What is Macular Disease? What are the symptoms?

Macular degeneration; It is an eye disease, medically known as macular degeneration, that causes permanent visual impairment over time. The yellow spot is the area responsible for vision located in the middle part of the retina, containing a special pigment. Macular degeneration occurs in this area due to cell loss or cell dysfunction due to reasons such as oxidative stress, genetic factors, advanced age, and excessive exposure to sunlight. Early diagnosis and treatment are very important in this progressive disease. If early diagnosis and treatment is not provided, vision may decrease to a degree that affects the person's quality of life. While central vision decreases initially, as degeneration progresses over time, symptoms such as the inability to distinguish colors and people's faces may occur. This disease can occur in people of all ages. However, it is most common in people over the age of 65.

What is Macular Disease?

Macular yellow spot, also known as macula; It is the area in the retina that is the basic element of visual function. Detailing in the visual process occurs thanks to this area. With the deterioration in this area, which also contains photoreceptor cells, initial loss of central vision occurs. As the disease progresses, peripheral vision also decreases. Initially, patients have a visual field that is dark in the middle and bright around it, but over time, the dark part expands into a ring shape. Macular degeneration is divided into two: wet type and dry type:

• Dry Type Macular Degeneration: Dry type is seen in approximately 90% of patients with macular degeneration. It also has less risk of vision loss. Called drusen in the retina; Accumulation of metabolic waste is observed. Drusen formation is the first finding to distinguish between wet type and dry type.
• Wet Type Macular Degeneration: The growth and development of new vessels with an abnormal structure called choroidal neovascular membrane (CNVM) is observed in the retina. The permeability of these vessels is very high and they leak fluid or blood. Compared to the dry type, vision loss and disease progression occur faster.

What are the Symptoms of Macular Disease?

Macular degeneration does not have classical findings that are valid for every patient. The disease may show different symptoms from person to person. Symptoms of macular degeneration, which occurs with the main symptom of weakening of vision, are as follows:

• Blurring of vision
• Difficulty in recognizing faces
• Recognizing colors and difficulty in distinguishing them
• Impairment in the perception of straight lines
• Dark, black shading in the visual center
• Decreased vision ability in dimly lit environments
• When doing fine work needing help (stitching, etc.)
• Blurring in reading

What Causes Yellow Spot Disease?

There are many risk factors for macular degeneration. Possible factors, including genetic factors and age, are as follows:

• Age: Age is the leading risk factor. The incidence of macular degeneration doubles in people over the age of 60.
• Gender: Although some studies have found gender to be an insignificant risk factor, there are studies showing that macular degeneration is more common in older women than in older men. It is thought that this is due to the estrogen hormone decreasing with menopause. Because estrogen hormone has a protective effect on many organs.
• Ethnicity: It is known that it is more common in white races than in black races. In addition, studies have shown that drusen in white people are larger than those in black people.
• Use of cigarettes and other tobacco products: It is among the preventable risk factors. Smoking adversely affects the course of the disease by increasing the amount of free radicals in the blood.
• Obesity: It is known that people above a certain body mass index are at higher risk than other people. Obesity is a factor that both causes the disease to occur and accelerates its progression.
• Drugs: It is known that some cholesterol medications reduce the risk of macular degeneration.
• Exposure to sunlight: People who are exposed to excessive sunlight. It is known that the incidence of the disease is higher. Harmful short wavelength rays from the sun can trigger the formation of macular degeneration. Among the UVA, UVB and UVC rays emitted from the sun, UVB rays are the most damaging to the retina. These rays have a harmful effect on the layers of the eye by increasing the amount of free radicals.
• Having other eye conditions: Hypermetropic people are more likely than other healthy people. They are more likely to suffer from macular degeneration.
• Iris Color: It is known that people with dark colored iris are more protected from the harmful rays of the sun and are less at risk. Dark colored iris has a protective effect against sun oxidative damage due to the high melanin it has.
• Blood pressure and diabetes: It is known that people with high blood pressure and diabetes are prone to macular degeneration.

How Does Macular Disease Develop?

The time of onset and progression of macular degeneration varies from person to person. Its effects may even be different in two eyes of the same person. Patients initially complain about blurred vision. Over time, more advanced symptoms appear, such as seeing straight lines bent, difficulty doing fine work, difficulty reading books, and difficulty recognizing faces. As the deterioration in the macula increases, both new symptoms emerge and existing symptoms progress. Although it is often seen in both eyes at the same time, in some cases the disease is found in only one eye. As the disease progresses, quality of life becomes quite limited. With the correct diagnosis and treatment, this progression can be slowed down or even stopped.

How to Diagnose Macular Disease?

In macular degeneration eye examination is of great importance. In addition to a detailed eye examination, other diagnostic methods are important in making a definitive diagnosis. The methods used in the diagnosis of macular degeneration are as follows:

• Amsler Grid: This test, which is performed with the help of cards that measure vision called Amsler grid, is very useful in diagnosis. The patient's test results are recorded each time and compared with the next result.
• Optical Coherence Tomography: With this method, the retina is visualized by using rays of certain wavelengths.
• Fundus Fluorescein Angiography: Especially in the diagnosis of wet type macular degeneration. is the method used. It is the process of obtaining images using a dye called fluorescence.
• Indocyanine Green Angiography: It is a method applied using a dye called indocyanine. This dye acts by binding to proteins and enables the detection of new vascular formations. It is especially useful in the diagnosis of latent macular degeneration.
• Fundus Autofluorescence: It is a diagnostic method based on recording the radiations occurring in the lower layer of the retina with the help of fundus cameras.

How is Macular Disease Treated?

In addition to life changes such as adjusting the diet, invasive options such as surgical methods may also be preferred in the treatment of macular degeneration. Methods used in the treatment of macular degeneration are as follows:

• Antioxidant and Vitamin supplements: The use of lutein and other vitamins beneficial for the eye may be beneficial for macular degeneration.

Laser Photocoagulation: It is a method in which new vessels and their leaks are burned using a high-energy argon laser. The procedure can be completed in as little as 15 minutes.
• Photodynamic Therapy: It is the process of destroying newly formed vessels with the help of laser.
• Anti-VEGF treatment: Anti-VEGF is called eye treatment for the treatment of macular bleeding. It is the process of injecting the drug. Anti-VEGF has a therapeutic effect by preventing new vascular formation and leaks.
• Steroid treatment: Anti-VEGF is the preferred treatment method in patients who are resistant to treatment. Suppressive drugs are used.
• Surgical treatment: It is preferred in patients who do not respond to most other treatment methods. Macular degeneration surgeryis performed under local anesthesia.

What Should Be Done to Prevent Yellow Spot Disease?

Although it is not possible to completely prevent the occurrence of macular degeneration, its progression can be slowed down by taking some precautions. Especially people with genetic predisposition should have regular eye examinations. In this way, it may be possible to start treatment early and prevent progression.

Products such as carrots and fish, which contain vitamins beneficial for the eye, should be included in the diet. should be included and consumed at frequent intervals. Using supplements to support eye health with the guidance of a doctor is also one of the practices that can be done to protect against the disease.

Since macular degeneration is progressive, early diagnosis and treatment is of great importance. If you think you are experiencing one or more of the symptoms, you can find out whether you have the disease with a detailed eye examination by contacting the nearest health institution, and you can regain your health with the treatment your doctor will give.

Source

1. https://www.researchgate.net/profile/Osman-Cekic-2/publication/308948428_Kuru_Tip_Yasa_Bagli_Makula_Degenerationunda_Yeni_Tedavi_Secenelerini/links/57fc87ee08ae51472e7e8a95/Kuru-Tip-Yasa-Bagli-Makuela-Degenerunda-Yeni -Treatment-Options. pdf
2. https://dergipark.org.tr/ en/pub/sabd/issue/72485/1134234