Maculopathy: symptoms and how to treat it

By Cristiano Antonino On Jan 18, 2023

Maculopathy or macular degeneration is a disease that affects the macula, the central area of the retina

It is progressive and irreversible, but it is possible to slow down or even halt its course if detected in time; hence the importance of early diagnosis.

Among the main symptoms: distorted and blurred central vision.

What maculopathy consists of

The macula is the central region of the retina where the image originates and is processed by the photoreceptors, cells within the fovea that transform light signals into bioelectric impulses.

When this process does not function properly, the subject will complain of altered vision, with images with poorly defined contours and colours.

The macula, in fact, allows a sharp and detailed vision of the image in front of us.

For different factors, however, it can degenerate and give rise to distorted central vision as opposed to lateral vision, which remains more defined.

It is a progressive and irreversible disease, but early diagnosis and appropriate therapy can prevent it from worsening.

The different forms of maculopathy are:

age-related maculopathy (ARMD – Age-Related Macular Degeneration): usually affects both eyes, usually at different times and is mostly found after the age of 50. In industrialised countries it is the leading cause of low vision and blindness after the age of 65. It occurs in 2 different forms: dry or atrophic, which is found in about 80% of cases, and wet or exudative, which is less frequent. It should be noted, however, that 10-15% of dry forms turn into exudative ones;
hereditary or congenital maculopathy, the cause of which is linked to genetic factors;
myopic maculopathy: as its name suggests, it usually, but not necessarily, affects those with significant myopia, greater than 6 dioptry. This condition, characterised by an anatomical elongation of the eyeball, naturally favours the onset of the disease, involving the posterior pole of the eye;
diabetic maculopathy: this is a form that can affect diabetic patients. Macular oedema may occur, due to an accumulation of fluid in the central part of the retina, which reduces visual capacity.

Important risk factors for macular degeneration include:

age of the patient
smoking;
hypertension;
diabetes;
hyperlipidemia;
obesity.

Symptoms

Those suffering from maculopathy have:

impaired colour perception;
reduced central vision (scotoma);
photophobia.

In particular, the most indicative symptom is the presence of metamorphoses, according to which images are perceived in a deformed manner.

The effects of the disease differ depending on the aetiology of maculopathy: in all forms, the central vision is affected to a greater or lesser degree, and this does not lead to complete blindness.

In the diabetic form, on the other hand, macular degeneration is usually associated with peripheral retinal degeneration and this can lead, if not adequately followed and treated, to total loss of vision.

However, it should be noted that, thanks to medical and surgical treatment, this is fortunately rare today.

Diagnosis of Maculopathy

The course of the disease is rather slow at the beginning and this delays its diagnosis, increasing the possibility of it degenerating into more severe forms.

In order to diagnose maculopathy, it is necessary to use certain precise tests in addition to the eye examination.

Specifically, it will be necessary to subject the patient to an overall examination of the eye, in particular of the ocular fundus, using tests such as:

fluorangiography
indocyanine green angiography;
optical coherent light tomography (OTC);
optical coherent light angio-tomography (angio-OCT).

The latter two instruments allow a ‘virtual’ histological assessment of the retina, highlighting in particular the presence of anatomical changes in the various cell layers, retinal oedema and, above all, retinal neovases.

Retinal neovases are blood vessels that, starting from the vascularised layer located under the retina (choroid) and supported by the growth of substances that facilitate their formation (VEGF, Vascular Endothelial Growth Factor), invade the retina causing maculopathy in its exudative form.

Treatment

In addition to drug therapies to improve retinal trophism and microcirculation, supplements with a delaying effect on disease progression (antioxidants and vitamins) are also administered.

In the presence of the exudative form of maculopathy, the best results are obtained with intravitreal injections directly into the eye (anti-VEGF drugs), molecules with different forms and characteristics, capable of inhibiting the vascular endothelial growth factor, with the aim of slowing down or even blocking the disease.

Anti-VEGF drugs are now numerous and new ones will soon be on the market.

With different mechanisms, but with the sole aim of blocking the disease, these drugs have now been used safely for years.

The new ones, now at an advanced stage of study, will aim to increase efficacy on the disease by reducing the number of injections to be performed.

Correct and early diagnosis and administration of the drug to the patient with exudative macular degeneration is always crucial.

There are also other studies underway that target the dry form, which evolves more slowly than the wet form, with the aim of blocking the progressive, albeit relatively slow, deterioration of the photoreceptors in the macular region.

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