It is the most common cause of central vision loss after the age of 50 and more than a million people suffer from it in Italy. These are maculopathies that are essential to be aware of in time so as to be able to start the correct therapy as soon as possible and thus avoid greater damage to sight. Following these patients is not easy both because in most cases they are elderly people with different pathologies, and because correct management would require dedicated structures that can follow each maculopath over time and according to individual needs. In this interview, the professor Lia Giustolisi, head of the Center for Diagnosis and Treatment of Maculopathies at the Policlinico Umberto I in Rome, explains what are the symptoms to identify, how to do prevention and above all who to contact to be followed along the entire therapeutic path.
What are maculopathies and how widespread are they in Italy?
“Maculopathies are diseases, of varying severity, which affect the central area of the retina called macula. They are distinguished in rare primitive forms, therefore hereditary that generally occur in adolescence and in so-called secondary forms much more frequent than the primitive ones and that of they are usually diagnosed in adulthood. It is very important to know the type of maculopathy you are suffering from in order to assess the level of urgency and then be able to proceed with the correct therapy. Maculopathies represent the first cause of loss of central vision after the age of 50 in industrialized countries. The risk of macular degeneration, the most widespread maculopathy, is more frequent as the years progress. In Italy it affects about 2% of the population, more than one million people; it is estimated that every year in Italy about 63,000 new cases of age-related macular degeneration (AMD) occur; about 10% of the world population is affected by AMD and it is estimated that the number of sick people will rise to about 288 million in 2040 “.
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What are the signs to watch out for to notice the disease?
“The symptom reported in all types of maculopathies, from the most severe to the least severe, initially, is a distorted vision of the images, sometimes not recognized in time by the patient because the healthy contralateral eye hides the disorder; from distorted vision one can pass to the vision of a fixed dark spot up to the total loss of central vision in the most severe and advanced cases “.
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What are the consequences on the lives of patients?
“Unfortunately, they can be extremely serious: difficulties in reading, driving, walking and therefore in general in carrying out normal daily and work activities; finally, the psychological impact that these patients must face should not be underestimated; we must consider maculopathies as chronic diseases with social impact, since although they can be cured with excellent results if promptly diagnosed and treated, they often recur “.
Is it possible to do prevention, despite the advanced age that characterizes patients?
“Prevention can and must be done because the result of the therapies depends on timely diagnosis and treatment; family doctors, doctors of other specialties as well as, obviously, ophthalmologists and the patients themselves are involved in prevention; it is recommended to all subjects, especially if familiar with maculopathy, to perform a complete preventive eye examination especially from the age of 50. There is a valid self-diagnosis test called Amsler Test which consists in evaluating, alternately closing first one eye and then the other, the possible distortion of the lines using a simple squared sheet “.
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Who should patients turn to?
“The next fundamental step for prevention to be successful is to go to Specialized Centers for the diagnosis and treatment of maculopathies where there must be expert and dedicated health personnel as well as all the most modern specific diagnostic instruments for the diagnosis of maculopathies”.
Why is the management of the patient with maculopathy complex?
“The complexity in the management of the maculopathic patient is linked to the characteristics of the disease which often recurs. In reality, the difficulties are easily overcome if the patients are managed in dedicated facilities able to follow each maculopathic patient over time and according to individual needs, with Scheduled subsequent appointments. Furthermore, the correct diagnosis of the type of maculopathy by specialized personnel avoids underestimating or overestimating its severity and therefore any treatment will follow the right appropriateness “.
Are there any effective treatments today? Which?
“There are effective treatments capable of eliminating the symptoms and blocking the pathology in most maculopathies. In the most serious and unfortunately most frequent forms of exudative macular degeneration linked to age as well as in maculopathies secondary to diabetes and thrombosis, the effective treatment consists of Intravitreal Injections, i.e. inside the eye, of substances called Anti-VEGF (Anti Vascular Endothelial Growth Factor). Fundamental for the good therapeutic result is to follow the treatment protocols that provide for the monthly repetition of the injections until complete resolution of the disease.
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