Age-related macular degeneration (AMD) is a disease that affects the macula, a small but essential part of the retina responsible for central vision. AMD is common among the elderly, with approximately 1.3 million French individuals affected, most of whom are over 50 years old. It is a leading cause of visual impairment, as it can gradually destroy the central part of the eye's retina.
Two major forms of AMD are now recognized: the wet form, which progresses rapidly, and the dry form, which progresses more slowly but can also be destructive. While there are therapies available to halt the progression of the wet form, there is currently no treatment for the dry form, which affects the daily lives of 800,000 people. There is hope, however, as ongoing studies are evaluating molecules that may prevent the premature death of retinal cells.
AMD can lead to difficulties in reading, watching television, and driving, as it severely affects central vision. However, peripheral vision remains intact, allowing affected individuals to maintain some degree of independence in daily activities such as dressing and eating.
The primary cause of AMD is age. As individuals get older, their risk of developing AMD increases. AMD affects approximately 1% of individuals aged 50 to 55, 10-12% between the ages of 55 and 65, 15 to 20% of those aged 64 to 75, 25% of those over 75, and 30% of those over 80.
Other risk factors identified by epidemiological studies include smoking, which can increase the risk of AMD sixfold, and obesity, which also significantly raises the risk. Additionally, a history of cataract surgery and a family history of AMD are risk factors. Women are more commonly affected by AMD than men.
Preventing AMD involves paying particular attention to several factors:
Regular Eye Check-ups: It's crucial to have regular eye check-ups with an ophthalmologist starting at the age of 50 to detect any white spots on the back of the eye.
Avoiding Smoking: Smoking increases the risk of developing AMD, so quitting smoking is essential.
Balanced Diet: A balanced diet rich in Omega-3 fatty acids (found in fatty fish) and low in lipids can help. Omega-3 deficiency can lead to a reduction in DHA in the retina, while an excess of Omega-6 fatty acids increases the risk of AMD.
Controlling Other Risk Factors: Reducing other risk factors like obesity is also important. When AMD is diagnosed, the doctor often strongly advises patients to reduce or quit smoking to limit the progression of the disease.
Eye Examination: The only way to diagnose AMD is through an eye examination, which is recommended from the age of 55, or even 50 if there is a family history of AMD.
It is recommended to consult an ophthalmologist as soon as possible to diagnose AMD and preserve visual function for as long as possible.
Early diagnosis, starting at age 50, through an ophthalmologist's examination, can significantly reduce the risk of vision loss. While AMD does not typically cause complete blindness, if it is not diagnosed in time and adequately managed, it can lead to complications in daily life, particularly in activities such as reading, writing, driving, and recognizing faces.
Consultation for Symptoms:
A decrease in vision in an older person should not be attributed solely to aging. It is advisable to consult an ophthalmologist, especially if the vision loss occurs rapidly, if straight lines appear suddenly curved, if there is a perception of insufficient light for reading or writing, or if there is a central spot in the field of vision. These could be signs of a scotoma (a blind spot). Only an ophthalmologist can perform various examinations before diagnosing AMD:
Measuring visual acuity at both near and far distances.
Conducting a painless examination of the back of the eye to identify abnormalities such as small white spots.
If necessary, performing angiography and OCT (Optical Coherence Tomography): These are complementary examinations that involve photographing the retina after injecting a fluorescent dye into a vein in the arm. OCT uses a light source to create images.
As explained by Dr. Salomon-Yves Cohen from the Paris 15th Ophthalmological Imaging and Laser Center, early diagnosis is crucial. AMD affects only the eyes and not the entire body. It is not a global degeneration but specifically affects the central retina. While central vision is at risk, peripheral vision remains intact. People can still feed themselves, dress themselves, and maintain daily independence.
Therefore, it is recommended to regularly perform self-checks, covering one eye at a time, and consult an ophthalmologist promptly if you notice distortions in straight lines and rapid vision loss. Only in-depth examinations can lead to proper management, including:
Visual Rehabilitation: This aims to make the best use of remaining vision and can be done by an orthoptist or at a rehabilitation center.
Regular Medication Injections: These injections can help block the development of harmful blood vessels in some forms of wet AMD.
Photodynamic Therapy (PDT): In certain cases of AMD, PDT can destroy abnormal blood vessels that proliferate in the retina and disrupt vision.
Nutritional Supplements: Some supplements, such as vitamins C and E, beta-carotene, zinc, copper, and essential Omega-3 fatty acids, can help slow the progression of the disease.
Optical Magnification Devices: Devices like magnifying glasses can be used when vision is severely affected.
It's important to note that these treatments are effective mainly for the wet form of AMD and can slow or block the uncontrolled proliferation of new blood vessels. Currently, there is no effective treatment for the dry form of AMD, although molecules are being evaluated to prevent the premature death of retinal cells. The development of a medication for this form may take around ten years.
In conclusion, it is advisable to consult an ophthalmologist as soon as possible for the diagnosis of AMD to preserve visual function for as long as possible.
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