Macular Degeneration Without Early Symptoms… Eye Examinations Are Essential After Age 50[베스트 닥터의 베스트 건강법]

Park Gyu-hyung, Professor of Ophthalmology, Seoul National University Hospital
Aging is the main cause, and the number of patients in their 40s has recently increased… It is easy to develop the disease as there are almost no initial symptoms
When symptoms appear, it is already terminal, and there is a risk of blindness… Objects appear crooked and the center is completely black
Amsler grid test – regular eye examinations are necessary… Quitting smoking – healthy diet – exercise are the best prevention methods

Professor Park Gyu-hyung of the Department of Ophthalmology at Seoul National University Hospital urged people to actively respond to macular degeneration, one of the three major blinding diseases, rather than simply considering it as a disease caused by aging. Professor Park recommended that people regularly self-diagnose macular degeneration and receive an eye exam every year after the age of 50. Provided by Seoul National University Hospital

Mr. Sang-Hyeon Ahn (pseudonym, 55) was always confident in his health. He also exercised frequently. Although his eyesight deteriorated slightly due to his age, it did not interfere with his daily life at all. Then, a few years ago, while traveling abroad, he found out that there was something wrong with his eyes.

I woke up early to see the sunrise. The moment the sun rose, the scenery suddenly looked distorted. I went to the hospital as soon as I got back. I was immediately examined. I was diagnosed with macular degeneration in both eyes. My right eye’s vision had deteriorated to the point where I could no longer use it. My left eye was already quite sick.

Professor Park Gyu-hyung of the Department of Ophthalmology at Seoul National University Hospital, who was in charge of Ahn’s treatment, said, “Ahn’s right eye vision was less than 0.1, and his left eye vision was less than 0.5.” Ahn is currently almost blind. Professor Park lamented, “If the disease had been discovered earlier, he could have preserved his vision to the point where he could live a normal life.”

● Let’s learn about macular degeneration

There is a thin, transparent membrane inside the eyeball. It is the retina. It converts the light information that enters the eyeball into electrical information and transmits it to the brain. The macula is located in the center of the retina. It is called the macula because it looks yellow due to the greenish-yellow pigment it contains. Macular degeneration begins when waste products called drusen accumulate in the macula. As the waste products increase in number and become larger, the photoreceptor cells densely packed in the macula die. Photoreceptor cells are responsible for receiving light. When photoreceptor cells begin to die, vision deteriorates significantly.

If left untreated, abnormal blood vessels will begin to form in the macula over time. These blood vessels will burst, causing bleeding and scarring. The stage before abnormal blood vessels form is called dry macular degeneration, and the stage after is called wet macular degeneration. It usually worsens from dry to wet. As wet macular degeneration progresses, the risk of blindness also increases.

Macular degeneration is one of the three major blinding diseases along with glaucoma and diabetic retinopathy. In the case of macular degeneration, the ‘central vision’ that sees the center of the field of vision falls below 0.1, so only the peripheral part can be seen dimly. This causes serious problems in daily life.

The biggest cause of macular degeneration is aging. According to the recent National Health and Nutrition Survey, the prevalence of macular degeneration is 11% in the 50s, 20% in the 60s, and 31% in the 70s and above. The prevalence increases with age. In the case of people in their 70s, more than 3 out of 10 sufferers of macular degeneration. Professor Park said, “The rate of increase in macular degeneration patients is very fast. Compared to 10 years ago, it seems to have increased by about 2 times.”

Recently, the number of patients in their 40s has been increasing. Professor Park said, “The prevalence of patients in their 40s with macular degeneration was 1% 10 years ago, but recently increased to 3.6%.” What is the cause? Professor Park explained, “Like cardiovascular disease, macular degeneration is a systemic disease,” and “Westernized eating habits, lack of exercise, obesity, high blood pressure, smoking, etc. are all direct causes of macular degeneration.” Sometimes, macular degeneration occurs in adolescents, people in their 20s, or people in their 30s. This is not related to aging. In these cases, it is usually caused by high myopia or genetic problems.

● In the beginning, you can hardly feel any symptoms.

Professor Park said that cases like Mr. Ahn’s are common among patients with macular degeneration. Even if you have macular degeneration, there are almost no early symptoms, so you often don’t realize it. Professor Park explained, “Even if macular degeneration progresses in one eye, if the vision in the other eye is still intact, you can hardly notice the disease.”

When it is dry macular degeneration, there are few symptoms, so there is a high probability that the disease will not be recognized. In the early stages, even the vision itself does not decline at all. It is difficult to detect the disease unless it is examined separately. Vision declines rapidly in the final stages when waste accumulates severely and the retina atrophies. If the disease worsens to this extent, vision may not be saved.

In the case of wet macular degeneration, symptoms appear immediately. Abnormal blood vessels burst in the macula, causing scarring, and the macula itself cannot function properly. Naturally, objects cannot be seen properly. If the symptoms are mild, the central part appears distorted or crooked. If it gets worse, the central part becomes so dark that it is impossible to see at all. Professor Park emphasized, “If symptoms appear at this level, treatment becomes difficult and vision can be lost,” and “It is best to visit a hospital before the symptoms worsen.”

Fortunately, self-diagnosis is possible to some extent. Professor Park recommended the ‘Amsler grid test’. It is said to be helpful in detecting the disease before the middle stage of dry macular degeneration.

Attach the checkerboard-shaped test sheet to the refrigerator or wall at eye level. Make sure the lighting is bright. If you wear glasses or contact lenses, wear them while taking the test. Cover one eye from about 3 cm away and look at the center of the test sheet. Test both eyes alternately.

If the checkerboard pattern appears straight, it is normal. However, if there are parts that appear curved and black, or parts that appear broken, there is a high possibility that macular degeneration is in progress. It is best to go to the hospital and receive treatment quickly. Professor Park said, “This test is so reliable that even ophthalmologists perform it themselves, so it is best to do it as often as possible.”

● Treatment varies by stage

Treatment varies depending on the degree of macular degeneration. For dry macular degeneration, there is no prescription drug. The main treatment is to improve lifestyle habits. Prevent the disease from worsening through consistent management. First of all, quitting smoking and wearing sunglasses are essential. Cigarettes and ultraviolet rays can accelerate the progression of the disease. In addition, you should eat foods rich in eye-friendly ingredients such as beta-carotene, lutein, and anthocyanin. The so-called Mediterranean diet is also helpful. Professor Park said, “However, in the case of beta-carotene, there are research results that show that it can cause lung cancer in smokers, so it is better to avoid it.”

There is one more thing. It is taking high doses of antioxidant vitamins. Professor Park said, “Many clinical trials have shown that high doses of vitamins slow the progression of dry macular degeneration,” adding, “However, it is different from the general vitamin supplements sold on the market, so you need to get a prescription from a doctor.”

If it has worsened to wet macular degeneration, active treatment is needed to preserve vision. First, treatment must be given to prevent rupture of blood vessels, so that scarring is reduced and the macula is less damaged. Treatment focuses on weakening the activity of blood vessels by injecting antibodies into the eye.

Usually, six injections are given in the first year of the disease. Injections are given monthly or every two months. After that, if necessary, injections are given at an average of two to four month intervals. However, the number of injections and intervals may vary depending on the patient. Professor Park said, “If you stop taking injections because you feel better, the blood vessel activity will become stronger again, which can lead to vision loss. Therefore, some patients need to take injections for life.”

● Quitting smoking and getting regular checkups are essential

If we summarize the risk factors for macular degeneration, there are three major ones. First is aging, second is genetic factors, and third is environmental factors. Professor Park emphasized, “Although aging and genetic factors are unavoidable, if we manage environmental factors well, it will be of great help in preventing and managing the disease.”

First, you should quit smoking. Professor Park pointed out that “smoking alone increases the risk of macular degeneration by two to three times,” and “therefore, you absolutely must quit smoking.” Second, you should prevent hyperlipidemia, high blood pressure, and obesity. This way, you can reduce waste products that accumulate in the macula. In addition, regular exercise is also essential.

Third, healthy eating habits are also essential. It is good to eat blue fish and green-yellow vegetables often. Professor Park additionally recommended green tea. Professor Park said, “I analyzed the eating habits of patients, and it was effective in slowing down the progression of the disease when they drank green tea more than twice a week.”

Fourth, you should wear sunglasses to block UV rays. Fifth, if you are over 50, you should have regular eye exams. Professor Park said, “You can detect macular degeneration, glaucoma, and diabetic retinopathy with just one fundus examination.” If you have any suspicious findings, you should have an annual examination to monitor the progress to prevent worsening. Professor Park repeatedly emphasized, “You should not ignore macular degeneration as presbyopia, but actively deal with it to prevent blindness.”

Reporter Kim Sang-hoon [email protected]

2024-08-17 00:20:38