2023-10-25 13:27:31
Dr. Ulrike Schupp editorial team
Your vision on the screen is weakening and you can more easily see a traffic sign than read it, even up close? Often that’s not a big deal. Then you just need new glasses. Thanks to good ophthalmologists and opticians, the quality of life often does not decline significantly as the eyes age. However, if the perception in the middle of the field of vision is blurred and people are difficult to recognize, this may be due to age-related macular degeneration (AMD), a dangerous disease that damages the retina in the exact area that has the most visual cells : at the macula. This is responsible for sharp vision.
In Germany, around six million people suffer from AMD. In advanced stages, it can lead to vision loss and even blindness. AMD is one of the most common causes of visual impairment in adults. Between 2011 and 2021, the number of those affected increased by more than a third (36 percent), reports the Commercial Health Insurance Fund (KKH). The reasons for this are excessive smartphone use, frequent screen work and increased UV radiation. “If the cell metabolism in the retina is disturbed, the center, the macula, is not optimally supplied with oxygen and nutrients. In addition, the waste products generated there are not removed effectively enough. This can lead to deposits, the so-called drusen,” explains Dr. Tarek Shamia, ophthalmologist at KKH. In some areas the visual cells die. A so-called geographical atrophy occurs.
“Dry AMD”, which affects around 85 percent of those affected, is particularly widespread. This can develop into the second form of the disease at any time, “wet AMD”. Although it is rarer, it progresses more quickly. The symptoms here include newly formed, small blood vessels that are supposed to improve the supply to the eye, but instead cause bleeding and swelling.
The risk of developing age-related macular degeneration is partly genetic, but also increases due to lifestyle factors such as smoking and diseases such as atherosclerosis, diabetes or coronary heart disease, increased blood pressure and, from the age of 60, with increasing age.
It is extremely important to diagnose the disease early in order to stop or at least slow down its progression, because dead visual cells do not regenerate. “Regular examination of the eyes using modern imaging optical coherence tomography (OCT) serves to document the progression of the disease, observe the treatment goals and, if necessary, adjust the treatment plan in a timely manner,” says Dr. Shamia. In the case of wet AMD, the progression can be slowed down using medications called VEGF antagonists, which are injected into the vitreous humor of the eye. They contain active ingredients that can prevent the formation of new blood vessels.
Dry AMD is considered incurable. “Syfovre” promises a silver lining. The new drug, which was first approved in the USA in 2023, is also scheduled to come onto the market in Germany in 2024. It contains an active ingredient that can block the proteins that cause deposits in the retina, the formation of drusen, and can also help reduce inflammatory processes in the eye. The drug is intended to at least greatly slow down geographic atrophy as a long-term consequence of AMD and has already been studied in a broad patient population in the USA. The active ingredient is also injected into the eye, currently every eight to ten weeks.
Another option are retinal chips, which can compensate for deficits in the macula by taking over the functions of the photoreceptors. The first implantation in Germany took place in 2021 at the Sulzbach Eye Clinic as part of an approval study. In 2022, a team from the Department of Ophthalmology at the University Hospital Schleswig-Holstein successfully inserted the retinal implants. After the procedure, patients wear special glasses with a microcamera that supply the chip with image signals and energy. The chip stimulates the nerve cells in the retina and transmits image information to the optic nerve. “In practice, the chip might lead to the ability to read medium-sized letters,” says Prof. Dr. Salvatore Grisanti, who carried out the operations.
Cataracts and glaucoma
Anyone who suddenly notices that they feel blinded more quickly than before, has difficulty seeing in twilight or backlight and therefore suddenly drives unsafely, for example, should have a check to see whether it is cataracts, also known as cataracts, another age-related problem eye disease. As the lens becomes increasingly cloudy, colors and contrasts gradually become increasingly blurred. If left untreated, those affected will ultimately only perceive light and dark. Diabetes and taking medications such as cortisone or some types of antidepressants can promote the development of cataracts. Fortunately, this can be treated with minimal invasiveness by replacing the cloudy eye lens with an artificial lens.
Less common is glaucoma, a damage to the optic nerve that occurs more frequently with age and can lead to blindness. It affects almost a million people in Germany. Risk factors such as increased intraocular pressure can already be identified in a further 1.3 million. If glaucoma is diagnosed early, it can usually be treated well with eye drops that contain active ingredients that are intended to lower intraocular pressure.
Even undetected diabetes can pose a danger to the eyes. The increased blood sugar levels destroy the fine blood vessels that supply the retina and can lead to diabetic retinopathy. Improved diagnostics for diabetes can ensure that secondary diseases can also be treated better.
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