight line becomes distorted, that is, the macula has a problem. At this time, it is necessary to go to a hospital with the ability to detect fundus diseases for further examination and confirmation.
Figure 2: (a) Amsler table for normal people, (b) Amsler table for macular degeneration patients.
4. What are the symptoms of macular degeneration?
Macular degeneration is divided into several types, and may appear as abnormal color vision, blurred central vision, central field dark spot occlusion, visual distortion, visual distortion, and color darkening.
A． Age-related macular degeneration (AMD):
At present, AMD should be a disease that destroys the quality of life of the elderly first, and its incidence is related to genetics, environmental factors, smoking (the first risk factor), hypertension, diabetes, atherosclerosis and other factors.
AMD is a number of age-related changes that occur in the macular area, divided into dry (macular atrophy) and wet (macular hemorrhage, exudation). In the early stage of wetness, things are distorted, and there will be a dark shadow in the center, and the dark spots will become larger and larger as the course of the disease develops, and in the late stage, it can only be seen by the afterglow. Dryness is mainly decreased vision. If left untreated, the less vision will be saved in the end.
Figure 3: (a) Normal macula (at black arrows), (b) Wet AMD: macular bleeding, exudation, (c) Dry AMD: macular atrophy.
B. Macular holes:
It often occurs in people over 50 years of age, and the causes include trauma, inflammation, high myopia, retinal degenerative diseases and many other factors. Macular cracks, that is, a hole in the retina of the macula area, can appear in the middle of the C C loss, see things deformed, vision decline, look at the distance may not be found, reading books and newspapers is easier to find. After the early treatment after discovery, the visual function damage is small, easy to recover, if the course of the disease exceeds half a year, the optic cells have no function, and the prognosis is poor.
C. Premacular membrane:
The eyeball is filled with vitreous bodies, and the vitreous bodies can also undergo senile changes. The vitreous and retina are originally very tightly bonded, and when the vitreous body is separated from the retina due to aging (post-vitreous detachment), the premacular membrane is produced during the separation process. There is a small depression in the center of the normal macula, if there is a layer of membrane, this membrane wrinkles the macula, the central depression of the macula pulls and deforms, changes the drum, and when looking at things, there will be a decrease in vision, blurred vision, reading words become larger or smaller, and things are distorted.
Figure 4: OCT examination shows (a) a normal macular (depression pointed to by the red arrow) ;(b) a macular lobe; (c) anterior macular membrane (between the blue triangles).
5. How is macular degeneration treated?
Depending on the stage of age-related macular degeneration, there are good anti-angiogenic drugs, photodynamic lasers, or combination therapy; The anterior macular membrane and macular fissures are mainly treated by surgery. The risk of general surgery is small, and the success rate of surgery is high after the operation in accordance with the doctor's medical advice. Patients need to go to the hospital to clarify the diagnosis; timely treatment is good, if the treatment is delayed, it will not save vision.
6. How to delay the occurrence of AMD?
The main components of macular vision cells are lutein and zeaxanthin. Therefore, it is advocated that patients eat more coarse grains (such as corn), green vegetables (such as spinach, broccoli, etc.), and fruits (kiwifruit, etc.).
In the early and middle stages of AMD, the combination of zinc and vitamins can delay the occurrence of lesions to a certain extent. Source from the Age-Related Macular Degeneration (AREDS) study at the National Institutes of Health Ophthalmology (NEI).
For more related content, please see the january 18, 2015 Yangshengtang broadcast: Professor Li Xiaoxin's lecture "Seeing Flowers in the Fog" to Solve the Blindness Crisis".