YELLOW SPOT DISEASE

(SENIL= AGE-RELATED MACULA DEGENERATION)

Intravitreal anti vegf Injection-PRP GROWTH FACTOR INJECTION AND MAGNOVISION THERAPY

The eyeball consists of refractive media from front to back to focus light on the retina. The cornea is most anteriorly, and the lens behind it focuses light on the macula, the most sensitive area of ​​the retina.The eyeball consists of 3 layers from the inside out: The innermost retina is the vascular layer in the middle, and the outermost is the white of the eye, which gives the eyeball its rigidity.Objects can be seen when the rays coming from the objects are focused on the retina. There are cells in the retina that convert light energy into electrical energy and transmit it to the brain.The region called the macula or yellow spot is the region where the light is fully focused and the sharpest vision occurs. The image is transmitted to the brain most clearly by the cone cells in this region. 90% of visual acuity is formed in the yellow spot and 10% is formed in the surrounding retina and transmitted to the brain. The yellow spot is the retinal region where lifelong high light-chemical and metabolic reactions occur. With increasing age and genetic predisposition, metabolic residues cannot be cleared from this region after the age of 50 and begin to accumulate. These yellow spots that accumulate in the retinal layers are called drusen.In electron microspic sections, metabolic wastes are seen to accumulate under the retinal pigment epithelial cells in the form of fat deposits called drusen.These accumulated fats prevent the retinal pigment epithelium from receiving oxygen and nutrients from the large choroidal vessels. The cells above the fat deposits die. This picture is dry type macular degeneration.The pigment epithelium is stem cell and secretes growth factors for the viability of photoreceptor cells. When these cells die, the photoreceptor cells above them go into sleep mode. In order for these cells to continue their viability, new blood vessels are formed.
However, since these vascular bundles are fragile and thin, they cause bleeding and leakage from the vessels, leading to the destruction of photoreceptor cells. This picture is wet type macular degeneration. The stage in which fat cells called drusen accumulate and pigment epithelial cells enter sleep mode is called early-stage dry senile macular degeneration (SMD).Diagnosis is very important during this period. Very serious measures should be taken to stop the progression of the disease; These can slow the course of the disease.If the disease progresses further, the pigment epithelial cells begin to die. In this case, central vision decreases. This stage is called atrophic dry type smd. If new vessel formations occur in the area where pigment epithelial cells die, this stage is called wet type smd. The most critical stage is this stage, and it causes severe vision loss. At this stage, injections of drugs called anti-VEGF are administered into the eye. With this, it is aimed to shrink / close the new vessels that are suitable for bleeding and to reduce / remove the edema in the macula. Otherwise, very serious bleeding may develop under the macula and into the vitreous. Approximately 8 intravitreal injections are required in the first year, and these injections often respond.However, there are cases that are resistant to injection. In this case, the drugs used for injection are changed or combined.

Again, if there is no response to the injections, “photodynamic laser treatment” should be considered, in which a special drug is injected into the arm’s vein and at the end a special laser is applied that only closes the damaged new vessel formations.

If unwanted vascular tangles cannot be controlled, excessive bleeding occurs in the eye.

When bleeding recedes, all retinal layers in the macula are disrupted, scar tissue and atrophy appear to form )disciform scar stage (.

As a result, central vision is severely affected and the patient sees only with her/ his peripheral retina.

Symptoms, complaints and management of macular degeneration.

It is very important for early diagnosis that every person over the age of 50, especially with a family history of macular degeneration, should have an eyeball check at least once a year.

In the early stage, that is, in the stage where the fats called drusen start to accumulate in the yellow spot, the patient may not have any complaints. For smokers at this stage, quitting smoking, controlling hypertension and cholesterol, and fighting obesity seriously slow down the rate of progression of the disease.

Again, in the early stage, the use of nutrition rich in antioxidant minerals and vitamins and the use of food supplement vitamin complexes will slow down the course of the disease.

B12-b6-b1- folic acid and omega-3 are especially necessary for the vital activities of neuronal cells, while vitamin a-lutein-carotene is necessary for the synthesis of pigments used in photoreceptors to perform their vision function.

In particular, carbohydrate and sugar consumption should be avoided.

Mediterranean Type Nutrition*Grilled salmon : 2 days a week (all oily fish can be grilled or baked)-( frying fish is useless.)*Have plenty of green salad + grated carrots*Soft-boiled eggs: 3 days a week (apricot-like hard-boiled eggs)

*Black seed raisins or fresh black grapes in season: 1 handful 1 day a week

*Raw almonds: 1 handful once a week

*Walnuts: 1 handful once a week*Kefir: 1 glass 2 days a week30 minutes of walking outdoors every dayAbsolutely no smokingabstinence from alcohol

It will slow the rate of progression of the disease considerably.

Safety glasses:

Filtering blue-violet light with a wavelength of 415-455 nm with yellow glasses reduces the photoreceptor death rate by 25%.

500 nm orange lenses are recommended for patients suffering from excessive light glare where initial cataracts or cone cells are also affected.

After wearing close goggles in a well-lit room, a few times a week, first cover one eye with your palm, and then repeat the process for the other eye.

If the break in the lines or the inability to see the middle point in the center has started, the disease has passed from the early stage to the advanced stage. Consult your ophthalmologist, who specializes in the field of retina, as soon as possible.If the atrophic type is diagnosed, the retinal pigment epithelium is usually in sleep mode at this stage. At this stage, the pigment epithelium is awakened with a micropulse-sub-threshold laser. With the application of this non-burning laser, both growth factor release and biophotomodulation are provided, and the pump function of the pigment epithelium is stimulated and the drusen clearing is accelerated. At this stage, together with micropulse laser, growth factor injections outside the eyeball can also be applied. Magnovision support is applied if necessary.

If straight lines such as a door edge or a flagpole appear broken, or loss of central vision has begun, it means that the age stage has begun.

New vessel formations in the wet stage; It must be dried with intraocular injection treatments and, if necessary, photodynamic laser treatment. Otherwise, very serious vision loss occurs at this stage.

If permanent loss of central vision occurs; Low vision rehabilitation tools such as telescopic glasses, light magnifiers, CCTV camera systems will especially facilitate reading.

Intraocular minitelescope surgeries may be a good option in appropriate cases for patients who have lost their central vision in both eyes due to macular degeneration.

At the end of the cataract surgery, this special lens is placed in the eye; These lenses focus the image on the yellow spot.

Intraocular telescopes magnify and shift the image to an intact retinal area other than the damaged yellow spot, with a prismatic effect.