Macular degeneration or age-related macular degeneration (DMU) is the leading cause of blindness in individuals aged 60 years and over. This disease affects the macula, the part of the retina that focuses on concentrated vision. People with DMU can still read, drive, and focus their eyes on faces and other objects. Although until now there is still no cure for DMU, you can reduce the symptoms of the disease by making some lifestyle changes, eye therapy, and other preventive measures.
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Part 1 of 5: Understanding DMU Penyakit
Step 1. Know the levels of DMU
Your ophthalmologist will determine the level of DMU you have based on the amount of drusen found in your eye. Drusen are white or yellow dots on the retina.
- Beginning level: medium-sized drusen equal to the width of a strand of hair without loss of vision.
- Intermediate grade: large drusen and/or pigmentary changes, usually without loss of vision.
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Final level: this section is of two types:
- Geographic atrophy/dry macular degeneration: photoreceptors on the macula are damaged. The eye cannot use light to channel vision to the brain. Sufferers may experience gradual symptoms in this condition and experience a loss of vision.
- Neovascular macular degeneration or wet macular degeneration: caused by abnormal growth of blood vessels that causes them to swell and rupture. Fluid builds up in and under the macula and causes vision changes. Symptoms in this type last faster than dry macular degeneration.
Step 2. Understand what causes dry macular degeneration
Dry macular degeneration is caused by the degeneration of cells in the retina. Degeneration or drying of these cells and lack of fluid makes it referred to as dry degeneration. These cells are also known as photoreceptors, or cells that use light that enters the retina to help our brain perceive objects using the visual cortex. In general, this part – which is sensitive to light – helps us to understand what we are seeing.
- Degeneration occurs because a fatty acid called drusen builds up in the macula as we age. On eye examination, the buildup can be observed as yellow spots on the macula. Although DMU does not result in total blindness, it can significantly reduce the visual field of view.
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Dry macular degeneration is more common than wet macular degeneration. Here are the signs and symptoms of dry macular degeneration:
- The writing looks blurry.
- Need more light to read.
- Hard to see in the dark.
- Difficult to recognize faces.
- Reduced center of view.
- Blind spot in the field of view.
- Gradual decrease in the ability to see.
- Various inanimate objects or geometric shapes are sometimes mistaken for people.
Step 3. Recognize wet macular degeneration
Wet DMU occurs when blood vessels grow abnormally under the macula. As the macula increases in size, the blood vessels will begin to leak fluid and blood into the retina and macula or, sometimes, rupture completely. Although wet macular degeneration is less common than dry macular degeneration, its effects are more aggressive and can lead to blindness. To date, the cause of macular degeneration is unknown; however, several studies have found that there are certain factors that can make everyone suffer from the disease in old age. Signs and symptoms include:
- Straight lines look wavy.
- The appearance of blind spots in vision.
- Rapid loss of vision.
- No pain.
- Injured blood vessels that can lead to permanent vision loss if not treated as soon as possible.
Part 2 of 5: Knowing the Risk of Getting DMU
Step 1. Understand the aging process
Macular degeneration is a common age-related disease. With age, the risk of developing DMU also increases. At least one in three adults over the age of 75 has DMU.
Step 2. Know the role of genetics
If one or both of your parents suffered from macular degeneration, chances are, you will also experience it when you are over 60 years old. However, remember that genes are not the only factor and that how you take care of yourself will also have an effect.
In general, women and white people have a higher risk of contracting the disease
Step 3. Understand that smoking is a high risk factor
Smokers have a great risk of developing this disease. Several studies have shown an association between smoking and macular damage. Cigarette smoke is also correlated with damage to the retina.
If you smoke (especially if you are a woman or a white person), macular degeneration is something you should be very aware of long before symptoms appear
Step 4. Observe health conditions
Your overall state of health can be a major factor in the development of DMU. People who suffer from certain diseases such as high blood pressure and diabetes have a high risk of developing DMU.
Individuals who do not have diabetes and have a diet consisting of carbohydrates with a high glycemic index are also more likely to develop DMU in old age. Keep in mind that one of the signs of wet macular degeneration is leakage of blood from vessels in the retina. This condition will get worse if you have clogged arteries due to too much plaque deposit
Step 5. Check the area around you
How often are you exposed to fluorescent lighting? Studies have shown that there is a possible correlation between fluorescent lighting and the risk of developing eye diseases. In addition, if you live in an area where your eyes are often exposed to sunlight, your risk of developing DMU is also greater.
Part 3 of 5: Getting Treatment for DMU
Step 1. Visit the nearest ophthalmologist
In a routine eye exam, the doctor will diagnose with eye drops to enlarge the pupil. If you have dry macular degeneration, your ophthalmologist can easily detect the presence of drusen during an examination.
Step 2. Observe the Amsler squares
You will also be asked to see an Amsler tile that looks like a grid of paper. If you notice the lines are wavy, you most likely have macular degeneration. To check for these symptoms, print out the Amsler swath test from the Blindness Prevention Site and follow these instructions:
- Place the chart at a distance of 61 cm from the eye.
- Put on your reading glasses and cover one eye with one hand.
- Focus on the point in the center of the graph for one minute. Repeat with the other eye.
- If any of the lines on the graph look wavy, see a doctor immediately.
Step 3. Ask your ophthalmologist for an ocular angiogram
This method is done by inserting paint on the veins in the arm. As the paint flows into the vessels in the retina, several photos will be taken to observe it. This method can detect the presence or absence of leaks in the vessels that indicate the presence of wet macular degeneration.,
- The paint will be observed entering the optic nerve about eight to twelve seconds after the injection.
- The paint will be visible in the retinal area about eleven to eighteen seconds after the injection.
Step 4. Perform an optical coherence tomography examination
This examination is done to observe the layers of the retina using light waves. This test can check for retinal thickness, retinal layer anatomy, and abnormalities in the retina such as fluid, blood, or new blood vessels.
- First, the doctor will dilate your eye, although optical coherence tomography can also be done without having to dilate the pupil.
- Afterward, you will be asked to place your chin on a support to stabilize your head, preventing it from moving.
- The beam of light will be directed into your eyes.
- By using light waves, tomography will detect living tissue quickly without causing the slightest pain.
Step 5. Consider getting an injection of an anti-FPEV agent
Vascular endothelial growth factor (FPEV) is a chemical that causes abnormal growth of blood vessels. When FPEV is suppressed using anti-FPEV or antiangiogenic, blood vessel growth may be reduced. Whether or not you get an injection of an anti-FPEV agent will be determined by your doctor.
- One example of an antiangiogenic is bevacizumab. The commonly used injection dose is between 1.25 to 2.50 milligrams into the vitreous cavity of the eye. This medication is usually given once every four weeks over a period of four to six weeks. The antiangiogenic ranibizumab was given at a dose of 0.50 mg, while aflibercept at a dose of 2 mg.
- The injection is done with a very small needle along with a local anesthetic to prevent pain. In general, this procedure causes little discomfort.
- Some of the side effects that can arise include increased intraocular pressure infection, bleeding, and damage to the lens.
- You will have better eyesight within a year. Vision improvement will start at two weeks and peak at three months after the third injection.
Step 6. Find out about photodynamic therapy
This method combines medication and light therapy to stop the growth of blood vessels and is only effective for wet macular degeneration.
- This therapy consists of two stages and is carried out in one day. First, a drug called verteporfin or visudyne will be injected into the vein. This drug works to stop the growth of additional blood vessels that occurs in wet macular degeneration and is given fifteen minutes before photodynamic therapy.
- After that, light with a certain wavelength will be emitted into the eye, especially on the abnormal blood vessels. The light will activate the verteporfin that has been given to seal the leaking blood vessels.
- Because the light is given at a specific wavelength, the injured tissue will not be disturbed.
- Consult your doctor about whether or not this therapy is right for you. Anti-FPEV has now become the standard treatment method. Photodynamic therapy is sometimes also used in conjunction with anti-FPEV therapy.
Step 7. If you experience severe symptoms, seek medical attention immediately
If you experience a sudden headache, a change in your ability to see, or experience unexplained pain while on treatment for macular degeneration, go to the nearest emergency room and call your ophthalmologist.
Part 4 of 5: Using Adaptive Tools to Support Vision
Step 1. Use a magnifying glass
In macular degeneration, the area most affected is the center of vision, with peripheral vision still partially functioning. With this condition, people suffering from macular degeneration will still be able to use peripheral vision to see. A magnifying glass can help make things appear larger so they are easier to see.
- The available magnification variations are in the range of 1.5 to 20 times the magnification. The magnifying glass is also easy to carry around. Many of these are available in pocket sizes.
- Try a standing magnifying glass. This type of magnifying glass varies from two to twenty times the magnification. It can also be placed on a table so you don't have to hold it all the time. This type of magnifying glass is especially helpful for patients who have unstable hands. Some of them also have additional lighting features to help see in dimly lit places.
Step 2. Try using a monocular or a telescope
This tool varies between 2.5 and 10 times the magnification and is useful for viewing objects that are very far away.
Step 3. Use binoculars
With the same magnification variation as a telescope, binoculars allow you to use both eyes to see objects.
Step 4. Try using loupe for glasses
This type of magnifying glass is attached to the patient's glasses and is useful for distance vision. This tool allows the patient to see far away with a telescopic effect. In addition, lenses for normal vision are also available.
- This tool works like a bifocal.
- The use of this tool has been approved and prescribed by an ophthalmologist who specializes in low vision.
Step 5. Use video magnifier
This video camera will enlarge the text to the screen. You can use these tools to help you read, write, work, and view photos. Some of them can be used to underline certain information. This tool can also be used with a computer.
Step 6. Use a reader with voice output
This machine will read the typed text.
Use ocular recognition software to turn your computer into a reading machine.,
Step 7. Find an absorptive lens
This type of lens functions by absorbing light that passes through the eye, reducing its intensity and shielding the eye from damaging ultraviolet light.
- Absorptive lenses can be transitioned from light to dark areas.
- These lenses can also be worn in conjunction with prescription eyeglasses.
Part 5 of 5: Caring for the Eyes
Step 1. Get regular eye exams
Macular degeneration cannot be prevented because it is connected to aging. However, regular eye exams can detect symptoms as early as possible and lead you to appropriate treatment. If macular degeneration is detected early, you can significantly delay the loss of vision.
Starting from the age of 40 years, routine eye examinations should be done at least once every six months or as advised by your doctor
Step 2. Ask your doctor for a specific eye exam
The ophthalmologist will perform several types of eye exams to detect the presence of drusen, vessel damage, pigmentary changes in the retina, or visual disturbances. Examples of these checks are:
- Visual acuity test: this test tests your vision at a certain distance using a chart.
- Amsler plot: this test tests for the presence or absence of central visual disturbances by asking the patient whether they see straight or wavy lines on the grid. If the patient tells that they see wavy lines, it is indicated that the patient has macular degeneration.
- Pupil dilation examination: in this examination, the pupil is dilated so that the doctor can see the optic nerve and retina to check for damage. The doctor will also check for pigment changes in the retina. The presence of pigment in the retina indicates poor light reception.
- Fluorescein angiogram: this test is done to examine the arteries in the eye to detect the presence or absence of leaky blood vessels. The doctor will inject a paint material into the patient's arm.
- Optical coherence tomography: this test is performed after first dilating the pupil. Infrared light is used to scan the retina to look for damaged areas.
Step 3. Avoid smoking
Apart from the other damaging effects it has on the body, smoking can also cause macular degeneration. Cigarettes contain tar which can stimulate the formation of drusen. In addition, cigarettes also contain caffeine, a stimulant that can increase blood pressure. Blood vessels under the retina and macula can rupture easily if your blood pressure is high.
- Smoking can double your chances of developing macular degeneration. Cigarettes are bad for you, your organs, your eyes, and everyone around you.
- Even after you quit smoking, it can take several years for the effects to wear off completely. Therefore, if you are still smoking, stop as soon as possible.
Step 4. Take control of a disease you already have, such as high blood pressure
Take medication, have regular check-ups, and change your lifestyle.
If you have hypertension and are diagnosed with wet macular degeneration, the already damaged blood vessels in your eyes will have a hard time dealing with high blood pressure. This condition will cause the blood vessels to rupture more easily, and will lead to leakage
Step 5. Do exercise regularly
Exercise will bring benefits to health, including for the eyes. The formation of drusen is associated with high levels of cholesterol and fat. Exercise can burn fat and reduce bad cholesterol thereby preventing the buildup of waste in the eyes.
You should exercise at least three times a week. Make sure you concentrate on aerobic exercise that can make you sweat and burn fat
Step 6. Increase your vitamin intake
Your eyes are constantly exposed to ultraviolet light from the sun and pollutants from smoke. Exposing your eyes to these elements can result in oxidative damage. Oxidation of eye cells can lead to macular degeneration and other eye diseases. To deal with this condition, you must eat foods that contain lots of antioxidants. Commonly found antioxidants that can help you include vitamin C, vitamin E, zinc, lutein, and copper.
- Vitamin C: the recommended daily dose of vitamin C is 500 mg. Good sources of vitamin C are broccoli, cantaloupe, cauliflower, guava, bell pepper, grapes, oranges, berries, lychees, and squash.
- Vitamin E: the recommended daily dose of vitamin E is 400 mg. Examples of good sources of vitamin E: almonds, sunflower seeds, wheat germ, spinach, nut butter, green broccoli, avocado, mango, pecan, and beetroot.
- Zinc: the recommended daily dose of zinc is 25 mg. Some good sources of zinc are: fat-free meats, skinless chicken, low-fat lamb, pumpkin seeds, yogurt, soybeans, nuts, flour beans, sunflower butter, pecans, lutein, kale, spinach, beet greens, lettuce, asparagus, okra, artichokes, watercress, persimmons, and green beans.
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Cuprum, lutein, and zeaxanthin: Lutein and zeaxanthin can be found naturally in the retina and lens of the eye. Both function as antioxidants, helping to absorb excess light and ultraviolet light. Both can also be found in green vegetables.
- Take two milligrams of copper every day.
- Take ten milligrams of lutein daily.
- Take two milligrams of zeaxanthin daily.
Step 7. Reduce the consumption of beta carotene
According to research, beta carotene can increase the risk of developing lung cancer, especially if you are a smoker. Research has also shown that beta carotene has no effect in reducing the development of DMU. Today, doctors usually prescribe supplements that do not contain beta carotene.
Step 8. Wear eye protection equipment, such as sun glasses
Excessive exposure to ultraviolet light can damage the eyes and promote macular degeneration. Choose sun glasses that are certified against ultraviolet and blue light for the best protection.
Step 9. Perform certain activities with caution
Some activities that at first glance seem like normal activities must be faced with caution. Depending on the degree of your visual impairment, some things must be done with the help of a colleague, friend, or family member. Instead of putting yourself at risk, you should ask for help in doing:
- driving
- Riding a bicycle
- Operate heavy equipment
Step 10. Recognize that, as a person with DMU, you may feel that you are losing control of your life
However, as a patient, there are things you can do with an ophthalmologist's care to help shore up your situation. Searching for adequate information is the best way to fully understand the disease and find out what treatment you can get. Start by learning about DMU, available treatments, and the latest technologies that have been developed to help with rehabilitation.
