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WHAT ARE THE RETINA AND THE MACULA?
The retina is a delicate light sensitive tissue lining the inner surface of the eye formed by nerve fibers and blood vessels nourishing it. It serves much the same function like the film in a camera. The objects we see are projected on it and converted into electrical impulses which are then sent through the optic nerve to the occipital bone of the brain where they are received and interpreted.

       
The macula is the central, most sensitive part of the retina. It allows us to read, differentiate colors and it is specialized for high acuity vision.

WHAT IS AGE-RELATED MACULOPATHY?
Age-related Macular Degeneration (ARMD) is a macular disease caused by a retinal disorder. It results in progressive loss of central vision without affecting peripheral vision. It is the leading cause of “legal blindness” in persons over age 50. Some of the impediments resulting from ARMD are: inability to read, watch TV, see the watch, etc. almost irreversibly.

HOW IS IT CAUSED?
ARMD starts with the appearance of small yellowish spots called “Drusen” formed below the macular retina. With time, it continues suffering degenerative and functional changes causing the death of the photoreceptors of the retina (rods and cones) which are the cells specialized in the reception of visual stimuli. The injuries described so far constitute the so called "dry" form of ARMD which is the most common (90%) and the less severe one. But when in addition to the above mentioned changes there is an abnormal blood vessel growth (neovessels) this is the “wet” form of ARMD. The neovessels- originated in the choroid layer of the eye- advance below the macular retina causing hemorrhaging and eventually irreversible cicatrizing damage. The "wet" form is more severe than the "dry" one and loss of vision is usually abrupt and severe.

WHICH ARE THE SYMPTOMS OF MACULOPATHY?
Normally, the symptoms appear more clearly in short distance vision, for instance while reading. The following facts can be observed:

Distortion of straight lines (they appear wavy) more noticeable in the central area while reading.

Blurry areas or dark spaces in your center of vision on a printed page.

Trouble discerning colors.


HOW IS IT DIAGNOSED?
Most patients realize they have a problem in their central vision when they are in very advanced stages. Early diagnosis is generally made by the ophthalmologist during a routine examination. This will then be confirmed by means of the following specific tests:

The Amsler Grid Test consists of observing a black card on which there is a white grid resembling a checkboard. It is used to evaluate the extension and evolution of central visual distortion.

The Retina Angiography is a test which consists of injecting a contrast substance (fluorescein) in one of the arm’s veins while photographing the retina vessels and the layers behind it. This test helps to see the alterations in the retina vessels and their back layers with precision.


WHICH FACTORS MAY FAVOR THE APPEARANCE OF MACULOPATHY?
Certain factors increase the risk of suffering this disease. Among them we can mention:

Family History: Research shows that first-degree relatives of patients suffering from ARMD are 3 times more likely to develop this pathology.

Cataracts: Research shows a close relationship between cataract surgery and ARMD.

Hypertension: Research shows that hypertensive patients with dry ARMD together with high cholesterol levels and low carotenoide in serum have a greater risk of developing a wet ARMD.

Exposure to Ultraviolet Rays of the sun.

Low pigmented eyes (blue / green eyes)

Smoking: Research shows that cigarette smokers are more likely to suffer AMRD.


DOES THIS PATHOLOGY LEAD TO BLINDNESS?
Age-related Macular Degeneration (ARMD) does not result in blindness because it attacks only the central retina while the peripheral retina is not affected. The expression “legal blindness” used in the USA refers to the visual deficit which prevents a person from reading or driving thus disqualifying him for the performance of certain tasks.  Loss of vision in the dry form is normally gradual, starting by blank spots in the central visual field which in time develop into a real central spot. However, in general it is not as serious as the wet type.

WHAT IS THE RECOMMENDED TREATMENT?
1- Currently, there is no treatment for ARMD.  However, there are optical aid and centers specialized in subnormal vision providing valuable support for these patients.
2- The wet types (those having the worst visual prognosis) nowadays have a therapeutic option which consists in the intraocular injection of a substance called AVASTIN or LUCENTIS which closes the abnormal vessels damaging the macula resulting in a possible improvement of vision. Although this is the best therapeutic option, the treatment is not successful in all cases. The ophthalmologist specialized in retina, shall evaluate each case and decide whether the patient is a possible candidate.  

IS PREVENTION POSSIBLE?

There in no effective prevention method. However, there are certain measures which might help:

Periodical ophthalmologic examinations: early diagnosis before the appearance of symptoms provides more opportunities for the prevention of visual loss.

Protection against ultraviolet rays (UVA & UVB) wearing sunglasses with filters blocking 99-100% of UV rays.

No smoking.

Controlling arterial hypertension.

A diet based on fruit and vegetables, fish, nuts, olive oil and other food rich in omega 3 fatty acids. Certain research proves that dark green-leaves vegetables such as spinach help to prevent ARMD.

A, E & C vitamins, certain minerals such as zinc and antioxidants would protect the retina from this condition.

Avoid trans fat.


 
   

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