Early diagnosis of maculopathies: the role of Optical Coherence Tomography OCT

By Cristiano Antonino On Dec 30, 2022

Maculopathies: Optical Coherence Tomography is a reliable and non-invasive examination that allows a better approach to the disease

Maculopathies are diseases that affect the posterior part of the retina, called the macula

This is the part of the retina responsible for seeing details and colours.

Age-related macular degeneration (AMD) is linked to the natural ageing process: with the passing of the years, the body is no longer able to guarantee the optimal blood and nutrient supply to its components.

Then there are other maculopathies that are more specifically connected with eye diseases (e.g. very high myopia) or with internal pathologies (e.g. diabetes, which in 1-3% of cases leads to severe visual impairment due to macular oedema).

However, if we restrict the discussion here to AMD alone, we are talking about a widespread disease: according to the International Agency for the Prevention of Blindness (IAPB), 5% of the world’s blindness is due to AMD, and it is the third most common cause of blindness; however, the percentage rises to 41% in Western countries and thus represents the first cause of irreversible loss of central vision after the age of 55 in the more affluent countries.

According to WHO (World Health Organisation) figures, within thirty years blindness in the world’s population will triple and the number of blind people will rise from 40 to over 120 million (in the USA alone it is predicted that by 2050 the number of people affected will rise from the current 11 million to 22 million).

There is an important correlation between macular degeneration and other diseases or bad lifestyle habits

Those who suffer from it are, for example, more affected by diabetes (25%) than the rest of the population over 50 (11%), have undergone or must undergo cataract surgery (35% vs. 13%) or suffer from hypertension (46% vs. 35%), just as there are more smokers (31%) than in the rest of the sample (23%).

The characteristic symptoms of this disorder are the perception of image distortions (or metamorphopsia) and dark spots (or scotomas) in the centre of the image, a sort of black hole that seems to swallow what is being stared at.

Maculopathies can occur slowly and in the initial stages symptoms are modest

Over time, however, they result in severe impairment of central vision, while peripheral or side vision is preserved.

AMD is a severely disabling condition for the elderly population: they can no longer drive cars, recognise faces, read, they no longer watch TV but only listen to it, they are unable to carry out the most mundane daily acts of life; to this we must add the consequent risks, such as depression and the risk of falls.

How can we tackle this problem that is so serious for the quality of life of those affected, for the well-being of the families concerned, and for the total economic cost to society?

The recent availability of ‘sight-saving’ drugs (anti-VEGF in intravitreal injection) allows us to achieve significant results in terms of stabilisation and improvement of visual capacity if administered in a timely, adequate and continuous treatment regimen.

This requires the early identification of the disease, which can be detected with a simple routine ophthalmic examination and confirmed with simple instrumental examinations: the most important is the OCT (Optical Coherence Tomography) examination which, with the latest generation of instruments, is both rapid, simple to perform, and absolutely free of annoying manoeuvres, and on the other hand gives exhaustive and reliable answers, immediately usable and, in most cases, without the need for further investigation.