Nowadays, macular degeneration has become one of the most common causes of blindness in the elderly. Age-related macular degeneration is divided into two types: dry macular degeneration and wet macular degeneration. Dry macular degeneration develops slowly and generally does not have a very serious impact on vision, but it needs to be prevented from being allowed to develop to an advanced stage. Wet macular degeneration develops rapidly, and the vision loss can be very serious in a few months or even days. Ninety percent of the severe visual impairment caused by macular degeneration is due to wetness. However, early age-related macular degeneration is almost asymptomatic and does not easily attract attention. Age-related macular degeneration mainly impairs central vision, causing darkening and dimming of the center when looking at things, dark spots, and distortion of seeing, but it does not cause pain. Macular degeneration can be detected early by mastering self-examination and going to the hospital for regular eye examinations after the age of 50. Self-examination: Amsler table How to detect macular degeneration at an early stage by yourself? There is a relatively simple, easy-to-use method that can be checked at home – the Amsler table self-examination method. The Amsler table is a table of several small squares with a black dot in the center. To check, a person stands in a well-lit place, 30 cm away from the Amsler table, covers one eye with his or her hand, and then locks the gaze of the other eye on the central black dot. If the table line is blurred, dark spot appears in the center and straight line has the tendency to become curved during the process of looking, it is possible to suffer from macular degeneration. When the above situation occurs, you should go to the hospital as soon as possible to avoid delaying the disease. This examination is convenient and direct, and can be done without tedious operations. Visual acuity check: application of special vision chart Some people think that they do not feel that their vision is declining, and the vision check prescribed by the doctor is unnecessary, so they simply do not check it. However, we are usually using two eyes to see things, and the loss of vision in one eye can be compensated by the other eye, and it is not easy to detect the problem. In outpatient examinations, many patients do not realize that their vision has declined so badly until the time of the vision test that they usually do not even notice it, so never ignore routine vision examinations. For older patients with poor vision, it is recommended to use this standardized LogMAR visual acuity chart. This vision chart features the same number of numbers on the top and bottom and is suitable for patients with advanced macular degeneration whose vision is already very poor. Patients with poor vision who cannot see the top digits are not able to continue the examination and are not detailed enough. Dilated Fundus Examination: It is easier to see the fundus through the dilated pupil. Many elderly people with cataracts have difficulty seeing the fundus through the small pupil without a dilated pupil, which can lead to missed diagnoses. A dilated fundus exam can help the doctor see the patient’s retina more clearly, which makes it easier to check for macular degeneration and less likely to miss a diagnosis. In essence, dilated pupils paralyze the eye muscles, causing them to temporarily lose their ability to adjust, in order to dilate the pupil, without causing any damage to the eye. It is normal for the eyes to become unclear when looking at the near side after pupil dilatation. It usually takes about five hours for the pupil to return to normal. It is best to bring sunglasses on the day of the examination to avoid the sun’s glare. Intraocular pressure (IOP) check: It is recommended that an IOP check be performed before the dilated eye exam. IOP is the pressure inside the eye. It is usually necessary to measure the pressure before a dilated eye exam. If you have a tendency for glaucoma, your doctor may recommend that you undergo a series of tests to clarify whether you have glaucoma first. Just because you have glaucoma does not mean you cannot have a dilated eye exam. Patients with open-angle glaucoma or closed-angle glaucoma who have undergone filtering surgery or iris YAG stoma can have a dilated eye exam. However, if you have a shallow anterior chamber and may be a potential closed-angle glaucoma patient, dilating your pupil may trigger a glaucoma attack, and it is recommended that you have a dilated pupil after you have undergone an iridostomy. A non-contact IOP test is usually performed as an outpatient screening test, in which a gas is applied to the eye of the patient to measure IOP. The test may be uncomfortable, but it is not painful or harmful to the eye. Fundus retinal angiography and choroidal angiography: check for neovascularization Fundus retinal angiography and choroidal angiography can help the doctor to examine the location and severity of blood vessel leakage and to understand the patient’s condition more clearly. An allergy test, in which a diluted contrast agent is injected into the body, is usually required prior to the imaging. Minor allergic reactions can usually be relieved with anti-allergy medication, but in a very small number of patients, severe allergies can occur. In addition, patients with liver or kidney insufficiency, such as those with high creatinine or proteinuria, should not undergo imaging. The pupils also need to be dilated before the examination. During the examination, the doctor will inject the contrast agent into the blood vessels in the elbow of the arm. When the contrast agent reaches the blood vessel in the eye, the doctor will start taking pictures. The entire procedure takes 5-10 minutes. As shown in the picture below, the color photo is the fundus image before the contrast dye is injected, and the black and white photo is the fundus image after the contrast dye is injected. The doctor uses the pictures of the contrast examination to observe whether there are abnormal symptoms such as bleeding and exudation from the blood vessels. On the day of the imaging, the patient’s face will be yellow, and the urine will also be yellow. But don’t worry too much, it is only temporary, and it will return to normal after 24 hours. OCT test: the most important test for macular degeneration OCT test is also called optical coherence tomography. It uses light waves to scan the tissues of the eye and present the damage to the eye tissues to the doctor in the form of a graph. It is a very high resolution test that allows direct visualization of the retina, especially the macula, to see if there is edema, neovascularization, fissures, and other lesions. OCT is quick and non-invasive, and can detect problems that cannot be identified with the naked eye, helping doctors to find small lesions in the eye. It is the most important test for diagnosis and follow-up of age-related macular degeneration! Some patients feel that it is too troublesome to go to a big hospital for examination, so they ask the doctor at the community hospital to see if there is bleeding in the fundus of the eye, which is not conducive to detecting early lesions. Usually, when bleeding is visible to the naked eye, the lesion is already serious, so it is recommended that patients with macular degeneration should have regular OCT examinations to monitor the changes of their condition. Although OCT can sometimes be performed without dilating the pupils, in most cases it is recommended to dilate the pupils, especially for patients with cataracts, so that the images taken are clearer and more helpful to the doctor’s judgment of the disease.