Disease Description (Causes and Symptoms)
Macular degeneration (age-related macular degeneration, AMD) is a degenerative disease that occurs in the central part of the retina (the macula) and reduces central vision (the ability to see details of objects). The main pathophysiology involves the accumulation of drusen (deposits) between the retinal pigment epithelium (RPE) and Bruch’s membrane, resulting in RPE atrophy (the dry type, geographic atrophy) or choroidal neovascularization (the wet type, CNV), which can cause bleeding, exudation, and scarring.
Major risk factors: older age (especially age 50 and over, with a sharp increase after age 75), genetic predisposition, smoking, cardiovascular disease and high cholesterol, ultraviolet exposure, low antioxidant status, and others.
Major symptoms: letters or straight lines appearing distorted (metamorphopsia), decreased central vision, development of a dark area in the central visual field (central scotoma), and changes in color perception. It may initially begin in only one eye, and as it progresses, both eyes may be affected.
Treatment Methods
- General principles: Treatment differs depending on the form of the disease (dry vs. wet). Regular monitoring and early detection are important.
- Dry (non-neovascular) macular degeneration:
- There is currently no restorative treatment, but nutritional therapy is recommended to help suppress progression (combination supplements containing antioxidants and zinc; AREDS/AREDS2 formulations are recommended). (Consult a doctor before taking them.)
- Lifestyle management: smoking cessation, lipid and blood pressure management, a balanced diet (leafy green vegetables, omega-3s, etc.), and ultraviolet protection (sunglasses).
- Low-vision aids (magnifying glasses, magnifiers, electronic device adaptations) and rehabilitation.
- Wet (neovascular) macular degeneration:
- First-line treatment: intraocular injections of anti-vascular endothelial growth factor (anti-VEGF) (major medications: ranibizumab, aflibercept, bevacizumab, including non-covered/unapproved use). Regular injections and follow-up may prevent worsening or improve vision.
- Adjunctive treatment: photodynamic therapy (verteporfin)—used for selected indications; laser photocoagulation has limited applications.
- If complications occur (bleeding, retinal detachment, etc.), additional surgical or procedural treatment may be necessary.
- Precautions during treatment:
- Be aware of complications related to intraocular injections (infection [endophthalmitis], bleeding, increased intraocular pressure, retinal detachment, etc.) and visit the hospital immediately if abnormal symptoms occur.
- Regular OCT and visual acuity tests are used to evaluate the response and determine the treatment interval.
- Prognosis: The dry type progresses slowly and may lead to loss of central vision, while the wet type can cause rapid vision loss. Anti-VEGF treatment can suppress progression or maintain/improve vision in many patients, but it does not guarantee a cure.
Checklist Before an Outpatient Visit (Including Example Questions)
Items and records to prepare:
- A list of currently taken medications (including prescription drugs, nonprescription drugs, and nutritional supplements)
- Previous ophthalmologic examination results (fundus photographs, OCT, fluorescein angiography, etc.) or examination records/photographs
- When the symptoms began and their progression (when they started, one eye/both eyes, and whether the change was sudden or gradual)
- Amsler grid (results from testing one eye at a time with the other eye covered: whether changes are present, their location, and the date they worsened)
- Blood pressure, blood glucose, and cholesterol levels (bring recent test results if available)
- Information about previous eye-related surgeries or treatments and allergies Example questions (things for patients to confirm with the doctor):
- “What changes have occurred recently on the Amsler grid?” / “Is the change in my central visual field gradually getting worse?”
- “Could you show me the results of my recent ophthalmologic tests (e.g., OCT)?”
General Example Questions to Ask the Doctor
- “What are the expected effects and common side effects of this medication (supplement/injection)?”
- “What is the prognosis in my case, and how likely is it that I can maintain my vision?”
- “What should I change first in my lifestyle (smoking, diet, exercise, etc.)?”
- “Would low-vision aids or rehabilitation therapy be helpful?”
Examples of Disease-Specific Questions
- “Do I have the dry or wet type? How should the test results (e.g., OCT, fluorescein angiography) be interpreted?”
- “How often do I need to receive anti-VEGF injections? What are the criteria for stopping treatment?”
(Additional information) Regular examinations and early treatment are important for preserving vision. Bringing the prepared items to a consultation with the doctor and providing specific information about changes in symptoms can help establish an optimal treatment plan.