Macular Degeneration

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The eyeball consists of refractive settings that focus light on the retina from front to back. The cornea in front, and the lens behind it focuses light on the macula, the most sensitive area of the retina.
The eyeball consists of 3 layers from the inside out: the retina is the innermost, the vascular layer in the middle, and the white of the eye, which gives the eyeball its rigidity, is the outermost.
Objects can be seen when the rays coming from the objects focus on the retina. There are cells in the retina that convert light energy into electrical energy and transmit it to the brain.
The region called the macula or yellow spot is the region where the light is fully focused and the sharpest vision occurs. The image is transmitted to the brain most clearly by the cone cells in this area. 90% of visual acuity is formed in the yellow spot and 10% is formed in the surrounding retina and then transmitted to the brain.

The yellow spot is the retinal region where lifelong high light-chemical and metabolic reactions occur. With increasing age and genetic predisposition, metabolic residues cannot be cleared from this region after the age of 50 and begin to accumulate. These yellow dots that accumulate in the retinal layers are called drusen.

In electron microspic sections, metabolic wastes are seen to accumulate under the retinal pigment epithelial cells in the form of fat deposits called drusen.
These accumulated fats prevent the retinal pigment epithelium from receiving oxygen and nutrients from the large choroidal vessels. The cells above the fat deposits die. This condition is dry macular degeneration.
The pigment epithelium has stem cell characteristics and these cells secrete growth factors for the viability of photoreceptor cells. When these cells die, the photoreceptor cells above them also go into sleep mode. In order for these cells to continue their viability, new glomerulus are formed. However, since these glomerulus are fragile and thin, they cause bleeding and leakage from the vessels, leading to the damaging of photoreceptor cells.

This condition is wet macular degeneration.

The stage in which fat cells called drusen accumulate and pigment epithelial cells enter sleep mode is called early-stage dry senile macular degeneration (SMD).
Diagnosis is very important during this period. Very serious measures should be taken to stop the progression of the disease, with these, the course of the disease can be slowed.
If the disease progresses further, the pigment epithelial cells begin to die. In this case, central vision is reduced. This stage is called atrophic, that is, dry SMD.

If new vessel formations occur in the area where the pigment epithelial cells die, this stage is called wet SMD. This is the most critical stage, and it causes severe vision loss.
At this stage, medication injections called anti-VEGF are administered into the eye. With this, it is aimed to shrink/close the new vessels that are suitable for bleeding and to reduce/remove the edema in the macula. Otherwise, significant hemorrhage may develop under the macula and into the vitreous.
Approximately 8 intravitreal injections are required in the first year, and these injections are often effective. However, there are cases that are resistant to injection. In this case, the drugs used for injection are changed or combined.

Again, if there is no response to the injections, "photodynamic laser therapy" should be considered, in which a special drug is injected into the arm's vein and at the end a special laser is applied that only closes the damaged new vessel formations.
If unwanted glomerulus cannot be controlled, excessive bleeding occurs in the eye.
When bleeding recedes, it is seen that all retinal layers in the macula are damaged, forming scar tissue and atrophy (disciform scar stage). As a result, central vision is severely affected and the patient sees only with their peripheral retina.

Symptoms, complaints and management of macular degeneration
It is very important for early diagnosis that everyone over the age of 50, especially with a family history of macular degeneration, should have an eyeball check at least once a year.
The patient may not have any complaints in the early stage, that is, in the stage where the fats called drusen start to accumulate in the yellow spot. At this stage, for smokers to quit smoking, controlling hypertension and cholesterol and fighting obesity severely slow down the rate of progression of the disease.
Again, in the early stage, the intake of nutritional supplements rich in antioxidant minerals and vitamins and the intake of vitamin complexes will slow down the course of the disease. B12-b6-b1- folic acid and omega-3 are especially necessary for the vital activities of neuronal cells, while vitamin a-lutein-carotene is necessary for the synthesis of pigments used in photoreceptors to perform their vision function.
In particular, carbohydrate and sugar consumption should be avoided.

Mediterranean diet

  • Grilled salmon: 2 days a week (all fatty fish are allowed, provided that they are grilled-fried fish has no benefits.)
  • Plenty of green salads + grated carrots
  • Soft-boiled eggs: 3 days a week (boiled egg with apricot consistency)
  • Raisins with black seeds (fresh when in season) : 1 handful 1 day a week
  • Raw almonds: 1 handful 1 day a week
  • Walnuts: 1 handful 1 day a week
  • Kefir: 1 glass 2 days a week
  • 30 minutes of walking outdoors every day
  • Absolutely no smoking
  • Abstinence from alcohol

should slow the rate of progression of the disease considerably.

Protective glasses:
Filtering of blue-violet light that are at a wavelength of 415-455 nm reduces the photoreceptor death rate by 25%.
500 nm orange lenses are recommended for patients suffering from excessive glare where the initial cataract or cone cells are also affected.
In the early stage, amsler grid test is used for self-examination and follow-up of patients at home.

After wearing reading goggles in a well-lighted room, look at the squared paper that your doctor will give you first by covering one eye with your palm and then doing the same for the other eye few times a week.
If there are refractions in the lines or inability to see the middle point in the center, the disease has passed from the early stage to the advanced stage. Consult your ophthalmologist as soon as possible.
If the diagnosis is of atrophic type, the retinal pigment epithelium is usually in sleep mode at this stage. At this stage, the pigment epithelium is awakened with a micropulse-sub-threshold laser. With the application of this non-burning laser, both growth factor release and biophotomodulation are provided, and the pump function of the pigment epithelium is stimulated and the drusen clearing is accelerated. At this stage, together with micropulse laser, growth factor injections can also be applied to the outside of the eyeball. Magnovision support is applied if necessary.

If straight lines such as door edges or flagpoles appear refracted or loss of central vision has begun, it means that the wet stage has begun.
New vessel formations in the wet stage; it should be dried with intraocular injection treatments and, if necessary, photodynamic laser treatment. Otherwise, very serious vision loss occurs at this stage.
If permanent loss of central vision occurs; low vision rehabilitation devices such as telescopic glasses, light magnifiers, cctv camera systems will especially facilitate reading.
Implantable miniature telescope surgeries may be a good option in appropriate cases for patients who have lost their central vision in both eyes due to macular degeneration.
At the end of the cataract operation, these special lenses are placed inside the eyes and these lenses focus the image on the yellow spot.
With a prismatic effect, these telescopes magnify and shift the image to an intact retinal area other than the damaged yellow spot.