Prevention and treatment of age-related macular degeneration (age related macular degeneration)

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What is age-related macular degeneration?Elderly patients with vision suddenly drop a lot, the bending deformation of vision, after the hosp

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What is age-related macular degeneration?

Elderly patients with vision suddenly drop a lot, the bending deformation of vision, after the hospital, was diagnosed as "senile macular degeneration" or "age-related macular degeneration" (Age-related macular degeneration, AMD). What is macular degeneration? As the name suggests, macular degeneration is a degenerative disease of the macula in the human eye. In the eye, eye retinal is located in the rear, as fundus camera film, in the retina and macular central, it is our human light sense, form vision and colour vision, human vision is the most sensitive place, we have to see some small things and distinguish colors, are required to use the macula. Therefore, if there is a disease of the macula, visual function is bound to be severely damaged. In young people, macular degeneration and genetic related in the elderly, with the increase of age, macular dysfunction, metabolic products accumulation appeared degeneration, fundus appearance of drusen, macular pigment disorders, severe macular hemorrhage and edema exudation and scar formation, namely macular degeneration. This disease occurs more than 50 years old, and with age, the prevalence increased. In our country, with the trend of population aging, the prevalence rate of AMD and the number of patients will be increased year by year, the society will become a serious public health problem, such as the number of AMD leads to the self-care ability is limited, can not read, because the visual impairment caused by older people fall fracture and the social psychological problems greatly increased and the quality of life of patients affected by very large.

Type of AMD

AMD is divided into "dry" and "wet" or atrophic and exudative type. Dry, namely drusen in the fundus yellowish white, also can cause progressive macular thinning atrophy, so that the function of influence.

"Wet", the more serious visual impairment, accounting for 90% of severe visual impairment caused by AMD. The main cause of visual impairment is abnormal growth of new blood vessels in the retina, resulting in retinal hemorrhage, edema and destruction of the retinal tissue, eventually leading to scar formation, resulting in loss of vision.

How to find the "wet" AMD?

In the early stages of AMD, vision may change slightly. The easiest way to do this is to check the Amsler table. Check the following steps: if there are glasses, please wear. Cover one eye and look at the center of the grid. Check the point. All the lines of a normal person should be straight and the grid should be of the same size. Binocular examination. If the inspection found that the mesh is fuzzy, deformation or abnormal color, must be to the eye fundus examination, usually projects with ophthalmoscopy, fundus fluorescein angiography and indocyanine green angiography and optical coherence tomography (OCT) (right and left respectively for normal and abnormal control).

How to treat "wet" AMD?

Because the pathogenesis of AMD is unknown, there is no cure for it. Before 2000, we had almost nothing to do with macular degeneration. After nearly 20 years of research, especially in science and technology in recent years the unexpected Mengjin development, has made great progress in the treatment of AMD. There are several treatments:

1 laser therapy: using laser thermal energy generated by the abnormal neovascularization macular areadestroying the disadvantage is also cause damage to the normal tissue near the visual function will be greatly affected, very few patients are currently only applicable to far away from the macula.

2 through the pupil thermotherapy (TTT): the use of infrared light to light the macular lesion area, so that the local mild lesions, so as to achieve the purpose of abnormal new blood vessels. The treatment cost is low, but also has some damage to the local normal tissue, the curative effect is not ideal.

3 surgical treatment: such as subretinal neovascular membrane resection, macular translocation. Operation risk, the effect is not accurate. Retinal transplantation is still in the research stage.

4: photodynamic therapy (PDT) is a specific light sensitive agent is injected into the patient's blood, when the drug circulation to the retina, using a special non thermal laser excites the photosensitizer, resulting in the destruction of abnormal neovascularization, and almost no damage to normal retinal tissue. PDT treatment for AMD value, finally have a way to break the foveal "forbidden zone", "wet" treatment for age-related macular degeneration, this is a milepost technology for the treatment of age-related macular degeneration in the process of! At present, the technology has been carried out in more than 10 years, but the technical shortcoming is expensive, every treatment needs about 14000 yuan, in addition, the curative effect, it is mainly to stable condition, not necessarily can significantly improve visual acuity.

5 anti angiogenesis therapy: understanding of wet AMD pathogenesis based on, people realize that vascular endothelial growth factor (VEGF) in the occurrence and development of CNV has played a pivot role, therefore, the study of anti VEGF drugs to control choroidal neovascularization induced by hemorrhage, prevent leakage. Previously only imported ranibizumab, the price is expensive, at present Chengdu Kanghong pharmaceutical has developed the first anti VEGF drugs in China and to clinical application, the price lower than the foreign countries, and achieved good effect, the current anti VEGF drugs have been used as the drug of choice for age-related macular degeneration treatment guidelines recommend. The disadvantage is that the price is still relatively expensive, and requires multiple injections, and currently only some patients can social security health insurance reimbursement.

The above treatment is targeted at the treatment of new blood vessels, symptomatic treatment, there is no way to cure. It is difficult for any treatment to recover the lost visual function. And "wet" AMD effects on visual function like a "wild horse", impact on visual function is very rapid and serious, therefore, promote early detection, early correct and timely use of advanced science and methods of treatment, in the absence of development to a very serious stage of treatment can obtain good curative effect.

How to prevent AMD?

Bian Que, the great physician of ancient times, said: "the treatment of disease, the treatment of the disease, the treatment of the disease. For any disease should be based on the principle of prevention. Because the exact pathological mechanism of AMD is not very clear, it is difficult to have a method for treatment. A large number of studies have shown that the occurrence of AMD is associated with genetic and environmental factors such as long-term exposure to ultraviolet radiation, environmental pollution, smoking, and decreased levels of blood antioxidant activity. For these reasons, the scientists put forward the following preventive measures:

1 due to the occurrence of AMD may have a certain relationship with the genetic, so if there is someone in the family suffering from AMD, then the family members of those over the age of 50 should be a regular eye examination.

2 because AMD may be associated with long-term UV exposure, it is recommended to wear sunglasses when the sun is strong.

3 because vegetables and fruits contain a lot of antioxidant substances, such as trace elements, vitamins, lutein, etc., therefore, it is recommended to eat more fruits and vegetables. Fish contains a lot of unsaturated acid, a strong antioxidant capacity, it is recommended to eat more.

4 recommended to add a variety of antioxidant, especially rich in lutein, zeaxanthin health care drugs. Multi center clinical study shows that long-term use of lutein, trace elements zinc and a variety of vitamins, unsaturated fatty acids in line with eye care drugs, help to prevent the development of AMD. A multicenter study of nearly 10 years, with a population of about more than 3 thousand people, suggests that the long-term use of the above eye care drugs could prevent at least 1/4 of the early AMD from developing to a later stage.

5 studies have shown that the occurrence of AMD with hypertension, high blood fat, therefore, should actively prevent hypertension, high blood fat, eat too much greasy food, exercise can help prevent or slow down the development of AMD. Studies have shown that there is a clear correlation between smoking and the occurrence of AMD, therefore, it is recommended to quit smoking.

In short, with the arrival of aging society in our country, AMD has a serious impact on the quality of life of elderly patients with the disease, the number of patients is increasing, is a serious public health problem. However, by actively promoting widespread awareness of patients and physicians to increase awareness of AMD, active prevention measures can reduce the incidence of severe AMD. In recent years, due to medical technology breakthrough, the treatment of the disease is not so terrible, as long as the patient can be found early, early appropriate treatment, patients with visual function and improve the stability of no longer distant dream, but optimistic reality!

(Professor Chen Youxin Peking Union Medical College Hospital famous yandebing experts, this paper found the doctor Chen Youxin personal website, informative and wonderful, is to be modified only for forwarding, forwarding the patient's health education, please cite Chen Youxin doctor website)

 

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