Macular Degeneration (MAD)

Macular Degeneration Impairment (MAD) is, as the name suggests, a degenerative disease that usually appears with age, in the fifth or sixth decade of life.

It does not cause blindness, but makes daily activities like reading, seeing money or recognising people's faces more difficult or impossible.

Without treatment the vision loss worsens. In the case of dry AMD, it develops slowly and progressively. Wet AMD, or exudative AMD, presents with a sudden loss of vision or a rapidly progressive form, over a short period of a few weeks 

The cause is unknown and appears to be linked to smoking, high blood pressure, obesity and a family history of IMD.

The symptomatology is variable and also depends on whether it is bilateral or not. 

It usually manifests itself with a deformation of the letters when reading, in the centre of the vision, i.e. in a word, only the letters in the centre are deformed. Later on, as the disease progresses, the area of deformation increases, making reading almost impossible. Over time the letters start to disappear and later a central area of non-vision (central scotoma) settles in, preventing the recognition of everything in which the gaze is fixed. A black spot that prevents you from reading, identifying people's faces, seeing coins in your hand, driving, watching television, everything you do day to day becomes impossible. A dark spot is always covering up everything you stare at. 

Other symptoms may include decrease in size of objects, straight lines appear wavy with deformation and colours appear faded. 

Usually the disease starts with one eye. At an early stage it is therefore difficult for the patient to identify the difficulties, because the good eye helps to hide the defects.  

Once the disease is established, the interference with vision is such that the sufferer realises that something is wrong. By covering one eye and the other he can identify the existence of the problem.

The best way to identify the disease is always to see an ophthalmologist.

At the consultation, direct observation of the fundus of the eye allows the doctor, most of the time, to identify the disease. Occasionally, it turns out to be a finding of the routine consultation to evaluate the refraction.

In order to make a correct diagnosis and to establish treatment, the doctor will order an OCT which allows you to see the stage of the disease and sometimes an angiography to better characterise the lesions.

As it is a dry, atrophic form of ARMD, it is, as has already been said, a progressive situation that will always end with the loss of the central part of the vision. In these cases, therapy is limited to monitoring and administering supplements and correcting risk factors, if any, such as smoking or correcting arterial hypertension, in order to delay as long as possible the inevitable loss of sight. 

Wet or exudative IMD is sometimes an acute situation, although most of the time it starts insidiously, but evolves relatively quickly, in weeks or months, with the aforementioned symptoms, of which the most important initially is the early identification of the image deformation. Once identified, it should be treated as soon as possible. 

Exudative AMD is the appearance of sub-retinal neovessels (new vessels that did not exist before) in the central part of the macula, forming a vascular membrane that destroys the anatomy of this very important area in terms of vision. As they are non-specialised blood vessels, they end up letting out blood components around them, hence the name exudative, creating a screen area that impedes vision.

Dry AMD is the most common and vision loss is very slow over time. 

Their treatment, based on the AREDS study, may be able to delay degeneration and consists of the administration of vitamin C, vitamin E, zinc and beta-carotene.

The formula was updated in AREDS2 by adding lutein, zeaxanthin, and omega-3. Beta-carotene has been removed from this formula as it has been linked to an increased risk of lung cancer in smokers. 

Dry AMD accounts for 90% of AMD cases and can progress to the wet form.

Exudative ARMD, although it only accounts for 10% of cases is the leading cause of blindness, related to macular degeneration

Its treatment consists of an intravitreal injection of anti-VEGF drugs (which fight the growth and are able to destroy the neovessels), and is currently the most effective weapon to prevent the progression of the disease and achieve, in some cases, remission with a substantial gain in visual acuity. In most cases, it is necessary to repeat the injections at one-month intervals. In other, more difficult, cases, the administration ends up extending over time.

Photodynamic therapy is another type of treatment, but less used, and consists of the intravenous administration of a drug that has an appetite for neovessels and the application of a laser that will selectively activate the injected substance, destroying the abnormal vessels.

Direct laser treatment to destroy the neovessels is another way to treat the disease.

The results of the treatment are variable, with a recovery of visual acuity, most of the time only partial, but which allows the patient to resume his or her daily activities.

It is an evolving disease and even with proper treatment, useful vision is not always achieved.

In any case, it never ends in total blindness. This is because the remaining retina is not affected and the patient can maintain the visual field. After some training he can see by looking a little sideways and can distinguish and see his surroundings clearly.

Like all diseases, prevention is the best medicine. 

Quitting smoking, a healthy diet, exercise, control of obesity and blood pressure and vascular diseases are important factors. 

If you have a family history of the disease you should see an ophthalmologist every year. In this case, you can also use the Amsler grid, which is placed in a visible place, usually on the refrigerator door. The grid consists of a grid with a central point. The patient fixes the central point, and while keeping the fixation on the point, try to see if he can see the 4 corners, if he notices any deformation of the lines or absence of squares. If so, the patient should consult an ophthalmologist.