What is Age-Related Macular Degeneration?

Age-related macular degeneration is a degenerative disease affecting the central part of the retina, called the macula, in people aged 55 or older. It is the leading cause of severe visual impairment in the adult population of the industrialized world, accounting for about two-thirds of all visual disabilities. However, advancements in therapies over the past ten years have favorably altered the outlook, and it is estimated that in about 50% of cases, it is now possible to prevent the progression of visual impairment. High blood pressure, high cholesterol, and high blood sugar are risk factors for this disease.

 

Understanding Types of Maculopathy

The most common form of maculopathy is age-related macular degeneration. The closer you get to old age, the higher the risk of degeneration of your macula. Age-related macular degeneration affects approximately 30 million people in the Western world, mainly women.

 

However, there are other forms of maculopathy:

• Myopic maculopathy;
• Diabetic maculopathy;
• Maculopathy due to retinal infarction;
• Maculopathy due to trauma;
• Maculopathy due to infection;

Classification of Maculopathy or Macular Degeneration

Initial Maculopathy

In the initial form of macular degeneration, lipid materials are deposited in the deep layers of the retina, forming yellowish deposits (drusen), associated with irregularities of the retinal pigment epithelium. At this stage, there is generally no visual disturbance. In 10 to 20% of cases, the initial form progresses to an advanced form, which is associated with visual impairment.

 

Atrophic (or Dry) Maculopathy

It is characterized by a lesion of the central retina, known as geographic atrophy. This is an area of retinal atrophy with sharp margins, through which the underlying choroidal vessels are visible.

 

Exudative (Wet or Neovascular) Maculopathy

The characteristic lesion is the presence of neovascularization which, unlike normal retinal vessels, allows the drainage of fluid (blood and serum) that accumulates in and under the retina. The retina thickens due to the presence of fluid; the photoreceptors and other retinal cells essential for vision are first misaligned, then damaged and degenerate. The disease progresses to a fibrous scar that occupies the center of the retina (disciform macular degeneration).

 

What are the causes of age-related macular degeneration?

As with all degenerative diseases, it is not possible to identify a true cause of age-related macular degeneration, but certain risk factors can be identified, i.e., physical, ocular, systemic, or behavioral characteristics that increase the likelihood of encountering the disease.

 

Among the main risk factors:

• Age;
• Smoking cigarettes;
• Family history of age-related macular degeneration;
• Hypertension and cardiovascular diseases;
• Obesity;

Symptoms of Maculopathy

Maculopathy is a subtle disease that, initially, is not easy to detect because it does not cause any symptoms that might alert the patient. This most likely occurs because, although the affected eye tends to degenerate and perhaps gradually lose vision, the other healthy eye does well enough to compensate for the deficiencies of the affected eye.

 

After a few months, or even a few years, it is possible to begin seeing objects in front of you in a constricted and distorted way; you may have difficulty distinguishing colors, and a kind of spot may appear in the center of your vision, while maintaining peripheral vision. This symptom is called central vision loss. It's as if, looking at a person's face, you can see the ears but not the nose. In addition, another typical symptom of this disease is the distortion of straight lines, so you may see the distorted outlines of a house, door, cupboard, or wall.

 

The macula, which is located inside the eye, contains special cells that, in a healthy eye, allow us to see well in the center of an image or object that is in front of us. This allows us to recognize things, faces, watch television, or, for example, drive a car. Since peripheral vision is not affected, you will never suffer from total blindness. Fortunately, this symptomatology very rarely progresses rapidly.

 

Vitrectomy in the Treatment of Maculopathy

Vitrectomy is a fundamental surgical intervention for the treatment of maculopathies. It involves removing the vitreous body that occupies most of the volume of the eyeball using a probe and an automated scalpel.

Today, thanks to the latest technological innovations, it can also be performed using a sutureless technique.

The instruments used are so small that the eye wall closes itself without the need for sutures. This type of intervention is mainly indicated in the treatment of myopic maculopathy, macular pucker, macular hole, and diabetic maculopathy.

 

The vitreous body is removed and may be replaced by aqueous humor or, in some cases, by substances such as gas or silicone oil. These substances are intended to serve as a tampon, i.e., to support the retina in its healing process. The gas remains in the eye for about one to two months and then resorbs. Silicone oil is usually removed after three months.

 

Vitrectomy is often associated with or followed by laser photocoagulation of the retina to promote rapid healing. In the treatment of severe forms of maculopathy, the latest frontier is represented by the artificial retina. These are cases where, in addition to the macula, peripheral vision is also compromised, as in the case of maculopathy due to retinitis pigmentosa associated with severe loss of lateral visual field.

 

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