I feel more accurate! Early detection of macular degeneration by self-detection method

Dr. Chen Yingshan, an eye care expert, is now the main cause of visual impairment in middle-aged and elderly people. However, at present, the diagnosis and treatment of macular degeneration are still focused on wet macular degeneration, which has been seriously damaged, while early dry macular degeneration, even mild pigmented macular degeneration, is completely absent. In fact, this kind of patients account for about 90% of macular degeneration, so whether the lesion can be found early and then the enemy plane can be defeated should be the most important topic. Nowadays, due to the reminder of health education, many patients have a sense of anxiety, and often want to seek help in early diagnosis to prevent problems before they happen, so the assessment of macula (MA-cula assessment * * * ent) is more important! In this paper, early macular degeneration is defined as "symptom complaint", but it is not easy to find lesions in various eye examinations. The symptoms we refer to are, for example, skipping while reading, small cracks in the computer, black corners in TV subtitles, different strokes, different colors and damaged fonts. Because eyes help each other visually, when habitual eye diseases occur, it is often necessary to cover healthy eyes or the symptoms will be obvious. At the same time, the symptoms will be alleviated by using eyes, but it will still cause considerable trouble to patients. If the symptoms have reached image distortion, the image has become larger or smaller, and the central scene can't be seen, it means that the lesion is serious enough to go beyond the discussion scope of what we call "early macular degeneration". At this time, all examinations are easy to find lesions, and of course they are not suitable for "early detection".

Dr. Chen Yingshan, an eye care expert, is now the main cause of visual impairment in middle-aged and elderly people. However, at present, the diagnosis and treatment of macular degeneration are still focused on wet macular degeneration, which has been seriously damaged, while early dry macular degeneration, even mild pigmented macular degeneration, is completely absent. In fact, this kind of patients account for about 90% of macular degeneration, so whether the lesion can be found early and then the enemy plane can be defeated should be the most important topic. Nowadays, due to the reminder of health education, many patients have a sense of anxiety, and often want to seek help in early diagnosis to prevent problems before they happen, so the assessment of macula (MA-cula assessment * * * ent) is more important! In this paper, early macular degeneration is defined as "symptom complaint", but it is not easy to find lesions in various eye examinations. The symptoms we refer to are, for example, skipping while reading, small cracks in the computer, black corners in TV subtitles, different strokes, different colors, damaged fonts and so on. Because eyes help each other visually, when habitual eye diseases occur, it is often necessary to cover healthy eyes or the symptoms will be obvious. At the same time, the symptoms will be alleviated by using eyes, but it will still cause considerable trouble to patients. If the symptoms have reached image distortion, the image has become larger or smaller, and the central scene can't be seen, it means that the lesion is serious enough to go beyond the discussion scope of what we call "early macular degeneration". At this time, all examinations are easy to find lesions, and of course they are not suitable for "early detection".

Macula refers to the most central tissue of fundus retina relative to pupil. Macula is named because it is rich in yellow pigment (lutein and zeaxanthin). Functionally, the macula is responsible for our central vision. In order to meet this most important visual demand, there are more than one layer of ganglion cells in histology to cooperate.

Macula can be said to be the highest visual evolution in animal visual evolution, and the brain also cooperates with the evolution of macula to expand the visual center of occipital region. In fact, only humans have this so-called "optic brain", which is the most accurate integration of macula and brain visual center.

The diameter of macula is only about half that of 1 cm (0.55 cm), and its area is only 5% of retina. However, in order to receive the highly complex image information conveyed by macula, the visual center of the brain uses 50% brain cells to analyze and form images.

The importance of macula lies in that it receives the image information about 20 degrees from the center of our daily life. It is precisely because of this highly evolved macular structure that when both eyes are staring at the target at the same time, the image fusion of the brain constitutes a "3D stereoscopic image". The eye can be said to be the window of the brain, and the retina represents the forefront of brain vision. Histologically, it can be proved that retinal cells are similar to brain cells. We often say that man is the spirit of all things, which means that the brain can think beyond the body, and the macula of the eye should also have this spiritual function. Macula usually sees the image that the brain wants to see, but it is actually the clearest and most important image that the brain can see. And what we usually call "eyes" refers to macula to some extent. In fact, the thoughts that the brain wants to express will be expressed in the eyes through the macula. For example, when a girl falls in love with a man or a woman, she will say, "Please look at me when you say you love me!" " Why? Because when a boy lies, his eyes will show it; At this time, girls will also use their own macula to examine: "I think your appearance is simply a lie!" The "eye-to-eye" between men and women is actually the "eye detection" between macula, hoping to see through each other's eyes in macula, and then deeply understand each other's thoughts.

How do you know there is something wrong with the macula? From the above, it can be said that macula is a kind of "spiritual organization of eyes", which can express invisible thinking and has physical functions. The biggest difference between macula and brain is that it needs to receive light to play its role, and it also needs light-avoiding substances, such as Omega-3 and lutein, to produce light protection. The most valuable thing is that this mental and psychological physical structure, like the brain, can be seen as "alive" when examined by doctors; And this organization can tell you many symptoms. A. The basic principle of macular evaluation: absolutely respect the patient's chief complaint, which is different from other symptoms such as cough, chest tightness and abdominal pain, because when the patient expresses the symptoms of macular, he has actually logically judged whether what macular said is true or not because it is directly connected with the thinking brain. If the examiner takes a negligent and negative attitude and insists that all examinations are normal, it will make patients feel disrespected and humiliated.

Because the macula has the ability of self-test, when the macula is diseased, it often feels it by itself, and the reliability is extremely high. This is the most important and sensitive evaluation method for macula. At this time, even if the macula has begun to appear unhealthy, the lesions may not be detected by the inspection of instruments and equipment. Because the sensitivity of macular self-detection is much greater than that of instruments and equipment. B. How do doctors evaluate macula: It is often relatively reliable for examiners to examine the fundus with their own macula and then use magnifying prism. In fact, this is the principle of using the most sensitive macula as an examination instrument. When the patient complains of symptoms and the doctor examines, the bright spot (Umbo) in the fovea disappears, and the pigment in the macula decreases or the density is irregular, which leads to the increase of retinal transparency, the obvious and thick choroidal blood vessels at the bottom, or the irregular surface of the blood vessels, and the focus moves too fast or the moving range is large, which often means that there is something wrong with the macula.

C macular degeneration, the so-called "optical illusion" will also appear. This is because when macular degeneration occurs, although no image information reaches the visual center of the brain, the visual center of the brain can ignore the macula and create an illusion image by itself. This is just like amputees can still feel the pain at the amputation site. Therefore, if we can't pay attention to the patient's chief complaint, rely too much on the examination of instruments and equipment, and ignore that hallucination may also be the cause of macular degeneration, so as to judge that the patient has no lesions, or even refer the patient to mental illness, then there will be serious diagnostic errors! D macular evaluation often checks structural changes and functional changes, which can not be ignored. For example, when the visual acuity is still 1.0, it doesn't mean that you can't see the lesions when you check the fundus, because the visual acuity may still be good when the macular histology changes seriously; When the subjective vision becomes worse, it is not necessarily obvious to check the fundus lesions, because sometimes the macular structure changes little, but the vision is already very poor, and both must be carefully evaluated to avoid missed diagnosis.

In fact, this goes back to our emphasis that the macula is an independent organization with subjective judgment, but also has an objective physical structure. Therefore, the subjective visual performance of the patient's own macula and the subjective examination of the doctor's own macula will of course sometimes produce wrestling and conflict. Therefore, the examination of patients' vision should focus on adequate lighting, comfortable environment, slow and meticulous, and repeat as much as possible. Now there is a so-called non-mydriatic retinal camera, which can enlarge and keep the images for further comparison and reduce the pressure of diagnosis. When patient e complains of symptoms, which kind of patients are at higher risk? 1. Older (over 65 years old); 2. Cataract surgery (more than five years after surgery); 3. High myopia (myopia degree is greater than 800 degrees); 4. Patients with long-term diabetes (with a medical history of more than ten years); 5. Have a general medical history (such as stroke, hypertension and heart disease, etc.). ); 6. Risk factors of cardiovascular diseases (such as family history, smoking, obesity, poor lipoprotein index); 7. The chief complaint of symptoms when seeing a doctor is clear and detailed (for example, there is a faint X symbol on the word you see, the word "Tai" is "big", and the next word of the target has a small shadow); At this time, we should carefully check and evaluate. In particular, it is now found that macular degeneration is also a new member of cardiovascular diseases (see article 20 1 1 in Healthy World for details). Short-term hypoxia attack (TIA) will occur in the early stage of cardiovascular disease, which will cause dizziness and discomfort for a few seconds, but it will recover quickly. Therefore, it is difficult to ensure that early macular degeneration will not have some early symptoms. Clinical evaluation of macular F often depends on subjective psychophysical tests. Mainly because we talk about macula, we naturally have to mention the body tissue that has entered the spiritual level, and its usual performance is also very subjective. Therefore, if you want to do early detection of macular lesions, it will be more difficult to identify. Of course, physical and mental examination is the most direct and harmless way, but its disadvantage is that the success of the examination is often related to whether the patient's attention is concentrated, whether the environment is comfortable, and whether the operating instructions are carried out. Subjective macular evaluation by subjective detection is easy to be distorted, and sometimes it needs repeated inspection to reduce the occurrence of errors and improve its reliability. What physical and mental tests are there? Of course, the most common ones refer to vision, macular micro-field, contrast sensitivity, amsler grid, color vision test, darkroom adaptation test and so on.

Now there are some new evaluation methods: 1. MPOD (macular pigment optical density): The macular pigment density usually represents the light protection of the patient's macula. If there is not enough pigment in the macula, the probability of macular degeneration will naturally increase.

2. Maia (Macular integrity assets * * * ent): This is a precise microscopic visual field examination, which mainly detects the visual sensitivity of the macular center. Because it has a positioning system, it can accurately observe the relationship between function and structure.

3. Early macular disease detector (PHP: pre-fatal hyperacidity perimeter): This is a concept of super vision, which is completely different from amsler grid examination. It is easier to tell whether two line segments are connected into a straight line through the patient's judgment than to ask the patient to draw a straight line and twist it in amsler.

In addition, when the brain is used to receive image information, it will selectively find large-area distorted images with serious lesions, while ignoring the lesions of the macula itself. As a linear distortion image used for detection, if it is smaller than the macula itself, the brain will detect early tiny maculopathy. G macular evaluation will eventually lead to some objective examinations, such as imaging medicine: fluorescence fundus photography (FAG), blood circulation green fundus photography (ICG) and eye tomography (OCT), and finally the so-called electrophysiological examination (VEP, EOG, ERG). In the electrophysiological examination stage, although the examination is objective, it is troublesome and time-consuming. Although the positive reaction has a tissue-specific effect, the potential will change only when a considerable number of cell tissues change, which is not easy to get results in macular area. There have been some breakthroughs in eye tomography, such as strengthening the eye tracking system, using longer wavelengths or adding optical connectors (OA). The thickness of choroid in macula can be calculated, including stereoscopic images of outer segment (OS), inner segment (IS) and retinal pigment epithelium, even choroidal vascular image (OCA) or cell polarity sensitivity test (PS OCT).