We often hear our parents or our middle-aged and elderly friends talk about “dimming eyes”, which most people think is an inevitable natural decline in vision as we age and let it develop. In fact, there are many other diseases of the human eye that are not known to us, and they are not “incurable”. The “Hospital Experience Camp” activity of “Media Health Day”, sponsored by Beijing Hospital of Ministry of Health, Sohu Health and Life Times, went to Beijing Hospital Ophthalmology Department to focus on a little-known eye disease that endangers the vision health of middle-aged and elderly people –Age-related macular degeneration. Etiology: Neovascularization causes visual impairment When it comes to macula, many people do not know that it is the most important optical center of the human eye, and even mistake it for a plaque in the eye. The human eye is a complex organ that perceives light, which enters the eye, passes through the cornea, pupil, lens and vitreous, falls on the retina, and is transmitted to a special area of the brain through the optic nerve. Professor Yu Xiaobing from Beijing Hospital said, “The macula is the most sensitive part of vision, located in the center of the retina, recognizing most optical signals such as shape, size, color, depth, and distance. If the structure of the macula is changed, resulting in damage to the optic nerve cells, the central vision will be reduced.” Macular degeneration can be caused by many reasons, the most common first category related to age is age-related macular degeneration; the second category is macular degeneration caused by high myopia, i.e. pathological myopia.” Here, it is important to emphasize the importance of sun protection for eye protection. Too much sunlight and too much sunlight will not only breed skin cancer, but excessive exposure of specific wavelengths to the eyes will also induce lesions to occur. It is recommended that people who work outdoors must use more sun protection tools such as sunglasses, parasols and hats, and it is best to avoid going outdoors at noon when sunlight is strongest.” Yu Xiaobing reminded. The vast majority of macular degeneration occurs in the elderly, namely age-related macular degeneration, also known as age-related macular degeneration (AMD), is an age-related macular disease of the fundus, which can lead to irreversible loss of central vision and loss of vision. Early symptoms of AMD are not obvious and treatment is easily delayed, making it the leading cause of blindness among people over 50 years of age in developed countries. In fact, in our daily life, we often hear our parents or our middle-aged and elderly friends mention “old eyes”, most of them think that this is the inevitable natural decline of vision as we grow older and let it develop. When they go to the hospital, they will find out that it is age-related macular degeneration, which has caused serious damage to their vision and there is nothing they can do about it. As early as 2005, a survey on the prevalence of age-related macular degeneration conducted by Shanghai ophthalmologists showed that the prevalence of age-related macular degeneration among Chinese people over 50 years old was as high as 15.5%, and the prevalence of age-related macular degeneration among people over 70 years old reached 20.2%, that is, about one in every seven people over 50 years old was a patient with age-related macular degeneration. Neovascularization is the main pathological mechanism of age-related macular degeneration blindness. According to whether there is formation of neovascularization, age-related macular degeneration can be divided into two categories: dry and wet. From the comparison of the degree of harm, wet macular degeneration is more worthy of our attention, 90% of the vision loss of such patients is caused by wet macular degeneration. Its cause of vision damage is mainly the growth of abnormal neovascularization in the macular area, causing retinal hemorrhage, edema and destruction of retinal tissues. Research shows that most patients with wet macular degeneration will experience a rapid loss of vision in the first 3 months of the disease, and if they do not receive timely and standardized treatment, 85.1% of patients will have their vision reduced to a level below 0.1 within 2 years, which is collectively referred to as medical “legal blindness”. Basic daily life such as reading, driving, laundry and cooking will be seriously affected, limiting the ability of middle-aged and elderly patients to live, reducing their confidence in self-care or sense of independence, and predisposing them to fractures, depression and other diseases, and the resulting care costs become a heavy burden for individuals and families. Prof. Xiaobing Yu also talked about that, in contrast to the high prevalence and serious harm of age-related macular degeneration, this disease is little known among middle-aged and elderly people in China. The results of a survey in Hong Kong showed that only 9.2% of people had heard of AMD, but only 92.9% and 78.4% had heard of cataract and glaucoma. Diagnosis: People over 55 should have an annual fundus examination Early symptoms of age-related macular degeneration are not obvious and can easily be misdiagnosed as cataracts. Although symptoms such as decreased contrast sensitivity, dark spots, visual distortion, decreased reading ability and decreased color vision will appear as the disease progresses, however, not all patients will have these symptoms, and symptoms are usually overlooked in the early stages of the disease or at the onset of monocular disease. It is because of its insidious nature and serious harm that experts especially remind patients to early detection, early detection and early treatment in order to buy precious time for timely and effective treatment, delay the development of the disease and maximize the maintenance and enhancement of existing vision. To discover macular degeneration is actually very simple. First of all, middle-aged and elderly people can first conduct a quick self-examination through the Amsler table, which consists of black and white squares with a black dot in the middle of the square. If there is a problem with the macular area, stare at the black dot and the lines may be bent. If the table you see is dark, black, and straight lines become curved, it may indicate impaired function of the macula, and you should go to the hospital for further examination in time. AMD International Alliance recommends that people over the age of 55 receive an annual fundus examination, and Professor Dai Hong of Beijing Hospital reminds patients that “once the signs of macular degeneration appear, they need to go to a large regular hospital, consult a fundus specialist, and undergo fundoscopy, optical coherence tomography and fundus angiography to finally confirm the diagnosis of age-related macular degeneration. “ Before 2006, there was almost nothing that could be done about neovascular age-related macular degeneration, and the main clinical cause was VEGF-A. Prior to 2006, the treatment of neovascular age-related macular degeneration was not available worldwide, and the clinical treatment mainly relied on photodynamic therapy and laser to stabilize the disease, which was difficult to improve the vision and easy to recur. It was not until the clinical application of anti-vascular endothelial growth factor (anti-VEGF) that a breakthrough in the treatment of this disease was achieved. ”The introduction of the anti-angiogenic drug ranibizumab (Noxid®) has brought a breakthrough in the treatment of wet age-related macular degeneration,” said Prof. Hong Dai, “The superior efficacy and safety of targeted therapy directly targeting the vascular growth factor VEGF-A has been widely documented by international and Chinese evidence. The excellent efficacy and safety of targeted therapy directly targeting the vascular growth factor VEGF-A has been widely confirmed by international and Chinese evidence, with international clinical studies showing up to four lines of visual acuity improvement in some patients after treatment with ranibizumab (nociceptor®).” International clinical studies have demonstrated that patients can rapidly improve and sustainably stabilize their visual acuity with monthly injections of Ranibizumab (Norcide®), improving vision by up to 21 letters at 24 months of treatment compared to the control group (ETDRS Vision Scale, used internationally in adult vision studies). The EXTEND II study, a 12-month multicenter clinical trial specifically designed for Chinese patients, demonstrated the safety and efficacy of ranibizumab (nociceptor®) in Chinese patients, showing sustained improvement in visual acuity over 12 months with monthly injections of ranibizumab (nociceptor®) 0.5 mg. Best-corrected visual acuity (BCVA) in the study eye improved by a mean of 9.5 letters from baseline at month 4 and by 12.7 letters at month 12. Anti-vascular endothelial growth factor has been recommended by several international clinical guidelines as a first-line treatment option for wet age-related macular degeneration. Ranibizumab (Norcetek®), one of the world’s top 10 scientific innovations in 2006, has also been approved by the Chinese Food and Drug Administration (SFDA), making it the only anti-angiogenic drug currently used in ophthalmology in China. Prof. Dai Hong emphasized that the anti-angiogenic drug Ranibizumab (Norcide®) is a vitreous cavity injection drug, which has very strict requirements on the qualification of the operating doctor and the operating procedure. Beijing Hospital started the clinical application of Norcodyl as early as 2007, and successfully performed the first Norcodyl vitreous injection surgery in China, which is also the eye center with the largest number of patients treated, and has treated more than 7000 patients so far. Meanwhile, in terms of vitreous injection operation standard, Beijing Hospital Ophthalmology Center has established a standard operation procedure on par with the United States and Europe, and participated in drafting China’s vitreous injection clinical standard, undertaking national major clinical research projects, and continuously delivering high-quality speakers for the diagnosis and standardized treatment of fundus disease, which not only can provide mature and high-quality treatment services for patients, but also plays an important role in improving the overall diagnosis and treatment of fundus disease in China. It has played an important role in improving the overall diagnosis and treatment of fundus diseases in China.