Patient Information. Macular Degeneration. What is the Macula?

Transcription

1 What is the Macula? The eye is like a camera. It has a lens system at the front and a light sensitive layer, the RETINA which lines the back. The retina sends information to the brain through the optic nerve. The most important part of the retina is right at the back of the eyeball called the macula area. A healthy macula is essential for sharp sight, fine detailed vision and driving a car. Under the retina is a brown layer of cells called the retinal pigment epithelium (RPE). It is the retina s factory and waste bin. Sight uses up lots of nutrients and chemicals and these cross to and from the RPE to the retina. The RPE sits on a layer of blood vessels - the CHOROID. Between the choroids and the RPE is a membrane which stops the blood vessels from the choroids growing into the RPE and retina. Page 1 of 6

2 Types of Macular degeneration (MD) In DRY MD, the RPE gradually deteriorates. Because the retina does not get it s chemicals as quickly as before the quality of sight is reduced and brighter light is needed. Dry MD is not yet treatable but usually the changes are gradual. WET MD often affects sight more dramatically. Gaps form in the membrane between the choroids and the RPE and the new blood vessels grow under the RPE and between the RPE and the retina. Fluid and blood leak out causing swelling of the macula (macular oedema) and preventing the exchange of nutrients, damaging central vision. Often the first sign of Wet MD is distortion of straight lines. Door and picture frames look kinked, people s faces look odd or have missing bits and the lines of print on the page go up and down. Sometimes people do not notice how bad one eye has got because the other one still works well. What happens next? Wet MD can be treated with drugs that stop the new blood vessels growing. After examination, two tests are done. The Medical Photographer takes pictures of the back of the eye while giving an injection of an orange dye called fluorescein. There is a separate leaflet which tells you about the fluorescein angiogram test. Page 2 of 6

3 The second test called an OCT scan gives different information about the swelling and fluid under your retina. If tests show that treatment may help you, we will tell you about the treatment benefits, risk and limitations and book your treatment. You will need to sign your consent form to indicate that you are happy to have the treatment. What is the treatment like? The drug used has a very complicated formula. It can not be given by mouth and has to be injected into the side of the eyeball. This is not as bad as it sounds. It does not hurt and it is very quick. Because of the risk of getting infection inside the eye, treatment must be given in a special clean treatment room. Treatment is a course of three injections given at monthly intervals. All three must be given for you to get the good results that clinical trials have shown. You will attend the Treatment Centre each time. Nurses take you to the Treatment Room where eye anaesthetic is given, the eye is cleaned with antiseptic and your face covered with a sterile drape. The injection does not hurt apart from a possible dull ache. You may see coloured lights for a few seconds. Afterwards the eye is covered with a clear shield so if your other eye has poor sight you can still see. You can take this off when you get home. As soon as you take off the shield you must start using antibiotic drops four times a day and continue to use them for one week. Some people start to notice a slight improvement even after the first treatment. But it is really important that we do the second and third injections too. So make sure you know the dates for your whole treatment programme. How will I know if it has worked? After the course of treatment you must have the eye checked every 4 6 weeks. We check your progress, measure your sight, examine your eyes and re-scan your retina. We may repeat the fluorescein test. Page 3 of 6

4 It is important for you to check for distortion yourself so either use the grid (Amsler grid) or pick straight vertical and horizontal objects to look at regularly window glazing bars or a contrasting door frame and shut first one and then the other eye to see if the distortion is changing. This treatment has not been available for long so we do not know much about the long-term results. So far, during the first year on average, patients need three extra treatments and in the second year, six more injections. What are the complications? Injecting into the eyeball has the following risks all of which are rare: Infection and sight loss and the need for additional surgery and antibiotics to cure it. Damage to the lens of the eye causing a cataract. Damage to the retina causing retinal tears or detachment. Changing the vitreous configuration causing floaters. Raising the intraocular pressure (usually transiently). The aim of treatment is to shrink the blood vessels under the retina but when this happens it is possible that the healing process can cause a retraction of the RPE layer (RPE rip). This may lead to a central blind spot which may not improve. Page 4 of 6

5 What other things can help? The Age-related Eye Disease Study (AREDS) showed that high risk patients (and you are one of them if you have MD) can reduce the risk of sight threatening MD in the other eye by taking high dose anti-oxidant vitamins and minerals. There are a number of commercially available supplements. Cheaper alternatives are available which do exactly the same. Please ask the nurses for our recommendations. If you are or until recently have been a smoker, you should take the smoker s formula preparation of these vitamins and minerals. High dose vitamin A has been shown to increase the risk of lung cancer in smokers. If you are still a smoker you should quit. Non- smokers have a much lower risk of developing MD. Lutein and Xeazanthin were thought to protect the macula but this is not proven. Some people develop white dots around the macula area. These are called DRUSEN and weaken the barrier membrane. This allows choroids blood vessels to break through. People with large numbers of drusen are at greater risk of MD and should be vigilant. Your optician can tell you if you have a lot of these. The AREDS formula vitamins and minerals may help you if you have a lot of drusen. Drusen may be inherited so if you have a strong family history of MD, have regular eye checks. If your sight has been reduced by either dry or wet MD with or without treatment, you may benefit from the following: Registration as sight impaired. An appointment for low vision aids to maximise what sight you have. Local support from the rehabilitation officer for the Visually Impaired. Milton Keynes Bucks Association for the Blind The Macular Society Sight Concern Bedfordshire The advice in this document is intended only as a guide for the benefit of patients. The exact detail may vary from patient to patient depending on the individual s condition. The details are in line with current views in ophthalmology. The list of complications of intravitreal injection of anti-vegfs is not exhaustive. Page 5 of 6

6 Produced by Milton Keynes Hospital NHS Foundation Trust Review Date: 05/2011 If you would like this leaflet in a different format, e.g. in large print, or on audiotape, or for people with learning disabilities, please contact PALS. Your local contact for more information is the Patient Advice & Liaison Service at Milton Keynes PCT HQ, Hospital Campus, Standing Way, Milton Keynes, MK6 5NG, Tel: (01908) , or pals@mkpct.nhs.uk If you would like help reading this leaflet please either tell the person giving you this information or contact the Patient Advice and Liaison Service on (01908) Kama unahitaji kusaidiwa, ili kuweza kusoma ukurasa huu wenye matangazo, tafadhali ambia yule mtu anaye kuarifiwa taarifa hii ama uasiliane na afisa wa ushirikiano wa huduma za ushauari wa wagonjwa (Patient Advice and Liaison Service) kwa simu namba jy quhwƒ ieh iesiqhwr pvn iv`c mdd cwhidi hy qw ik pw krky jw qy auh ivakqi ijhvw quhwƒ ieh jwxkwri idmdw hy aus ƒ d`so jw rogi slwh Aqy smprk syvw ƒ (01908) qy smprk kro[ 假如需要幫助解讀此單張, 敬請告知給予閣下是項資料之人士, While Milton Keynes Hospital NHS Foundation Trust will ensure that all content on this website is current it cannot be held responsible for any problems arising from out-of-date or inaccurate information contained within the site. Page 6 of 6