Visual impairment is a fairly common condition. According to WHO data, it affects 253 million people worldwide and can be prevented or treated in more than 80% of cases. The data show in Italy an estimate of almost 1.5 million visually impaired and 220,000 blind. But what are the most frequent pathologies affecting the health of our eyes?
Protect the retina, save the sight of those suffering from senile maculopathy
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“We have several conditions that can be responsible for the loss or reduction of visual acuity,” he explains Michael Allkabes, medical director at the Rimini Ausl and specialist of the Doctorium telemedicine platform (www.doctorium.it). “The main ones are glaucoma, a serious ocular disease that causes the progressive destruction of the optic nerve with consequent loss of the visual field, and maculopathies, the term of which includes all the diseases that affect the central part of the retina which is called the macula and which it allows us to see the details and colors of the world around us in the clearest way. However, if you get sick your vision can become blurry and distorted. People with it have great difficulty in reading, writing, drawing and sewing “.
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The various types of glaucoma
There are four types of adult glaucoma, which typically occur in people over the age of 40: primary open-angle glaucoma; the primary one with closed angle; the secondary one with open angle and the secondary one with closed angle. But what does ‘open corner’ and ‘closed corner’ mean? “In normal conditions – explains Allkabes – inside the eye there is a liquid called aqueous humor that is continuously produced and reabsorbed. If the ‘drainage channel’ of this liquid is blocked – in the corner formed by the cornea and from the iris – the pressure inside the eye tends to increase thus causing lesions on the head of the optic nerve or at the level of the optic disc. In the eye there are regulatory mechanisms that tend to keep the pressure limit more or less constant In the ‘open angle’ form the fluid is able to pass but it does so too slowly and this causes the increase in intraocular pressure and consequently the damage to the nerve. ‘eye suddenly locks due to the closing of the angle formed between the cornea and the iris and the pressure increases rapidly “.
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How to distinguish between the various types of glaucoma
When open-angle glaucoma develops, the patient is often asymptomatic until damage to the optic nerve is severe, unless signs of early glaucoma are recognized during a routine eye exam. “Acute angle-closure glaucoma, on the other hand, can develop suddenly and cause a more rapid decline in vision with associated corneal edema, eye pain, headache, nausea and vomiting. Secondary glaucoma, on the other hand, is usually related to a previous eye injury. or to a systemic disease, which causes high intraocular pressure and the related optic neuropathy “, explains the ophthalmologist. Unfortunately, glaucoma cannot be prevented but it can be diagnosed early by undergoing an eye examination and its progression can be avoided thanks to the use of drugs, laser treatment of glaucoma or surgery.
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Le maculopatie
The most common form of maculopathy is certainly age-related macular degeneration, called AMD, linked precisely to the aging process. “The disease – explains Allkabes – causes a serious reduction in visual acuity and, therefore, compromises the quality of life. It is estimated that 5-10% of the population over the age of 75 is affected. It can be dry or humid. in the dry form accumulations of cell waste are formed on the retina which can be reabsorbed or calcified. In the wet form, new vessels are formed under the retina which cause damage “. In addition to senile maculopathy, there is also myopic maculopathy which affects those suffering from severe myopia. “Myopia is a refractive defect. The image of distant objects is formed in the eye in front of the retina making their vision indistinct. All this is due to the excessive axial elongation of the eyeball. This condition can cause the separation of the eyeball. retinal layers in the macula and a consequent accumulation of subretinal fluid “, continues the specialist.
From prevention to diabetic retinopathy, teleophthalmology improves treatments
In diabetic maculopathy
Diabetic maculopathy, on the other hand, typically develops in patients with diabetes mellitus. Hyperglycemia results in the formation of advanced glycation end products (AGE). The latter are osmotically active and can be responsible for the accumulation of fluids in the macula. Hyperglycemia also causes disruption of the blood-retinal barrier (BRB). “This is most likely the crucial point in the pathogenesis of diabetes-associated macular edema,” Allkabes explains. “In fact, the rupture of this barrier causes the accumulation of intraretinal and / or subretinal fluid. In more serious situations, the rupture of the retina and its subsequent detachment can occur, which obviously leads to blindness if not operated on”.
The macular pucker
There is another type of maculopathy, the one that originates from the relationships that the retina interchanges with the vitreous body, a kind of ‘gel’ that fills the largest and deepest cavity of the eye and which keeps the eyeball turgid and also serves to maintain the retina well attached to the inner surface of the eye. “In some conditions – explains the ophthalmologist – the relationships between the retina and the vitreous body degenerate, giving rise to the so-called vitreo-retinal interface syndrome (also called macular pucker) in which a kind of film is formed between the vitreous body and the retina. deforms the retinal profile creating undulations that thus alter the vision “. The patient complains of a distortion of the profiles of the images he sees, associated in the most severe forms with a significant decrease in visual acuity. Sometimes the traction is such that it results in a real macular hole or a serous-looking retinal lift with loss of central vision. How is it treated? “If the sight is actually damaged, it will be advisable to surgically remove the vitreous traction forces, thanks to a highly precise mini-invasive surgery, with the help of advanced technologies and instruments”, concludes the ophthalmologist.
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