Can AMD be treated (and prevented)?

This week, The Count of Monte Cristo. Last week, Red and Black. Throughout his life, since he was a child , Ignacio has been a voracious reader. But now, in his 77 years, he has had to reading and surrendering to audiobooks. He has age-related macular degeneration (AMD), an eye disease that has put a black spot in the center of everything he sees. “First I started reading on a tablet and an electronic book to be able to upload the body of the letter, but, progressively, that stain has spread, like chapapote, and reading is too difficult for me. I have seen my quality of life reduced, but thanks to the treatments I have not completely lost my vision. It’s like having an eclipse in your eye. ”

The name of this disease already defines it: it is a degenerative pathology, that is, its natural tendency is to worsen over time; It affects the macula, which is the central area of ​​the retina, which allows us the most precise vision, the vision of details; and is associated with age: it usually appears in people older than 50 years and its incidence increases as we get older. In fact, AMD is the most common cause of severe visual loss in people over the age of 50 years in the western world. Currently in Spain it is estimated that it affects 700. 000 persons.

I have seen my quality of life reduced, but thanks to the treatments I have not completely lost my vision. It’s like having an eclipse in the eye

Ignacio, AMD patient

“Due to the increase in life expectancy, AMD has gone from being an infrequent visual problem to becoming a real social health problem,” explains Dr. Marta Figueroa, director of the Retina Unit of the Baviera Clinic. “Older people affected can suffer significant visual problems that incapacitate them in their daily life, which causes great disorders for them and their families.”

Late symptoms

“I have never paid much attention to making periodic reviews. I didn’t go to the eye doctor until I started having vision problems. And when they saw me, they told me that the disease had already progressed a lot, ”Ignacio recalls. His is a common case: as in other retinal diseases, AMD does not usually give symptoms until it is in advanced stages. But, although the person does not feel anything, the pathology is already there and can be detected in a review, explains Dr. Figueroa: “In the initial stages of the disease, when there are still no symptoms, small deposits form under the retina which are called drusen. These drusen tend to increase in number with age. ”

The appearance of symptoms is not the same in all patients, and their suddenness will depend on the type of AMD they suffer. “When the disease progresses, it can do so in two directions: towards an atrophic or dry form, which is the most frequent, or towards an exudative or wet form,” continues the retina specialist. And, while vision loss – one of the most frequent symptoms – is progressive in the atrophic form, it is sudden in the exudative form.

Las personas que padecen esta enfermedad conviven con una mancha negra en el centro de todo cuanto ven.

People who suffer from this disease live with a black spot in the center of everything they see.

Other common symptoms that alert us that we may be facing AMD are distorted vision of the shape of objects, wavy perception of lines straight lines and the appearance of blind spots or dark areas in the central vision (central scotoma), which can cause visual difficulties when carrying out daily activities, such as reading, watching television or driving.

Are there effective treatments?

“The wet form is characterized by the growth of abnormal vessels under or within the retina which can cause the accumulation of fluid or blood and a sudden loss of vision. Assume between a 10 and a 15% of AMD cases, is more aggressive and, if left untreated, it can cause severe visual loss in a few weeks ”, describes Dr. Figueroa. “The dry or atrophic form, on the other hand, is characterized by a progressive thinning and deterioration of the macula, which is accompanied by a loss of vision.”

The latter, the most frequent , is the one that Ignacio suffers. “I have been losing sight over the years, it has not been all at once. I know people who have the other form of AMD and for them it was a shock , because in a matter of no time they were left almost without seeing ”. In these cases of wet AMD, treatment is urgent if we want to avoid irreversible destruction of central vision in a short period of time.

The objective of this treatment with drugs administered directly into the eye is to stop the loss of vision and in many cases it is also possible to improve it

Marta Figueroa, director of the Retina Unit of the Baviera Clinic

Fortunately, in recent years there have been great scientific advances in the treatment of wet AMD, explains Dr. Figueroa. “This has been the case thanks to the introduction of so-called antiangiogenic drugs that, administered by injection into the eye, inactivate and stop the growth of these abnormal vessels. The objective of this treatment with drugs administered directly into the eye is to stop vision loss and in many cases it is also possible to improve it ”. But it should not be forgotten, he continues, that “injections usually have a temporary effect, so periodic reviews and injections are usually necessary.”

Regarding dry AMD, the results The efficacy of the different drugs that have been tested have not been completely satisfactory. “The administration of oral antioxidants is only recommended to slow the progression of the disease.”

But there are good expectations: at the moment there are various treatments under investigation. Among them, gene therapy, in which “thanks to a surgery the treatment that seeks to genetically modify the cells is injected under the retina to stop or reduce the progression of the disease. Other treatments under study are administered by intraocular injections and even orally. Although these studies are still in the initial stages, they open a door to hope for the treatment of patients suffering from this disease. ”

The target, detect it in time

There are several precautions to avoid a runaway evolution of the disease. Heredity, environment and lifestyle are determining factors.

– It is advisable to carry out routine ophthalmological controls from the 50 years, which is the age at which the eyes begin to show greater symptoms of aging.

– If you have relatives who have suffered from the disease, this periodic monitoring is very important, since AMD has a hereditary component that increases the risk of suffering from it 3 to 6 times.

– Ophthalmological examinations must be complete and include an eye fundus in order to appreciate the typical lesions of this disease. Another very useful diagnostic test is optical coherence tomography (OCT), which takes less than a minute.

– We must avoid risk factors, such as tobacco or exposure to ultraviolet light.

– It is advisable to follow a healthy diet, rich in fruit and vegetables. Sometimes, and depending on the severity of the lesions, your ophthalmologist may recommend taking antioxidants.

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