常見老年眼疾 – 老年黃斑病變

老年黃斑病變是一個頗為常見的眼疾,世界衞生組織於2012年發表報告並指出老年黃斑病變是全世界第3號的致盲眼疾。1 香港的醫院管理局於2010年估計,全港每年有三千宗老年黃斑病變新求診個案,亦估計出現時全港約有五十多萬人口患有老年黃斑病變。隨著人口老化,這個數字必然會有增無減。本篇網誌會探討一下它的徵狀、種類、成因、預防及治療方法。

老年黃斑病變的徵狀

黃斑點是視網上一個非常重要的結構,當中有數以百萬計的感光細胞集中在這個直徑大概為5毫米的結構當中,它的作用是把接收到的光線轉為影像,並將影像傳送到腦部。日常生活有許好活動如駕駛、閱讀和書寫都需要依靠黃斑點帶來精細的中央視力來進行。而老年黃斑病變就是這個結構出現退化,一般會產生以下的徵狀:

  • 視力模糊
  • 視覺中央出現盲點
  • 直線變曲
  • 事物形狀大小變得異常

老年黃斑病變的種類和成因

老年黃斑病變可以分為乾性和濕兩種。乾性佔病例約90%,乾性患者的黃斑點底部出現黃白色的積聚物,這些積聚物是由感光細胞所排出的代謝物所形成,一般它們不會急速地影響視力,但病情惡化會轉成濕性。濕性佔病例約10%,濕性患者的黃斑區有不正常的血管增生,這些生增血管容易破裂,導致黃斑出血及結疤。濕性老年黃斑病變可在極短的時間令視力嚴重衰退,如發現中心視力有急劇的變化,就應盡快找眼科醫護人員作詳細的檢查。

老年黃斑病變的成因於現階段亦未能完全掌握,一些被發現與老年黃斑病變有關的風險因素如下:

  • 年紀越大,風險越高。75歲或以上的人士當中,約有3成患有老年黃斑病變。
  • 吸煙
  • 高血脂肪或膽固醇
  • 有老年黃斑病變的家族病史

老年黃斑病變的預防方法

在這15年間,有不少科研嘗試找出有沒有維他命或營養補充劑能預防老年黃斑病變,結果發現患有中期乾性黃斑病變患者每天服用一種名為AREDS 2 的營養補充劑,比起沒有服用的,能減低25%演變成晚期或濕性黃斑病變的風險。2,3 AREDS 2 營養補充劑的主要成份有維他命C及E、葉黃素、玉米黃素、乙型胡蘿蔔素及礦物質鋅,患有中期乾性黃斑病變患者應考慮每天服用。其他方法如戒煙、減少眼晴受到太陽的紫外光照射和均衡飲食避免高血脂都有助預防病患。

老年黃斑病變的治療方法

乾性黃斑病變能透過服用營養補充劑來預防晚期濕性黃班病變。至於濕性黃班病變的治療方發有1) 眼內注射血管內皮生長素抑制劑、2)光動力療法和 3) 激光凝固法,這三個治療方發的目的是透過藥物或激光去抑制新增血管生長或破壞已新增的血管,從而減少新增血管的滲漏,緩減濕性黃斑病變對視力做成的影響。眼科醫生會因應個別的情況而選擇進行那一種治療方案。

最後,隨著年齡的增長,出現眼睛疾病的機率就越高,長者應每年找眼科視光師作全面的眼科視光檢查,若發現早期的問題就應正視,以免日後對視力做成不能逆轉的影響。

註冊眼科視光師(第一部份) 陳家豪


以上護眼資訊由瑞士寶視光中心提供

地址 : 香港新界荃灣海盛路11號 One Midtown 23樓全層

查詢/預約電話 : +852 2751 8491

網址: www.swisscoat.com.hk


參考文獻:

  1. Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. The British journal of ophthalmology 2012; 96(5): 614-8.
  2. Age-Related Eye Disease Study Research G. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Arch Ophthalmol 2001; 119(10): 1417-36.
  3. Age-Related Eye Disease Study 2 Research G. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA 2013; 309(19): 2005-15.
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