Macular degeneration or MD (decrease in central visual acuity)

We obtain more than ninety percent of all information through our eyes. Of course you have no choice, but many people will find vision more important than the other senses. But what if you are faced with an eye condition such as macular degeneration (MD). In the Netherlands it is estimated that at least one hundred thousand people live with some form of MD. How do you know if you are dealing with this condition and what can be done about it? In April 2014, a special egg made the news. It can prevent macular degeneration if you catch it in time or stop the process if you already suffer from macular degeneration. Where can you buy these eggs?

Article content

  • The macula
  • Macular degeneration
  • The retina
  • Forms of macular degeneration
  • How can macular degeneration occur?
  • Juvenile macular degeneration
  • What are the complaints/symptoms of age-related macular degeneration/AMD?
  • Making the diagnosis of AMD
  • The prognosis
  • Two forms in AMD
  • Risk factors for AMD
  • The treatment for AMD
  • What can you do to protect your eyes
  • What if the condition is already advanced?
  • Important
  • Preventing age-related macular degeneration by eating a special egg (April 2014)


The macula

The macula is a very sensitive spot in the center of the retina. It has a diameter of four millimeters. The macula is also called yellow spot , it is colored yellow due to the presence of pigment.

Macular degeneration

Macular degeneration is an eye condition that significantly reduces central visual acuity (the ability to see details). You can describe it as wear and tear of the retina. There will be problems with reading and recognizing people. You cannot solve this with other glasses, because the problem is not in the glasses strength or eye lens but in the retina (at the very back of the eyeball). Macular degeneration mainly occurs in middle-aged people, but there is also a variant that is observed in young people. In the Western world, age-related macular degeneration or AMD is the leading cause of permanent decline in people over 65 years of age.

The retina

This part of the eye is also called the retina. It is a layer of cells on the inside of the eyeball that are light sensitive. The retina consists of cone-shaped cells and rod-shaped cells. The eight million cone-shaped cells are sensitive to colors and are mainly located in the macula lutea, the one hundred and twenty million rod-shaped cells are sensitive to light and dark. The cones make it possible to perceive small details, the rods provide peripheral vision. You can see movements very well with this. In macular degeneration, the cones die, causing sharp vision to disappear and a spot to remain in the center of the image. The rest of the retina continues to function. Complete blindness almost never occurs with AMD.

Forms of macular degeneration

It is a collective name for various retinal disorders, each with a different cause. In all forms of MD, damage is caused to the same spot in the retina: the macula or macula. Rarely, both eyes are affected simultaneously. The most important forms of MD are age-related macular degeneration (AMD) and juvenile macular degeneration (JMD).

How can macular degeneration occur?

  • It can be caused by old age: age-related macular degeneration/AMD usually starts after the age of fifty. It is also called age-related macular degeneration (OMD) or age-related macular degeneration (AMD).
  • As a result of diseases, for example diabetes.
  • Due to an injury.


Juvenile macular degeneration

This form of macular degeneration occurs in children and young people. In most cases this condition is clearly hereditary. It is not known exactly how many people have this condition; the figure is approximately 3,500. It depends on the type of hereditary condition who in the family gets MD. A hereditary condition means that you have a greater risk of developing MD if one or more blood relatives have MD.

The most common juvenile forms:

  • Stargardt’s disease: the most common hereditary form of MD, it usually manifests itself in early childhood. In the initial phase there are mainly disturbances in color vision. If more and more cones are affected, visual acuity decreases further.
  • Cone dystrophy: this primarily affects the cones.
  • Best’s disease: an egg-yolk-like pattern in the area of the macula that occurs in the active phase.


What are the complaints/symptoms of age-related macular degeneration/AMD?

  • Distortions or distortion of images: straight lines are not straight but curved. For example, you will notice it if you look at blinds or lines in a notebook. Another word for this deformity is metamorphopsia.
  • A dark spot in the center of vision.
  • Looking at things or people becomes difficult because you can no longer look in a focused manner.
  • You see less clearly.
  • You have less sense of color and contrast.


Making the diagnosis of AMD

  • The visual acuity/vision is determined by means of the examination with the letter chart.
  • Examination of the retina with the ophthalmoscope. The ophthalmologist uses the ophthalmoscope to look through the pupil at the inner eye. To examine the macula it is usually necessary to dilate the pupils, this is done by instilling drops into the eyes. Vision may be temporarily blurred and bright daylight may be bothersome. Do not drive the car back yourself and take sunglasses with you. The assessment of the macula through this examination is usually decisive in making the diagnosis, but additional examinations such as Fluorescence Angiography/FAG may also be necessary. Dilation of the pupils is also necessary for the fluorescence examination.
  • Amsler test: a page with a checkered pattern is used to test whether distortions or other abnormalities of vision occur. You can also do this test at home (self-check). If you notice deformities, be urgently referred to an ophthalmologist, don’t wait!


The prognosis

The prognosis depends, among other things, on:

  • The form of MD.
  • The speed of making the diagnosis.
  • The possibility of possible treatment and the speed at which treatment is started.
  • Personal circumstances.


Two forms in AMD


This form starts as small pale yellow deposits that accumulate in the macula. The deposits are also called drusen. The accumulation of drusen is accompanied by a reduction in the number of cones in the macula, which will deteriorate vision. It is an insidious process, it is very slow. It can take many years for vision to deteriorate. Usually both eyes are done almost equally. If you have dry AMD, keep a close eye on whether there is any distortion in the images in the environment. For example, in the lines of a notebook. This may indicate the development of the wet form and this form is more serious than the dry form.


Other names used for wet AMD are exudative AMD, discoid AMD or Junius-Kuhnt disease. The loss of vision in wet AMD is much faster than in dry AMD. Blood vessels behind the macula start to grow, causing fluid and blood to end up in or under the retina. This damages the light-sensitive cells in the retina, causing a rapid (and serious) deterioration of vision. A scar will eventually form in the macula, which will result in the loss of central vision.

Risk factors for AMD

  • Age: this is the most important risk factor. Approximately 20 percent of 65 to 75 year olds suffer from some form of AMD, and this has risen to 37 percent among those over 75.
  • Heredity: It may be partly hereditary.
  • Smoking: smoking causes a decrease in the amount of protective antioxidants. AMD is said to be five times more likely to occur in people who smoke more than one pack of cigarettes per day.
  • Arterial hypertension.
  • Diet: There is a possible link between AMD and a lack of antioxidants. Alcohol removes antioxidants from the body. High concentrations of saturated fats and cholesterol are harmful to the blood vessels and may be involved in the development of damage to the macula.
  • Gender: A woman over 75 years old is twice as likely to develop AMD as a man of the same age. The low estrogen levels in women after menopause increase the risk of AMD.
  • Excessive UV exposure: Too much sunlight is harmful to the eyes.
  • People with blue eyes are more likely to develop AMD.


The treatment for AMD

In recent years, options have been added to treat certain forms of MD. Most of these treatments are designed for wet AMD. They mainly combat the consequences of the disease and do not remove the cause. Damage that has occurred to the retina cannot be repaired.

  • Treatment is usually only possible in the early stages of the wet form of AMD. In a minority of patients, visual acuity improves, but in most cases stabilization can be achieved. Leaking blood vessels are closed with classic laser treatment. Further bleeding and deterioration of vision is prevented. It is possible in a very small number of patients and there is no guarantee that the effect will remain favorable.
  • Photodynamic therapy/PDT can help a limited group of patients with wet AMD. Only the leaking blood vessels are treated. The decline in visual acuity is slowed down. Whether someone is suitable for this treatment is determined on the basis of a Fluorescence Angiogram.
  • Sometimes a combination of PDT and vascular growth-inhibiting drugs is chosen. Vascular growth inhibitory drugs have been administered (for a short time) via an intravitreal injection. The new vessel stops leaking and growing, further deterioration is prevented.
  • Radiotherapy: in the short term, it appeared that only a limited group of patients with wet AMD responded moderately favorably to radiotherapy. This treatment hardly takes place anymore.
  • Surgical treatment: due to the frequent occurrence of complications, this treatment is almost never done anymore.


What can you do to protect your eyes

  • Wear protective sunglasses when you come into contact with the sun or tanning bed.
  • Consume a diet with lots of fruit and dark leafy vegetables such as spinach, green cabbage and kale.
  • Do not smoke.
  • Limit the use of alcohol.
  • Consult with your ophthalmologist about nutritional supplements.
  • Exercise every day.
  • Keep weight, blood pressure and cholesterol at the best possible level.
  • Take the Amsler test regularly.


What if the condition is already advanced?

You can use aids for the visually impaired when reading and watching television. Think of telescope glasses, magnification devices, talking books and adapted computers. Specially trained specialists (Low-Vision specialists) can be helpful in finding solutions. You can also contact regional centers for assistance to the blind and partially sighted for advice. There is also an association that can provide help: Macular Degeneration Association Netherlands.


If you have any questions, please consult your GP or ophthalmologist! Be well informed about treatments, developments sometimes move quickly. Early diagnosis and early treatment can help control the wet form of AMD.

Preventing age-related macular degeneration by eating a special egg (April 2014)

Eating special eggs to prevent age-related blindness or macular degeneration or, if you already have it, to stop the process. One of the causes of macular degeneration is a deficiency of certain nutrients such as lutein . Lutein is found in corn, broccoli, kale and eggs, among others. However, you have to consume so many of these foods to get the right amount of lutein that an egg has been developed with all these nutrients in concentrated form: Macu-View . About two special eggs per day are sufficient. However, eggs are not easy to transport, which is why they are mixed into a drink. You can buy the eggs via the internet and a few pharmacies in Limburg. Newtricious is the company behind the eggs. The aim of Newtricious is to sell the eggs throughout the Netherlands and, if possible, also outside the Netherlands. To achieve this, additional studies need to be conducted. The eggs cannot cure macular degeneration , it is not a medicine! But preventing you from getting it if you catch it early or stopping the process if you already have macular degeneration is a breakthrough.

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