警惕慢性眼病——黄斑变性 Vigilant eye disease, chronic macular degeneration

　　步骤： steps：

　　1.把方格表放在视平线30厘米之距离，光线要清晰及平均 1. The square table on horizon 30 cm distance，The light to clear and average

　　2.如有老花或近视人士，需佩戴原有眼镜进行测试 2. If there are aging or myopia people，The original will need to wear glasses to the test

　　3.用手盖着左眼，右眼凝视方格表中心圆点 3. Covered by the hand of the left eye，His right eye square table at the center dot

　　4.重复步骤1至3检查左眼 4. Repeat step 1 to 3 check the left eye

　　当凝视中心圆点时，发现方格表中心区出现空缺或曲线，就可能是眼底出现毛病的征兆，请尽快找眼科医生做详细检查 When stare at the center dot，Found in central square table vacancy or curve，May be eye signs of trouble there，Please as soon as possible to find an eye doctor do detailed examination

　　首都医科大学眼科学院院长、北京同仁医院副院长 王宁利：

The capital university of medical sciences, dean of the college of ophthalmology、Beijing tongren hospital, vice President of mester v：

　　许多读者都知道白内障、青光眼，但黄斑变性却鲜为人知。其实，与白内障致盲疾病相比，老年黄斑变性造成的后果更加严重。

Many readers know cataract、glaucoma，But macular degeneration, but little-known。In fact，Compared with cataract blindness disease，Older macular degeneration of the consequences of more serious。

　　白内障可以通过手术治疗恢复视力，而老年黄斑变性则会造成不可恢复的视力丧失，因为黄斑区的视网膜细胞一旦被破坏，视力便永久受损。世界卫生组织的研究报告表明，全球约有3000万黄斑变性患者，每年约有50万人因黄斑变性致盲。根据我国发布的一项调查结果显示，中国50岁以上人群的黄斑变性患病率为15.5%，患者总数超过400万。而且，随着人口老龄化发展，黄斑变性的患病率将逐年增高，严重影响我国中老年患者生活质量，已逐渐成为严重的公共卫生问题。

Cataract surgery can help by treatment restore vision，Older macular degeneration, and can cause irreversible loss of vision，For macular area once retinal cell damage，Vision and permanent damage。The world health organization study reports，Global about 30 million patients with macular degeneration，Each year about 500000 people for macular degeneration blind。According to our country released the results of a survey showed，China's 50 years old or above the crowd of macular degeneration prealence was 15.5%，Total more than 4 million patients。and，As the aging population，The prevalence of macular degeneration will be increased year by year，Serious effect on our country's old patients the quality of life，Has gradually become serious public health problem。

　　黄斑变性易致50岁以上人群失明 Macular degeneration easy to persons over the age of 50 blindness

　　与年龄相关性黄斑变性(AMD)也称作“老年黄斑变性”，是一种慢性眼病，同时是引起50岁及以上人群重度视力丧失的主要原因之一，也是全球成年人致盲的首要疾病之一。该病的出现源于视网膜中心位置的黄斑区细胞退化，由于早期病症并不明显，患者往往误以为随着年龄增加，视力自然会衰退，因此延误就医。很多患者都经历了中心视力急剧下降，影响阅读、驾驶、识别时间等症状却没引起重视，最终导致失明。

And age-related macular degeneration(AMD)Also called“Old macular degeneration”，Is a chronic eye disease，At the same time is a cause of 50 years old and above the crowd severe vision loss, one of the main reasons，Is the world of one of the first blind adults disease。The appearance of the disease from retinal center position the macula cells degenerate，Because the early symptoms are not obvious，Patients often mistakenly think that increase with age，Eyesight will naturally recession，So late treatment。Many patients experienced a sharp central vision decline，Affect reading、driving、Identify the symptom such as time didn't take seriously，Eventually lead to blindness。

　　老年黄斑变性分为干性和湿性两个类型，干性AMD又称萎缩型AMD，最常见的症状为轻度视力模糊，不加控制会发展为严重的类型，即湿性AMD，又称渗出型AMD。湿性AMD多引起严重的视力障碍，占AMD引起严重视力损害的90%。其造成视力损害的原因主要是异常的新生血管在视网膜下生长，引起视网膜出血、水肿及视网膜组织的破坏，患者可在2-3个月内失明。这一切都将严重影响患者的身心健康。视力的严重损害限制了老年患者的生活能力，降低了他们的自理信心或独立感，易发生骨折、抑郁等疾病，由此产生的护理费用也成为个人和家庭的沉重负担。

Older macular degeneration into dry and wet sex two types，Dry AMD and says atrophy type AMD，The most common symptoms are mild blurred vision，Do not add control for the type of development will be serious，Namely wet sex AMD，And the type of AMD said。AMD wet sex more serious vision problems，Accounting for AMD cause serious eye damage by 90%。The eye damage caused by the reason of which is abnormal new blood vessels in the retina to grow under，Cause retinal hemorrhage、Retinal edema and the destruction of the organization，Patients can be in 2-3 months blindness。All this will seriously affect the person's physical and mental health。Vision of serious damage, limit the ability of elderly patients with life，Reduced their self-care confidence or independent feeling，Easy fracture、Diseases such as depression，The resulting care costs also became the personal and family of the heavy burden。

　　早期发现和及时诊断是关键 Early detection and timely diagnosis is the key

　　黄斑变性的症状为：对比敏感度下降、暗点、视物变形、阅读能力下降、色觉功能减退等，然而，不是所有患者都会有这些症状，疾病早期或单眼发病时症状通常被忽视。因此，建议55岁以上人群每年一次的眼底检查必不可少。

Macular degeneration of the symptoms：Contrast sensitivity decline、The dark spots、Inspect content deformation、Reading ability、Color loss of function，however，Not all patients will have these symptoms，Disease of early or worse when symptoms are often ignored。so，Suggest people over 55 annual fundus examination is indispensable。

　　诊断AMD其实很简单，首先，老年人可先通过阿姆斯勒表进行快速自查，这个表由黑白方格组成，方格中间有个黑点。如果黄斑区出现问题，盯着黑点看，线条可能就弯曲了。如果看到的表格发暗、发黑、直线变曲线了，可能提示黄斑的功能受损，要及时前往医院进行进一步检查。老年黄斑变性的诊断和评估步骤如下：视力检查——阿姆斯勒表检查——眼底镜检查和生物裂隙灯立体检查——光相干断层扫描荧光素眼底血管造影和吲哚菁绿造影。

Diagnosis AMD is simple really，first，Old people can be first through the arms of table fast self-examination，The table by black and white squares composition，There is a black spots among squares。If macular area appears problem，Staring at the black spots look，Line may be bent。If see form dark hair、black、Linear change curve，That could indicate the function of macular damaged，To timely to hospital for further examination。Older macular degeneration diagnosis and evaluation procedure is as follows：Vision examination-Michael table examination-Ames funduscopic examination and biological slit lamp stereo inspection-light coherence tomography scan fluorescent element fundus angiography and indole Kim green imaging。

　　高危人群要注重保护 High-risk groups want to notice to protect

　　大量的研究表明，AMD的发生与年龄、遗传、环境因素如长期暴露在紫外线下、环境污染、吸烟、与血抗氧化水平下降等因素有关。

A lot of research shows，AMD occurrence and age、genetic、Environmental factors such as long-term exposure to ultraviolet light、Environment pollution、smoking、And the blood antioxidant levels dropped the other factors, such as the。

　　50岁以上老年人、有糖尿病史、高血压史和吸烟史，或长期从事户外工作的人群都是老年黄斑变性的高发人群，此外，研究表明女性比男性更容易患病。

50 years of age or older、A history of diabetes、History of high blood pressure and smoking history，Or long engaged in the outdoor job crowd is old macular degeneration of high-risk groups，In addition，Research shows that women are more likely to disease than men。

　　为尽早预防AMD，建议吃荤的东西多的人，多吃一些色彩斑斓的植物性食物，或者补充保健品。户外活动时也应佩戴防护眼镜。有家族史的人更要注重保护。

As early as possible to prevent AMD，Suggest something more people eat meat，Eat some colorful plant food，Or supplementary health products。Outdoor activities should wear protective glasses。A family history of more want to notice to protect。

　　治疗不再束手无策 No longer treatment at a loss what to do

　　2000年以前，人类对黄斑变性的治疗几乎束手无策，近年来，在AMD的防治方面有较多基础和临床研究成果，为减少AMD致盲率提供了依据和手段。当前的治疗方法主要有激光治疗、手术治疗、经瞳孔温热疗法、光动力疗法和抗血管内皮细胞生长因子。但是，激光治疗、手术治疗、经瞳孔温热疗法、光动力疗法都是对于长出的新生血管进行封闭，延缓疾病进展，无法实现改善视力。而以诺适得(雷珠单抗)为代表的抗血管内皮细胞生长因子治疗方案具有划时代的创新性，不仅可以实现阻断疾病进展，更可以提高视力，帮助患者重获光明。

2000 years ago，Human beings to macular degeneration treatment almost helpless，In recent years，In the prevention and control of the AMD has more basic and clinical research，To reduce AMD blind rate to provide the basis and method。Current treatments mainly laser treatment、Surgical treatment、The pupil tepid therapy、Light dynamic therapy and against vascular endothelial growth factor。but，Laser treatment、Surgical treatment、The pupil tepid therapy、Light dynamic therapy is for long of a newborn blood vessels were closed，Delay progression of disease，Unable to realize improve vision。And Enoch comfortable(LeiZhu single resistance)As a representative of against vascular endothelial growth factor treatment of epoch-making innovation，Not only can realize blocking the progression of disease，More can improve eyesight，Help patients regain the light。

　　雷珠单抗注射液是用于治疗湿性(新生血管性)年龄相关性黄斑变性的生物制剂，专为眼科使用设计，经玻璃体腔内注射给药，每月一次给药可获得最佳视力改善。该药于2006年首次被美国食品药品监督管理局批准用于眼科治疗，2011年被国家食品药品监督管理局批准用于治疗老龄患者致盲性眼疾——湿性黄斑变性。目前在全球超过100个国家和地区注册使用，经10年10000例患者入组临床试验证明其疗效和安全性，雷珠单抗可有效改善解剖结构，提高中心视敏度。

LeiZhu single injection is used in the treatment of wet sex(neovascular)Age-related macular degeneration of biological agents，Designed for eye use the design，The glass the cavity of the injected drug，Once a month to medicine to obtain the best visual acuity improved。The drug in 2006 for the first time by the us food and drug administration approved for the treatment of ophthalmology，2011 by the national food and drug administration approved to treat patients aged blind eye disease--of wet sex macular degeneration。At present in more than 100 countries and regions register and use，After 10 years 10000 patients into the group of clinical trials showed its efficacy and safety，LeiZhu can effectively improve the single of anatomical structure，Improve center visual acuity。

　　链接 link

　　首批眼底病诊疗示范中心启动 The first YanDeBing demonstration center to start the diagnosis and treatment

　　眼底病诊疗示范中心日前在京启动，旨在培训各级临床医生黄斑变性临床诊疗指南及规范化玻璃体腔注射标准流程，优化院内诊疗流程，最大化医院容量及患者获益。在诺华公司的支持和推动下，首批诊疗示范中心已在北京、上海、广州、成都5家全国重点医院的眼科中心建立，专门邀请欧洲最大的眼科医院——摩尔菲尔斯眼科医院专家，为这5家眼科中心的40余位教授进行课程讲解、手术示范、病例分享讨论等全面的交流和互动，分享和交流医院管理方面的经验和心得。

YanDeBing demonstration center in Beijing before diagnosis and treatment start，At all levels aimed at training clinical doctors macular degeneration clinical diagnosis, guide and standardized glass injection process) standard，In optimization of diagnosis and treatment process，Maximize capacity and patients to benefit from the hospital。In the novartis support and promote，The first diagnosis and treatment demonstration center has set up a file in the Beijing、Shanghai、guangzhou、Chengdu five key national hospital ophthalmic center set up，Specially invite Europe's biggest ophthalmic hospital-Moore, Phelps ophthalmic hospital experts，For the five ophthalmic center more than 40 professors of the course to explain、Surgery demonstration、Cases such as share excellent communication and interaction，Share and exchange of hospital management experience and insights。

　　目前，北京同仁医院、上海市第一人民医院、中山大学中山眼科中心、四川大学华西医院、复旦大学附属眼耳鼻喉科医院的诊疗示范中心已陆续设立并进行对即将开展雷珠单抗诊疗的下一级临床医生的培训。参加培训的医生将获得听课程讲解、看手术示范及病例分析讨论的机会，同时安排进院学习的眼科医生实验操作玻璃体内注射，增加临床实际操作经验。(高楠)

At present，Beijing tongren hospital、The first people's hospital of Shanghai、Zhongshan ophthalmic center of sun yat-sen university、Sichuan university, west China hospital、Fudan uniersity eye and ear infirmary, diagnosis and treatment of the demonstration center has been a succession of establishment and is about to develop resistance to LeiZhu list below the rank of clinical diagnosis and treatment of doctor training。To participate in training the doctor will have to explain course、See surgery and case analysis of discussion demonstration opportunity，We will arrange into the courtyard of the study the eye doctor experiment glass injection in the body，Increase the clinical practical operation experience。(GaoNan)