关键要点
- AMD的治疗取决于病情处于早期、中期、湿性还是晚期干性AMD阶段。
- 湿性AMD通常采用抗VEGF注射治疗，部分患者也可能接受光动力疗法。
- AREDS2营养补充剂可能有助于延缓中期AMD患者或某些晚期AMD病例的病情进展。
- 定期进行眼科检查和视网膜成像对监测AMD病情以及判断治疗效果至关重要。
Age-related macular degeneration (AMD) affects the macula, the central part of the retina responsible for detailed vision. It can make reading, recognising faces, driving, and other activities requiring clear central vision more difficult. AMD does not usually cause complete blindness, but it can significantly affect central vision as the condition progresses. Because AMD can develop differently from one person to another, treatment is not the same for everyone. The AMD的治疗方案 取决于疾病的类型和阶段、是否存在异常血管、视力受损程度，以及眼科检查和视网膜成像的结果。
AMD如何治疗？
AMD的治疗主要取决于疾病的类型和阶段。早期AMD可能无需药物或手术治疗，但定期进行眼科检查有助于监测病情变化。对于中期AMD，眼科专家可能会建议合适的患者服用AREDS2营养补充剂，以帮助降低病情进展至晚期的风险[1]。 湿性AMD的治疗 may require injections that target abnormal blood vessel activity in the retina. This means treatment is generally focused on slowing progression, controlling abnormal retinal changes, preserving useful vision, and helping patients maintain independence. In some situations, treatment can also improve vision, particularly when fluid associated with wet AMD is addressed promptly.
了解不同类型的黄斑变性
There are two broad forms of AMD: dry and wet. Dry AMD is more common and can progress through early, intermediate, and late stages. Late dry AMD can involve geographic atrophy, where areas of retinal tissue become damaged. Wet AMD, also called neovascular AMD, occurs when abnormal blood vessels develop beneath or near the retina. These vessels can leak blood or fluid, damaging the macula and causing more rapid changes in central vision. Knowing which type is present is essential because the appropriate AMD disease treatment can differ considerably between dry and wet disease.
治疗过程中会发生什么？
对于接受 黄斑变性治疗, the process usually begins with a comprehensive eye examination. The ophthalmologist may examine the retina after dilating the pupils and use optical coherence tomography (OCT) to produce detailed images of retinal structures. OCT can help identify fluid or other changes associated with wet AMD. Additional imaging may sometimes be performed when the doctor needs more information about the retinal blood vessels or the extent of disease [2]. The results help the ophthalmologist determine whether observation, supplements, injections, or another treatment approach is appropriate.
湿性黄斑变性的治疗情况如何？
Anti-VEGF injections are the most common treatment for wet AMD [3]. VEGF, or vascular endothelial growth factor, contributes to abnormal blood vessel growth and leakage. Anti-VEGF medicines work by blocking this activity, helping reduce leakage and slow further vision loss. Before an injection, the eye is numbed and cleaned to reduce discomfort and infection risk. The medication is then delivered into the eye using a very small needle. Although the procedure itself is usually brief, 黄斑变性治疗 往往需要多次复诊。许多患者初期约每月接受一次注射，此后可根据治疗反应及专科医生的评估调整治疗间隔。
干性黄斑变性呢？
一旦确诊为复发性或慢性疾病， 治疗方案 for dry AMD depends on its stage. There is currently no treatment that reverses early AMD, so patients may be monitored regularly to identify progression. For people with intermediate AMD, AREDS2 supplements may help slow progression toward advanced AMD [4]. They are not recommended as a AMD的常规治疗, and they do not prevent AMD from developing in people who do not have the condition. AREDS2 contains specific amounts of vitamin C, vitamin E, zinc, copper, lutein, and zeaxanthin. Because the formulation contains high doses of certain nutrients, patients should discuss whether it is appropriate with their eye-care professional.
AMD治疗一览
AMD类型或阶段 | 常规管理 | 主要目标 |
| 早期干性AMD | 定期随访及健康生活方式干预 | 监测病情进展 |
| 中期AMD | 随访，并在适当情况下进行AREDS2检查 | 延缓病情发展至晚期年龄相关性黄斑变性 |
| 湿性AMD | 抗VEGF注射 | 减少异常渗漏，保护视力 |
| 晚期干性AMD | 随访、低视力支持及适当的康复治疗 | Maximise remaining vision and independence |
一旦确诊为复发性或慢性疾病， 正确的黄斑变性（AMD）治疗方案 可能会随着病情的发展而调整。患者初期可能只需进行随访观察，但若出现新的视网膜病变，后期则可能需要采取更积极的治疗措施。
医生如何判断治疗是否有效？
Monitoring is an important part of AMD disease treatment. During follow-up visits, the ophthalmologist may compare visual acuity, symptoms, retinal photographs, and OCT scans with previous examinations. For wet AMD, the presence or absence of fluid beneath or within the retina can help determine whether additional injections are needed [5]. Some people require ongoing treatment over an extended period, while treatment intervals may be lengthened when the condition becomes more stable. Patients should also report new or worsening distortion, blurring, blind spots, or other changes in central vision promptly.
治疗能恢复已丧失的视力吗？
The outcome varies depending on the type of AMD, how advanced it is, and how much retinal damage has already occurred. Wet AMD treatment can sometimes improve vision by reducing retinal fluid and controlling abnormal blood vessel activity, but treatment cannot always restore vision that has been permanently lost. The primary aim of AMD disease treatment is often to preserve existing vision and prevent or slow further deterioration. Early assessment is particularly important when symptoms suggest that dry AMD may have progressed to wet AMD.
患者在治疗期间还能做些什么？
Medical treatment is only one part of managing AMD. Regular eye examinations allow changes to be identified and addressed appropriately. Patients may also be encouraged to avoid smoking, maintain a balanced diet, exercise regularly, and manage conditions such as high blood pressure. For people experiencing significant vision loss, low-vision services and rehabilitation can provide practical strategies and devices that make everyday activities easier [6]. Self-monitoring can also be useful. Some patients may be advised to use an 阿姆斯勒方格表 或眼科专家推荐的其他方法，以识别中心视力的变化。
为何随访就诊至关重要
AMD disease treatment is often not a one-time process. The condition can change over time, and the treatment that is appropriate at one stage may not be necessary or sufficient at another. Keeping scheduled appointments allows the ophthalmologist to monitor the retina, assess treatment response, identify new activity, and adjust the management plan when needed. Missing appointments can make it more difficult to detect changes promptly, particularly in wet AMD, where retinal fluid can recur. Patients should also discuss any new medications, supplements, or changes in their health with their healthcare team.
结论
AMD treatment varies according to the type and stage of the disease. Early AMD may primarily require monitoring, while intermediate AMD may benefit from AREDS2 supplements when appropriate. Wet AMD is commonly managed with anti-VEGF injections. The overall goal of AMD disease treatment is to preserve vision, slow progression, and help patients maintain their quality of life. Regular eye examinations, appropriate retinal imaging, and timely attention to new visual symptoms are important parts of long-term care. For anyone diagnosed with AMD, the most appropriate AMD disease treatment should be determined by an ophthalmologist based on the individual’s retinal findings, symptoms, stage of disease, and overall health.
参考文献
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