Age Related Macular Degeneration (Yellow Spot Disease)
Yellow spot disease, in Turkey, as well as all over the world in 55-60 years age group is among the most common disease-causing vision loss. People with yellow spot disease have trouble doing daily tasks such as reading, driving, choosing their faces, watching TV. However, even in the advanced stage of the disease, the person does not experience complete blindness, he maintains his daily life with the field of vision other than central vision.
What is Yellow Spot Disease?
The retina layer of the eye is a layer of nerve cells that notices the light coming from outside and transmits it to the brain. If we compare the eye to a camera, the retina is the film strip inside the camera. The macula region is located in the middle of this layer. In the middle of the macula region is the fovea region, in which the light is focused and about the diameter of the needle head. The "yellow spot" is the most important region of the retinal layer responsible for central vision and detailed vision. In yellow spot disease, the person experiences distortion and impaired vision.
The yellow spot (fovea) is the most important part of the eye that provides the visual function
Although the retina layer contains a vein layer in itself, it is fed from a vein-rich layer that is located just below it.
There is a thin membrane between these two layers and acts as a barrier filter between the two layers. The residual substances that accumulate throughout the life in the yellow spot region with the toxic effect of light, are cleaned from this area with a certain mechanism and transmitted from the vein beneath it to the rich layer and removed by blood.
In yellow spot disease, often in some people after 50-55 years, residual substances between layers become indistinguishable from this region for a reason not yet known, and accumulate in this region, triggering some unwanted events. In this way, the disease begins.
Yellow spot disease is divided into dry type and wet type. In this type of dry type, a certain amount of loss is experienced due to the residues that accumulate in the cells. In wet type, undesirable vascular buds are formed between the layers just below the yellow spot. Leakage and bleeding occurs in a very short time from these vascular buds and vision loss begins. Although 90% of all yellow point diseases are dry type, 90% of the visual loss caused by yellow point disease is responsible for the age type. In other words, although it is seen less frequently, it causes more vision loss. A yellow spot disease that begins as a dry type may turn into a wet type over time. So regular checks are essential.
What are the Symptoms of Yellow Spot Disease?
If the disease turns into age type, the early symptoms are distortion (distortion, strain) sensation in straight lines and decreased vision.
A simple card with a grid pattern is given to the patients to test themselves from time to time in order to detect the feeling of impairment in the lines. This card is called Amsler card. The patient wears his / her close glasses (if he is using it) and closes each eye one by one to look at the middle point of the Amsler card in his hand and test if there are any deformities in the lines forming this card. In this way, he can notice distortion in straight lines in wet type yellow spot disease. If a different image than usual is noticed, a retinal examination should be performed immediately.
Example of deformity that the patient can see on the Amsler card in wet type yellow spot disease
Is the Other Eye Affected in Yellow Spot Disease?
Yellow spot disease is a disease that affects both eyes. However, his condition in one eye is often heavier than the other.
Are there any protective measures? What are there?
Although it is not entirely possible to prevent the transition from dry to wet, some changes in lifestyle and diet reduce the risk of disease progression to more serious stages.
The role of smoking in the progression of this disease has been proven. If the patient is smoking, he should quit as soon as possible. In addition, it has been proven by studies that consumption of vegetables and fruits with dark green fibers slows the course of the disease.
Also, in multi-centre and large-scale studies of this disease, some anti-oxidant vitamins and minerals have been proven to reduce the risk of transition from dry to wet, and therefore to loss of vision. The vitamins recommended in these studies are:
What is Yellow Spot Disease Treatment?
Yellow spot disease from dry to wet type is a condition that requires urgent treatment. While the treatments applied in this disease have not yielded satisfactory results until recently, extremely successful results have been achieved with the developing technologies and new treatment methods.
The purpose of the treatment in wet type yellow spot disease is to dry the undesired vascular buds, fluid leaks and bleeding between the layers causing the disease. There are different treatment options for this.
It is the oldest treatment method used in wet type yellow spot disease. Laser treatment situations are limited today. Approximately 15% of all age-type yellow spot patients are eligible for standard laser therapy. In patients undergoing laser therapy, 50% of vascular buds can be reactivated.
Photodynamic Therapy (PDT)
It is a treatment method developed after standard laser treatment and applied for about 10 years. In PDT, a substance called verteporfin (Visudyn) is injected through the arm, and this drug is connected to the damaged tissue in the eye. A special laser treatment is then applied to the eye for 83 seconds. It is effective in some types of wet yellow spot disease. Generally, it does not increase vision, the current vision protection rate is approximately 50-60% during the 1-year treatment period. This rate decreases in the following years. It is rarely used alone today, only in suitable cases. Apart from this, it can be used in combination with new drugs, which are given by injection into the eye (zerk) in the section below.
Vascular Development Preventive Therapy (Anti-VEGF treatment)
Today, it is the most effective and most developed treatment method in wet type yellow spot disease. It consists of active ingredients such as Bevacizumab (Avastin, Altuzan), ranibizumab.
In wet-type yellow spot disease, undesirable vascular buds form between the layers that form the back wall of the eye (see What Is Yellow Spot Disease?). Vascular growth factors affecting that area play a role in the formation of these vascular buds. In wet type yellow spot disease, these growth factors are neutralized by preventing vascular development, and the resulting vascular bud is eliminated and leakage and bleeding is prevented. In this treatment, drugs such as bevacizumab (Avastin, Altuzan) are given by direct injection into the eye.
With this treatment, the rate of maintaining current vision in a 1-year period in wet type yellow spot disease is over 90%. The rate of achieving vision increase in the same period is around 30%. These injections are frequently repeated at certain intervals to prevent loss of vision or even increase vision.
What Should Be Done To Prevent Yellow Spot Disease?
No smoking A diet rich in green fiber and fruits, containing fish at least 1-2 times a week should be started. Frying foods containing trans fats should be avoided and the use of olive oil should be increased. Normal lipid-cholesterol and arm blood pressure values should be decreased. Weight control should be done Exercise habit should be gained If dry-type yellow spot disease has begun, the above mentioned combination pills containing vitamins and minerals should be started on the recommendation of a doctor. If the family has yellow spot disease or other risk factors, regular retinal examination should be performed at regular intervals
It is absolutely necessary to consult an ophthalmologist before taking vitamin / mineral combinations. There may be some additional suggestions on this subject (eg smokers should not use beta-carotene, vitamin E should not exceed 400 IU).
Risk Factors for Age-Related Macular Degeneration (Yellow Spot Disease)
Yellow spot disease in the family Smoking High arm blood pressure and high lipid-cholesterol Obesity (obesity) .
Anti-VEGF treatment in Wet Type Yellow Spot Treatment
What should be done during follow-up?
Yellow spot disease, whether dry or wet, is a disease that requires regular follow-up. Eye angiography (FFA-fundus fluorescein angiography) and retinal tomography (OCT-optic coherence tomography) should be performed during the diagnosis and follow-up.