The retina is the neural tissue of the eye and is the primary site of human vision. Any diseases that affect the retina can result in a severe vision loss. Diabetic retinopathy is, for example, the leading cause of blindness in Europe and US; retinitis pigmentosa (a group of inherited retinal dystrophies) is an important cause of low vision in young people.
Dr. Marco Lombardo and his staff offer their expertise in the diagnosis and treatment of retinal diseases. At our Eye Clinic, we perform all tests for a correct diagnosis and for the choice of the most appropriate therapy for each patient.
Diabetes mellitus is an abnormality in the metabolism of glucose in the blood, due to altered production or activity of insulin, which results in high blood glucose (values greater than 140 mg/dl).
Diabetic retinopathy is today the most important cause of blindness in western countries. After 20 years of diabetes, nearly all patients have some signs of diabetic retinopathy. The late stages of diabetic retinopathy is accompanied by the most serious complications of the disease, such as retinal detachment and secondary neovascular glaucoma, both conditions that can lead to blindness. The prevalence of diabetic retinopathy in the general population has dramatically increased over the past 40 years, paradoxically, this phenomenon has happened for the best care to which they are subjected diabetic patients, allowing them to live longer.
Diagnosis and treatment of diabetic retinopathy
In the early stages, diabetic retinopathy is usually asymptomatic. If the retinal disease worsens, visual acuity may be compromised by a macular edema or by vitreous hemorrhages. These complications can severely impair the patient’s social life, and require prompt intervention from the eye specialist.
An in-depth eye examination, OCT retinal imaging and fluorescence angiography are needed for a complete evaluation of diabetic retinopathy and, eventually, for laser treatment or surgery indications.
The focal laser treatment of diabetic macular edema may allow an improvement in visual acuity. When retinopathy is approaching to the stage at high risk for proliferative diabetic retinopathy is of crucial importance to consider the laser treatment with panretinal photocoagulation. The scope of panretinal laser therapy is to reduce the risk of serious complications of diabetic retinopathy, such as vitreous hemorrhages, retinal detachment and secondary glaucoma.
The term Retinitis Pigmentosa encompasses a broad group of inherited retinal degenerations. There are various classifications of the disease; to date, the most frequently used is based on the population of retinal cells primarily affected by the retinal degeneration, which created the terms: Rod-cone dystrophy and Cone-rod dystrophy. The age of onset of symptoms is varied and very often associated with the type of genetic transmission.
Diagnosis of retinitis pigmentosa
These diseases represent the leading causes of visual disability in the age-young adult in the western world. In the typical forms of retinitis pigmentosa (rod-cone dystrophy), the initial symptom is night blindness, namely the reduction of visual function in low-light environments. Visual acuity is usually preserved until the late stages of the disease. The severity of vision loss is not correlated with the age of onset of symptoms or the genetic subtype.
The patients suffering from Cone-rod dystrophy can experience a more dramatic vision loss and early disturbance of color vision. The diagnosis of Retinitis Pigmentosa is established when the following conditions are present:
- bilateral involvement;
- loss of peripheral vision;
- dysfunction of the photoreceptors as found in electrophysiological testing (ERG);
- progressive loss of photoreceptor function.
The patient should be also tested by different tools in order to define the stage and progression of the diseases: electroretinograms, visual field test, color test, optical coherence tomography (OCT).
Treatment of Retinitis Pigmentosa
There are currently no therapies to regenerate dead retinal cells or to stop the progression of these diseases. Patients today can benefit from the use of optical aids: polarized lenses, telescopic systems, wide-angle clusters (for widening field of view). Supplementation with vitamin A, omega-3 fatty acids, lutein, curcumin etc. can improve the metabolic conditions of the areas of the retina degenerate but there is no evidence that their use can halt the progression of the disease.
The gene therapy, transplantation of retinal cells and retinal implants represent the next golden standard for the treatment of retinitis pigmentosa.