Maculopathy

Dr. Marco Lombardo and his staff offer their expertise in the diagnosis and treatment of macular degeneration and other age-related maculopathy. The macula is the central area of the retina deputed to distinct vision. Any disease that affects this area is called “macular degeneration” and has serious effects on vision.
At the Dr. Lombardo’s Eye Clinic you can receive an accurate diagnosis of the type of maculopathy and the most appropriate therapy for your visual disturbance.

Age-related macular degeneration

Age-related Macular Degeneration (AMD) represents a pathologic change of the macula, the area of the retina deputed to clear vision. The age-related macular degeneration is the most common cause of legal blindness in the Western world over the age of 60.
Clinically, there are two forms of AMD, in relation to histopathological features of the inner retinal layers and choroid: the “atrophic” and the “exudative” macular degeneration.
Aging is, undoubtedly, the most important risk factor. It is recommended to avoid smoking, behave in a healthy life and wear sunglasses with UV protection.

Diagnosis

The early stages of age-related macular degeneration are completely asymptomatic (without any visual disturbance). The evolution of the disease is accompanied by the appearance of symptoms more or less severe in relation to the form of age-related macular degeneration, “atrophic” or “exudative”, such as “metamorphopsia” (image distortion with reading difficulties) and decreased vision. In the atrophic form the visual impairment is gradual. In late cases, it may appears a dark spot in the center of the visual field (central scotoma), as shown in the figure.
In the exudative form, the visual acuity is reduced much more quickly, sometimes so suddenly.

Paesaggio AMD
Paesaggio normale
Simulated vision in advanced macular degeneration. A dark spot greatly reduces the central vision.

The diagnosis of macular degeneration is performed with the examination of the ocular fundus. Some diagnostic tests can be useful to determine the type of macular degeneration, such as the Amsler grid, the optical coherence tomography (OCT), the fluorescein angiography (FA), the angiography with indocyanine green (ICG) and the multifocal electroretinogram (mfERG).

AMD_atrofica
atrophic macular degeneration
AMD_umida
Neovascular Macular Degeneration

Treatment of AMD

The AREDS studies (Age Related Eye Disease Studies) have shown that nutritional factors may prevent or reduce the incidence of the disease. The treatment of macular degeneration involves the integration of dietary lutein, zeaxanthin, vitamins A, E, C and B. The integration with antioxidant nutrients may provide protection to the retinal tissue.

In the case that the macular degeneration progresses to the “exudative” form, urgent therapeutic actions are needed to avoid serious visual loss. There are three surgical options: the photocoagulation therapy, the photodynamic therapy and the intravitreal injections of anti-angiogenic drugs. The treatments for macular degeneration are painless and are performed on an outpatient basis. The total duration of therapy is a few minutes for the intravitreal injection of anti-VEGF and 30 minutes for photodynamic therapy.

Laser photocoagulation

Laser photocoagulation is indicated for the treatment of extrafoveal neovascular membranes. The procedure has some complications, such as the formation of small scotomas (dark areas) in correspondence of the treated areas.

The intravitreal injections

The anti-angiogenic (anti-VEGF) are the most widely used drugs for intravitreal theraphy. The major complications of anti-VEGF are rare, they may occur in 1% of cases treated (traumatic cataracts, detachment of retina, endophthalmitis). The anti-VEGF drugs available today for macular degeneration are three, whose names are Lucentis, Avastin, Macugen and Eylea.
The injections of anti-VEGF drugs have been shown to be effective in selected cases and to slow the progression of the neovascular membrane.

Photodynamic therapy

The photodynamic therapy consists in the intravenous administration of a photosensitizing drug that is activated by the absorption of a red light projected onto the retina. The photosensitizing agent used in the photodynamic therapy is verteporfin. Verteporfin is selectively taken up by the newly formed capillaries; the light activation of the drug gives rise to a cascade of processes that will have as supramolecular end occlusion of neovascularization. Complications of photodynamic therapy are rare. Photodynamic therapy is currently being carried out in combination with intravitreal injections in most patients. It is still the therapy of primary choice for the treatment of myopic macular degeneration and for the treatment of chronic central serous chorioretinopathy.

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