Disease Description (Causes and Symptoms)
- Definition summary: Macular degeneration is a disease in which central vision (identifying objects, reading, recognizing faces, etc.) deteriorates due to degenerative changes in the central part of the retina (the macula).
- Pathophysiology: In the early stages, drusen (deposits beneath the retinal pigment epithelium) and retinal pigment epithelium (RPE) atrophy appear (the dry form). In some patients, choroidal neovascularization beneath the macula (retinal-choroidal neovascularization, CNV) develops, leading to hemorrhage, exudation, and fibrosis (the wet form).
- Main causes and risk factors: Advanced age (increasing age), genetic predisposition, smoking, cardiovascular disease and hypercholesterolemia, excessive light (ultraviolet) exposure, and low blood antioxidant levels, among others.
- Main symptoms: Reduced central vision, metamorphopsia (objects such as letters appearing bent or distorted), a central scotoma (blind spot in the center of the visual field), and blurred or distorted vision (especially straight lines appearing bent).
Treatment Methods
- Diagnostic test-based management: Fundus examination, retinal photography, optical coherence tomography (OCT), fluorescein angiography (FA), and, if necessary, indocyanine green (ICG) angiography.
- Dry form (non-neovascular)
- Definitive restorative treatment is currently limited.
- There is evidence that AREDS2 supplements (including vitamin C, vitamin E, zinc and copper, lutein and zeaxanthin, etc.) reduce the risk of vision deterioration and conversion to the wet form in moderate or more advanced (high-risk) dry-form disease.
- Lifestyle measures: Stop smoking, manage cardiovascular health, eat an antioxidant-rich diet (leafy green and dark-green vegetables), and protect against ultraviolet radiation (sunglasses).
- Wet form (neovascular)
- First-line treatment: Use of anti-VEGF medications through intravitreal injections (for example, ranibizumab, aflibercept, and bevacizumab [off-label]). The treatment strategy is adjusted after an initial intensive injection phase (for example, monthly injections), using a PRN or treat-and-extend approach.
- Adjunctive and selective treatments: Photodynamic therapy (verteporfin) and laser photocoagulation (limited indications) — determined according to the lesion’s type and location.
- Complication management: Additional treatment is necessary if hemorrhage, retinal degeneration, or other complications occur.
- Vision aids and rehabilitation: Low-vision aids (magnifiers, special lighting) and vocational rehabilitation programs.
- Precautions during treatment
- Regarding ocular injections: Possible infection (endophthalmitis), temporary elevation of intraocular pressure, retinal detachment, and hemorrhage.
- Supplements: For smokers, formulations containing beta-carotene may increase the risk of lung cancer; formulations with alternative ingredients (lutein/zeaxanthin) are recommended.
- Rarely, a risk of thrombotic events has been reported with systemic anti-VEGF treatment — consult a specialist if you have a history of cardiovascular or cerebrovascular disease.
Checklist Before an Outpatient Visit (Including Items to Bring, Records, and Example Questions)
- Items to bring
- A list of medications currently being taken (especially anticoagulants, antiplatelet drugs, and recent steroids)
- Previous ophthalmic test results (fundus photographs, OCT, fluorescein angiography reports) or digital files that can be brought
- A record of recent changes in vision (when they began, one eye or both eyes, gradual or acute, etc.)
- Amsler grid (a photo or record of the results of testing at home)
- Information about underlying diseases (hypertension, diabetes, cardiovascular disease) and smoking history
- Information that may be helpful to tell the doctor during the outpatient visit (including example questions)
- When the symptoms began and how they have progressed (for example: When did the letters begin to look bent?)
- Whether one eye or both eyes are affected, whether there is pain, and whether glare or floaters are present
- Medications taken recently (especially anticoagulants) and any history of allergies
- History of previous ophthalmic treatment (anti-VEGF injections, laser treatment, PDT) and whether there was a response
Examples of General Questions to Ask the Doctor
- What are the expected benefits and possible side effects of this treatment (for example, anti-VEGF injections)?
- What do my current test findings (OCT/fluorescein angiography) mean? What is the prognosis?
- May I take AREDS2 supplements? If I smoke, what combination is recommended?
- What is the treatment schedule (injection frequency), and how often will I need long-term follow-up?
- To what extent might my vision recover, and how long is it expected to be maintained?
Examples of Disease-Specific Questions
- Do my OCT/fluorescein angiography results show drusen, geographic atrophy, or neovascularization (CNV)? What does each finding mean, and what treatment is recommended?
- If I start anti-VEGF treatment, how many regular injections will I need (what are the criteria for decisions after the initial intensive treatment)? What alternatives are available if there is no response to treatment?
(Note: If you have test results or images, the doctor can more accurately assess the type and progression of the lesion during the consultation and present an individualized treatment plan.)