MACULA DEGENERATION

MACULA DEGENERATION

Macula is the small yellowish area of the retina near the optic disk that provides central vision. That allows you to to look straight, focus and to read etc

Macular degeneration is a common eye disorder that causes central vision loss.

The central vision is what is seen when looking straight ahead.  Peripheral vision is what is seen on the side when looking straight ahead. Macular degeneration doesn’t cause total blindness because it doesn’t affect  peripheral vision.

CAUSES

The cause of this disease is deterioration of the macula, which is a small area in the center of the retina in the back of the eye. The cause is idiopathic but here are some risk factors associated with this condition:

➡️ obesity

➡️ Caucasian ethnicity

➡️ being female

➡️ a family history of the condition

➡️ smoking

➡️ high blood cholesterol levels

➡️ cardiovascular disease

➡️ hypertension

Types of macular degeneration

The two types of macular degeneration are dry macular degeneration and wet macular degeneration.

➡️ Dry macular degeneration is the most common form of this eye condition, affecting about 85 to 90 percent of people who have the macular degeneration.

This form of the disease occurs due to small yellow deposits called drusen developing under the macula. This causes retinal damage and vision loss.

➡️ Wet macular degeneration affects about 10 to 15 percent of people with the condition. This occurs when abnormal blood vessels develop under the retina and macula. If you have this form of macular degeneration, you may see a dark spot in the center of your vision due to blood vessels bleeding or leaking fluid.

Symptoms of macular degeneration

Macular degeneration is a progressive disease. This means that it will get worse over time. The symptoms of dry macular degeneration include the following:

➡️a distortion of straight lines in your field of vision

➡️a reduction in central vision

➡️ the need for brighter lighting

➡️difficulty adapting to low lights

➡️blurriness

➡️trouble recognizing faces

Some symptoms of wet macular degeneration also resemble those of dry macular degeneration, such as visual distortions and reduced central vision. People with wet macular degeneration may also experience:

➡️a blurry spot in your field of vision

➡️ hazy vision

➡️ rapidly worsening symptoms

DIAGNOSIS

➡️ Visual acuity measurement: This test measures the central vision's ability to distinguish details and shapes. Patients will be asked to look at and read a chart to measure how well  various distances can be seen.

➡️ Dilated eye exam: Eye drops is introduced in the eyes to widen, or dilate, the pupils, and use an instrument called an ophthalmoscope to view the interior of the eye to look through the pupil at the retina.

 ➡️ Amsler grid: In this test, patient looks at a grid that is a pattern of horizontal and vertical intersecting lines, similar to graph paper.  One eye is covered and stare with the other at a black dot in the center of the grid. If, while staring at the dot, straight lines appear wavy, and/or some of the lines are missing, shows  symptom of AMD.

➡️ Fluorescein angiography: In this procedure, a vegetable dye is injected into the arm and travels to the retina. A special camera takes pictures of the retina as the dye passes through it. This technique maps the blood flow in the eye and can show any abnormal leakage or changes in the retina.

 The results help to confirm the type of AMD present. The procedure also helps to evaluate the damage and determine whether the leaking blood vessels can be treated.

➡️ Tonometry: An instrument measures the pressure inside your eye. Numbing drops may be placed in the eyes for this test.

MANAGEMENT

The management will be based on medical and nursing management.

MEDICAL MANAGEMENT

➡️Verteporfin (Visudyne) was the first drug therapy approved by the FDA for treatment of wet AMD, but newer drugs have largely replaced its use.

 ➡️Visudyne is used in photodynamic therapy, in which the light-activated drug is administered intravenously in the patient's arm. Then, a low-powered laser beam is shined into the eye to stimulate the drug, starting a chemical process that destroys the leaky blood vessels. Like laser surgery, the photodynamic laser therapy cannot restore lost vision.

➡️Verteporfin causes sensitivity to light for five days after treatment, as well as other side effects.

➡️Because dry AMD can sometimes progress to wet AMD, regular eye examinations are important.

Nursing Management

Nursing management is primarily educational. Verteporfin is a light-activated dye, and patient education is important preoperatively.

➡️The patient should be instructed to bring dark sunglasses, gloves, a wide-brimmed hat, long-sleeved shirt, and slacks to the PDT setting.

➡️ The patient must be cautioned to avoid exposure to direct sunlight or bright light for 5 days after treatment.

➡️ The dye within the blood vessels near the surface of the skin could become activated with exposure to strong light. This would include bright sunlight, tanning booths, halogen lights, and the bright lights used in dental offices and operating rooms. Ordinary indoor light is not a problem.

➡️ If a patient must go outdoors within the first 5  days after treatment, he or she should be counseled to wear long-sleeved shirts and slacks made of tightly woven fabrics.Gloves, shoes, socks, sunglasses, and a wide-brimmed hat should also be worn if the patient has to go outdoors during daylight hours during this period.

➡️ Inadvertent sunlight exposure can lead to severe blistering of the skin and sunburn that may require plastic surgery.