Maculopathy


Diseases that affect the macula are called maculopathies.

Age-related macula degeneration (AMD)

  • It affects people over age 50. The risk increases with age.
  • It is a degenerative, slow onset process that affects the macula, the specialized area in central vision.
  • The macula is a small area of the retina (5-6 mm diameter) set between the temporal vascular arcades.

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Fotografía color (Daytona) centrada en la mácula (la zona central de la retina). Puede apreciarse el Nervio óptico hacia la izquierda, y las arcadas vasculares que emergen de él. La mácula representa el área dentro de dichas arcadas vasculares.


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Tomografía de coherencia óptica (OCT, Heidelberg Engeenering) de una mácula normal, que permite evaluar con mayor resolución la anatomía de la misma, exponiendo todas las capas que la componen con gran detalle. Obsérvese la concavidad central, que otorga a la mácula una forma de “V” corta. A la izquierda, puede observarse una fotografía en blanco y negro que permite correlacionar que zona de la mácula está siendo observada.



Causes:

They have not been elucidated yet. It is a multifactorial etiology that involves genetic factors (it is important to know if your parents or grandparents have suffered from this disease) as well as environmental factors such as lifestyle (bad eating habits, lack of frequent exercise and, above all, smoking.)

Initial symptoms:

  • Blurry vision.
  • Inability to visualize or recognize people’s faces at a distance.
  • Trouble in the transition from luminous environments to dim ones.
  • Need for a more powerful light for reading.

AMD types:

• 85%-90%: Dry AMD
It affects both eyes, even though it may first develop in one eye, and then affect both. It is because of this that it may go underdetected at first. It develops slowly till its last phase which is called geographic atrophy. This involves the progressive loss of pigment epithelial cells, causing areas of partial alteration in the field of central vision (scotomas)


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Tomografía de coherencia óptica (OCT, Heidelberg Engeenering) que evidencia DMRE en su variante atrofia geográfica.


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Retinografía color de campo amplio (Daytona), centrada en la parte central de la retina, que evidencia DMRE seca, con alteraciones pigmentarias y drussens confluentes maculares.


• 10-15% Wet AMD
It is characterized by the presence of vessels that invade the retina. This generates fluid leaks and bleeding at a macular lever. Its initial symptoms include a rapid and severe loss of central vision, metamorphopsia (lines appear distorted or curved), and finally, scarring.

AMD diagnosis:

Annual ophthalmology check-ups. In case AMD is diagnosed, the specialist will determine the frequency of the check-ups.
It is important to know if there is family history as regards AMD, and, in such case, it must be communicated to the ophthalmologist.

Treatment:

Dry AMC:

There is no specific treatment at present. It is advisable to do regular ophthalmologic check-ups every 3 months. You will be given a graph paper called Amsler grid for the patient to do self checks weekly. If from one week to the other you notice any deformation in the grid, which was not present in the previous check, you must see your doctor ahead of schedule. It is essential to make some changes in your lifestyle such as quitting smoking, if you do; doing exercise regularly and also including leafy green vegetables.


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Grilla de Amsler. Representa una manera de autocontrolarse semanalmente, mientras se aguarda el próximo control.
Cómo realizar el control:
1 – Colocarse su anteojo de lectura (si los necesitara).
2 – Tapar el ojo izquierdo. Con el ojo derecho destapado, debe mirar al punto central. Mientras lo hace, debe registrar si ve el cuadriculado bien, o si nota alguna zona deformada en el mismo.
3 – Repetir con el ojo contrario.
4 – En caso de notar alguna diferencia con respecto a su autocontrol previo, debe pedir turno inmediatamente con su oftalmólogo, de manera que éste pueda repetir su tomografía de coherencia óptica (OCT).


Wet AMC: Nowadays there is a treatment which intends to “dry” the wet macula. In involves intravitreal injections (inside the eye) of anti-angiogenic substances , which are performed in the OR under topical anesthesia. Their objective is to stop the formation of vessels which produce fluid and bleeding in the macula. Usually, they are applied three times a month but the frequency of application will be determined according to each person’s development, in order to accomplish the goal. In some cases it is possible to delay the time between applications in a progressive way by following the “Treat and Extent” protocol. In other cases, the “PRN” (Pro re nata) protocol is followed. This implies applying the injections when necessary. This model is determined by the specialist in each case in particular, which gives the patients a personalized treatment.



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