"건성 황반변성, 치료제 없어… 눈 영양제로 失明 진행 막아야" - 헬스조선 > 공지사항

"건성 황반변성, 치료제 없어… 눈 영양제로 失明 진행 막아야" - 헬스조선

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"건성 황반변성, 치료제 없어… 눈 영양제로 失明 진행 막아야" - 당신의 건강가이드 헬스조선

100세 시대에 가장 중요한 장기나 신체 부위는 무엇일까? '몸이 천냥이면 눈이 구백냥'이란 말처럼 많은 사람이 눈을 꼽을 것 같다. 대부분의 사람이 다른 어떤 장애보다 실명(失明)을 더 충격적으로 받아들인다. 다행히도 백내장이나 녹내장 등으로 인한 실명은 크게 감소했다. 눈 속에 다초점 수정체를 삽입해 근시와 원시, 난시까지 동시에 교정하는 백내장 수술법이 개발되면서 백내장 수술을 라식수술처럼 생각하는 사람도 많다. 그러나 실명원인 1위인 황반변성과 2위인 당뇨망막병증 등 망막질환은 갈수록 증가해 '건강 장수'의 복병이 되고 있다. 서울성모병원 안과 이원기 교수와 함께 망막질환에 대한 궁금증을 풀어봤다.

▲ 신지호 헬스조선 기자

―황반변성과 당뇨망막병증 등 망막질환이 크게 늘고 있는 이유는 무엇인가?
"고령인구의 증가가 1차적 원인이다. 망막은 당뇨병 등 전신질환과 밀접한 관련이 있다. 이런 성인병이 증가한 것도 망막질환이 늘고 있는 이유다. 황반변성 유병률은 40세 이상 인구의 6.62%고, 당뇨망막병증은 당뇨병 진단을 받은 환자의 15%가 앓고 있다."

―각막 질환과 달리 망막질환은 치료법의 발전이 더딘 것 같다.
"혈관이 없는 조직인 각막의 질환은 병 자체가 단순하고 치료도 대부분 1회성으로 끝나지만 망막질환은 병이 복잡하고 지속적으로 치료해야 한다. 망막질환 치료법도 획기적으로 발전했다. 그중 '눈 속 주사제(루센티스)'는 세계적인 잡지 사이언스에 혁신적인 사건으로 소개될 정도로 획기적인 약이다. 이전 치료제나 치료법들은 시력이 나빠지는 속도를 늦추는 데 불과했지만 눈 속 주사는 시력을 좋아지게 하는 효과가 있다. 난치성 망막질환자들을 실명의 위험에서 구원한 약으로 평가 받는다."

―어떤 증상이 있을 때 망막질환을 의심해야 하나?
"초기증상은 직선이 휘어져 보이거나 물체가 찌그러져 보이는 변시증이다. 한쪽 눈에 망막질환이 생겨도 모르고 지내는 경우가 많으므로 주기적으로 한쪽 눈씩 번갈아 가며 체크를 하는 것이 좋다. 시력감퇴도 망막질환의 증상인데 근거리가잘 안보이는 것은 노안 때문이다. 만약 먼 곳의 물체가 잘 안보인다면 검사를 받아봐야 한다. 눈이 침침해지는 증상은 망막질환 때문인 경우도 있지만 안구건조증이나 노안 때문인 경우가 더 많다."

―종합검진을 받으면 망막질환을 조기발견할 수 있나?
"종합검진에선 보통 안압검사와 안저검사가 포함돼 있다. 안압검사는 녹내장 검사, 안저검사는 망막질환 검사다. 안저 검사는 망막을 특수 카메라로 촬영하는 것인데 최근 해상도가 좋아져 대부분의 망막질환을 찾아낼 수 있다. 안저검사에서 문제가 발견되더라도 너무 겁먹지 말고 정밀 검사를 받아보면 된다."

―황반변성은 일반적으로 자외선 노출·비만·흡연 등이 원인으로 알려졌는데, 최근 한 국내 연구에선 자외선과 비만은 상관성이 없었고, 오히려 뚱뚱한 사람보다 마른 사람에게 더 많이 발병하는 것으로 나타났다.
"황반변성의 가장 중요한 원인은 노화이며 그 다음으로 유전적 소인이다. 환경적 요인에 대해서는 자외선, 비만, 혈압, 흡연 등이 거론돼 왔지만 그중 확실한 것은 흡연 뿐이다. 최근 국내 연구에선 외국과 달리 마른 사람과 B형 간염 보균자에게 발병률이 높은 것으로 나타났다. 그러나 아직 단언할 수는 없는 수준이며 앞으로 추가 연구가 필요하다."

―콜레스테롤이 황반변성과 관련이 있다는 연구도 있다.
"가능성 있는 위험요인 중 하나다. 황반변성을 유발하는 유전자 변이 중에는 콜레스테롤 대사와 연관된 것이 있어서 '간접적으로 콜레스테롤이 황반변성과 연관이 있겠구나'라고 추측하는 수준이다."

―황반변성 일으키는 유전자는 밝혀졌나?
"미국 국립보건원(NIH)이 황반변성과 관련된 유전자 52개를 발표했는데, 이중에는 아주 관련성이 높은 유전자들도 있다. 미국에선 유전자 검사를 해서 이 유전자가 발견되면 발병 가능성이 높다고 보고 적극적으로 생활패턴을 변화시키는 등의 치료를 한다. 그러나 한국인과 서양인은 유전자가 같지 않아서 우리나라에선 이런 유전자 검사를 할 수 없다. 문제가 되는 유전자를 조작하는 등의 유전자 치료는 아직 멀었다."

―황반변성의 종류와 병의 경과에 대해 설명해 달라.
"황반변성은 건성과 습성이 있는데, 서양의 경우 건성이 약 90%, 습성이 약 10%다. 그러나 우리나라는 습성의 비율이 서양보다 훨씬 높다. 망막의 시세포가 위축되고 퇴행하는 건성 황반변성은 습성처럼급격하게 악화되지는 않는다. 실명 수준으로 시력이 저하되는 경우는 전체의 5%에 불과하다. 치료제는 없으며 현재로선 눈 영양제 복용이 유일한 대처법이다. 비타민A·C·E, 루테인, 지아잔틴, 오메가3의 복합영양제를 복용하면 시세포 위축이 황반으로 침범하는 위험을 약 25% 감소시킨다. 또 건성 황반변성이 습성으로 변화하는 것을 막는 효과도 있다. 일반적으로 건성 황반변성은 5년 안에 약 7%가 습성으로 변한다. 습성 황반변성은 망막 아래로 비정상적인 혈관이 새로 생기고 그곳에서 혈장 성분이 누출되거나, 피가 나서 급격한 시력 저하를 일으키는 병이다. 습성 황반변성을 치료하지 않고 내버려 두면 2년 안에 50% 이상이 실명 수준(0.1 이하)으로 시력이 떨어진다. 습성 황반변성은 레이저치료 등의 치료법이 있었으나 시력 저하 속도를 늦추는 등의 효과 밖에 없었는데 눈 속 주사의 개발로 전기를 맞게 됐다."

―눈 속 주사는 얼마나 효과가 좋나?
"대개의 경우 눈 속 주사치료만 지속적으로 받으면 큰 문제 없이 평생 살 수 있다. 그러나 1~2개월마다 계속 맞아야 하며, 1회당 약 값이 100만원 정도로 비싸다는 것이 문제다. 14회까지는 보험 혜택(환자 부담 20만~30만원)을 받을 수 있지만, 그 이후엔 전액을 환자가 부담해야 한다. 이 때문에 환자가 치료 스케쥴을 지키지 않거나, 치료를 중간에 포기하는 경우가 많다. 이렇게 되면 돌이키기 어려운 상태로 병이 악화될 수 있다. 고혈압이나 당뇨병처럼 망막질환도 평생 관리한다는 자세로 치료에 임해야 한다. 전체 습성 황반변성 환자의 10~20%는 눈 속 주사가 듣지 않는다."

―아시아인은 황반변성의 타입이 달라 눈 속 주사의 효과가 더 떨어진다고 한다.
"그렇다. 습성 황반변성에는 여러 타입이 있는데 그 중 결절맥락막 혈관병증은 약 30%가 주사 치료가 안 듣는다. 우리나라는 전체 습성 환자의 30~50%가 결절맥락막 혈관병증이다. 이런 환자는 레이저치료, 광역학치료와 주사치료를 함께 받아야 한다."

―당뇨망막병증 얘기를 해 보자. 당뇨병 진단을 받고 5년 이내에 19%, 15년 이내에 74%가 당뇨망막병증이 나타난다는 통계가 있다. 혈당을 잘 조절해도 당뇨망막병증 발병을 피할 수는 없나?
"약으로 아무리 혈당을 잘 조절하더라도 24시간 혈당이 일정하게 유지되는 것은 아니다. 어느 순간 혈당이 높아질 때가 있는데 그 때 망막혈관이 손상을 받아 망막병증이 생긴다."

―당뇨망막병증은 어떻게 진행되고 어떤 치료를 하나?
"당뇨망막병증은 크게 망막혈관이 막히면서 신생혈관이 생기는 증식당뇨망막병증과 신생혈관이 없는 비증식당뇨망막병증이 있다. 또 양쪽 모두 황반이 붓는 황반부종이 발생할 수 있으며 시력 저하의 가장 흔한 원인이다. 증식당뇨망막병증은 15년 이내에 약 16%가 실명 수준까지 악화된다. 예전엔 증식당뇨망막병증에 레이저가 표준치료였는데 요즘엔 주사치료도 많이 하고 있다."

―눈을 건강하게 유지하는 비결이 있으면 알려달라.
"비만과 흡연은 피해야 하며, 눈에 좋다고 알려진 채소나 등푸른생선, 항산화 영양소 등을 챙겨 먹으면 도움이 된다. 안과 검진은 3~4년에 한 번, 당뇨병을 앓거나 가족력이 있는 등 고위험군은 1년에 한 번 안저검사가 필요하다. 노안은 돋보기를 잘 활용하는 방법 밖에 없다. 노안이 왔는데도 돋보기 없이 맨눈으로 글을 읽으려 하면 눈의 모양근이 혹사당해 눈 피로가 심해진다. 돋보기 도수는 2~3년에 한 번씩은 체크하고 5년이 지나면 필히 바꿔야 한다. 최근 노안수술도 유행하는데 신중히 선택해야 한다. 독서 등으로 눈을 혹사하면 눈이 나빠진다고 오해하는 환자들이 많은데 관계가 없다. 책을 많이 보면 눈이 피곤하지만 눈에 병이 온 것이 아니라 모양근이 긴장한 상태이기 때문이다. 따라서 독서 등 근거리 작업을 했으면 멀리 보면서 모양근을 풀어주는 습관을 가지는 것이 좋다."

이원기 교수는
한국인에게 많은 난치성 황반변성의 한 종류인 '결절맥락막 혈관병증'에 관심이 많다. 여러 국제 학술지에 결절맥락막 혈관병증의 자연 경과와 치료 효과에 대한 논문을 여러 편 발표했다. 망막 분야에서 신약과 최적의 치료법에 대한 글로벌 임상 연구를 주도하고 있으며, 망막의 신생혈관을 제거하는 등의 미세 수술(유리체 절제술)을 한 해 500건 이상 집도하고 있다.

이전글ABC안과 삼일절 진료 안내 16.02.25
다음글2월 7일[일]~2월 9일[화]설연휴 진료안내 16.01.25

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James님의 댓글

James 작성일 18-07-15 04:56

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William님의 댓글

William 작성일 18-09-15 22:46

Rodolfo님의 댓글

Rodolfo 작성일 18-10-31 14:17

Sarah님의 댓글

Sarah 작성일 18-11-06 10:26

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Franky Widjoyo님의 댓글

Franky Widjoyo 작성일 18-12-25 19:43

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Katina 작성일 19-02-13 19:15

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Katina 작성일 19-03-18 02:53

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Catalina 작성일 19-06-26 18:37

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Rodolfo 작성일 19-09-13 11:38

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Anthony 작성일 19-12-06 03:20

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William 작성일 20-04-16 18:30

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Darleen 작성일 20-06-14 19:40

Nike Shoes님의 댓글

Nike Shoes 작성일 20-06-16 11:08

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ウレ

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ウレ

Katherine님의 댓글

Katherine 작성일 20-07-01 09:25

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William 작성일 20-07-19 08:18

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럭키걸 Lucky girl 작성일 20-09-10 18:34

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Sarah 작성일 21-04-17 01:54

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Catalina 작성일 21-05-06 04:20

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Rodolfo 작성일 21-06-11 08:09

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Katina 작성일 21-06-12 17:36

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Catalina님의 댓글

Catalina 작성일 21-07-19 06:04

jiuer7845님의 댓글

jiuer7845 작성일 21-07-22 12:10

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Sarah님의 댓글

Sarah 작성일 21-07-30 16:29

jiuer7845님의 댓글

jiuer7845 작성일 21-08-05 17:43

Holder님의 댓글

Holder 작성일 21-08-25 04:03

Bynoe님의 댓글

Bynoe 작성일 21-08-26 15:53

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Barbara님의 댓글

Barbara 작성일 21-11-17 17:49

Parker님의 댓글

Parker 작성일 21-12-08 06:17

Parker님의 댓글

Parker 작성일 22-01-04 09:05

Bynoe님의 댓글

Bynoe 작성일 22-02-18 08:42

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Nicholas님의 댓글

Nicholas 작성일 22-09-12 20:33

Anthony님의 댓글

Anthony 작성일 22-09-16 07:58

Tim님의 댓글

Tim 작성일 22-09-21 09:39

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