Age-related macular degeneration (macular dystrophy): how to preserve central vision
Blurring in the center of your visual field is a reason to have your retina examined. This condition can make it difficult for a person to read, recognize faces, see small text, and see clear outlines of objects. This is a common symptom of age-related macular degeneration—damage to the macula, the area of the retina responsible for central vision. This condition is also known as macular degeneration.
At K+31, we perform diagnostics, explain the results to the patient, and develop a treatment plan.
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Causes and risk factors for the development of AMD
There is no single cause for the disease. Risk is influenced by:
- Age
- Heredity
- Smoking
- Hypertension
- Lipid metabolism disorders
- Diabetes
We verify the patient's family history, medication use, and the rate of symptoms. This is necessary to assess the risk of progression.
Age-related changes and heredity
After 55-60 years, the tissues of the fundus become more sensitive to metabolic products. In some patients, changes remain minimal. In others, macular degeneration develops with drusen and areas of thinning. If close relatives have a history of age-related macular degeneration, the risk is higher, especially when combined with smoking or vascular disorders.
Smoking, vascular, and metabolic disorders
Smoking impairs microcirculation and increases oxidative stress in ocular tissue. Hypertension, high cholesterol, and diabetes also affect the retinal vascular support. Age-related vision changes often manifest earlier in these conditions. Therefore, we tailor the monitoring plan to the patient's overall condition.
What increases the risk of progression
The risk is higher with large drusen, pigment epithelial changes, and disease in the fellow eye. Neovascularization requires special attention. This is the growth of defective blood vessels under the retina. They can leak fluid and blood. Because of this, central vision deteriorates rapidly.
Regular screening is important for AMD.
First symptoms that shouldn't be ignored
Symptoms of age-related macular degeneration often develop without pain. Initially, a person may need a brighter lamp, small text becomes less clear, and their usual glasses may be less effective. One eye may compensate for the other for a long time. Therefore, when performing self-examination, it's helpful to periodically close each eye separately.
Distortion of lines and letters
Metamorphopsia is a visual distortion in which straight objects appear wavy or interrupted. Wall tiles may "break," a door frame may appear crooked, or lines in a book may appear arched. Line distortion is especially significant when moisture is suspected, so waiting months is unsafe.
Decreased clarity in the center of vision
Gradual vision loss manifests itself in different ways. Some patients have difficulty reading small print, others have difficulty recognizing faces, and still others notice a gray or dark spot in front of their eyes. Sometimes a scotoma—an area of visual loss that doesn't disappear after rest—develops.
Dark spot, difficulty reading and driving
The spot in the center interferes with looking directly at objects. Letters fall out when reading, and when driving, it's difficult to distinguish license plates, road markings, and pedestrians' faces. If these complaints persist for several days, an ophthalmologist should examine the fundus. This is necessary to rule out active vascular disease.
What forms exist?
In clinical practice, a distinction is made between dry and wet forms.
- The dry form of age-related macular degeneration is more common and usually progresses more slowly.
- The wet form of age-related macular degeneration is associated with abnormal blood vessels, fluid, swelling, or hemorrhage.
Before choosing a strategy, we explain the differences in simple terms:
| Signature | Dry form | Wet form |
|---|---|---|
| Speed | Often slow | Often fast |
| Complaints | Poor reading and contrast | Spot, curved lines |
| Examination | Drusen, atrophy | Fluid, blood, new vessels |
| Tactics | Observation | Urgent treatment as indicated |
Dry form: how it manifests and what are the dangers
The dry form of age-related macular degeneration is associated with drusen, changes in the pigment epithelium, and gradual tissue thinning. Symptoms remain mild for a long time. For example:
- Small text becomes harder to read
- Contrast decreases
- Fatigue develops
Late atrophy can limit central function, so retinal dystrophy requires monitoring.
Wet form: why urgent treatment requires
Wet age-related macular degeneration develops when new, defective vessels grow in the macula. Fluid leaks through their walls. Sometimes blood appears, and the cells in the center become swollen. Metamorphopsia, a fast blur, and a sharp decrease in clarity may indicate active progression.
What is the difference between prognosis and monitoring tactics?
With the dry form, the primary focus is observation, risk factor management, and retinal structure assessment. With the wet form, the doctor looks for signs of activity: fluid, hemorrhage, pigment epithelial detachment, and vascular growth.
The retinologist determines the frequency of visits and the need for the procedure based on the examination results.
Diagnostics: How we conduct the examination
The examination begins with a conversation. We clarify:
- When did the complaints begin?
- Have one or both eyes changed?
- Any history of diabetes, hypertension, surgery, or trauma?
Then a vision test, anterior segment examination, and fundus examination are performed. For us, diagnosing age-related macular degeneration means assessing the structure, function, and risk.
Ophthalmologist examination and visual acuity testing.
During the appointment, the ophthalmologist checks visual acuity without correction and with trial lenses. This step helps determine whether the complaint is related to the lens or whether there are signs of central damage. Visual acuity is compared dynamically with data from previous visits. The doctor then examines:
- Crystal lens
- Vitreous body
- Optic disc
- Macular area
OCT, Amsler test, and additional tests
OCT reveals the layer-by-layer structure of the macular area. Images show drusen, atrophy, edema, subretinal or intraretinal fluid, and pigment epithelial changes.
If the retina is edematous, an image helps assess the depth of the changes. The Amsler test helps assess retinal deformation. Fluorescein angiography clarifies vascular activity according to indications.
How we rule out other causes of vision loss
Similar complaints can occur with cataracts, glaucoma, diabetic macular edema, inflammation, and diseases of the optic nerve. Therefore, we don't limit ourselves to a single test. Retinal diagnostics are combined with an assessment of the transparency of the optical media, intraocular pressure, and nerve structures.
General information
Modern treatment
The plan depends on the form, stage, activity of the process, and the condition of the second eye.
- For the dry form, the basis of care is observation, correction of controllable risk factors, and nutritional support as indicated.
- For the wet form, medications are administered to suppress pathological vascular growth.
Monitoring and controlling risk factors
For the dry form, we determine the stage, schedule follow-up visits, and explain what changes should be monitored at home. Important:
- Smoking cessation
- Blood pressure control
- Sugar and lipid control
- Protecting the eyes from excessive ultraviolet radiation.
Monitoring progression is especially necessary for changes in the second eye.
Injection therapy for wet neovascular disease
Injection therapy is performed under sterile conditions after assessing the indications and contraindications. Anti-VEGF medications suppress the action of vascular growth factor, reduce fluid leakage, and help stabilize the macula. Intravitreal injections are administered according to a schedule adjusted by the physician based on imaging data.
Supportive measures and nutritional therapy as indicated
Treatment is not limited to a single prescription. Some patients require observation, others require a course of injections, and still others require frequent follow-up examinations.
Anti-VEGF therapy is used for active neovascular disease. Vitamin and mineral supplements are considered supportive at certain stages.
FAQ
What is age-related macular degeneration in simple terms?
What are the first symptoms of a diagnosis of macular degeneration?
Is it possible to cure age-related macular degeneration?
Do vitamins help with AMD?
Age-related macular degeneration requires close monitoring because it impacts reading, working with fine details, driving, and everyday independence. At K+31, we diagnose age-related macular degeneration, determine the disease's form, and explain the next steps to the patient:
- Monitoring
- Risk factor management
- Treatment as indicated
If macular degeneration has already been diagnosed or the doctor has mentioned the risk of macular damage, it is important to come in for a checkup if new complaints arise, such as blurriness, spots, distorted lines, or decreased central vision.
During the consultation, the ophthalmologist will evaluate the fundus, check the retina, and specifically discuss the impact on central vision. If treatment for age-related macular degeneration is required, the doctor will explain the treatment plan, monitoring timeframes, and any signs that require an appointment earlier than the scheduled one.
Clinical Guidelines of the Ministry of Health of the Russian Federation — https://cr.minzdrav.gov.ru/
Ministry of Health of the Russian Federation — https://minzdrav.gov.ru/
Ophthalmology Bulletin / Media Sphere — https://www.mediasphera.ru/journal/vestnik-oftalmologii
Ophthalmology Portal EyePress — https://www.eyepress.ru/
Russian Medical Journal (RMJ) — https://www.rmj.ru/
eLIBRARY — scientific publications in Russian — https://www.elibrary.ru/
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What is age-related macular degeneration?
AMD affects the macula, the central area of the retina responsible for clear, straight-ahead vision. The disease can progress slowly, and in the wet vascular form, noticeable changes sometimes appear within a few weeks.
The macula and its role in vision
The macula is the central part of the fundus. Here, the retina perceives letters, contrast, contours, and facial expressions. If drusen, atrophy, fluid, or blood appear in this area, visual acuity decreases even with intact lateral vision. The macula is assessed separately during examination.
Why is central vision affected?
Central clarity depends on the photoreceptors, pigment epithelium, and choroid. With age, tissue metabolism changes. Waste products are eliminated more slowly, and cellular nutrition becomes less stable.
Again, age-related changes in vision occur. In some people, these progress to macular lesions. Images also show how the retina changes over time.