Age advances and the eyesight can be affected to varying degrees. When the retina undergoes this process of aging we speak of senile macular degeneration, one that is related to age. What are the possible warning signs and what is the role of prevention? We asked doctor Mary Romano, ophthalmologist at Humanitas.

What is senile macular degeneration?

Maculopathies are the ocular pathologies affecting the macula, the central part of the retina, the membrane that covers the inner surface of the eye. The most common among maculopathies is senile macular degeneration, which leads to a progressive reduction of the central vision until possible vision loss. In other words, the eye can no longer focus on the center of the field of vision while being to perceive the details positioned at the edges of the field of vision, on the periphery.

Both eyes or only one eye may be affected. Reading, for example, may prove very tiring, as well as driving or watching TV. Therefore, the pathology has a significant impact on the patient’s quality of life.

The most common form of this pathology is the so-called “dry” form. The macula becomes thinner and piles of proteins are formed, called drusen: “Senile macular degeneration is a disease with no symptoms in the initial form. When it begins, around 55-60 years of age, the drusen appear, which are the warning signs of the disease; the ophthalmologist recognizes and diagnoses the disease thanks to the examination of the bottom of the eye “, adds Dr. Romano.

In addition, there is also the “wet” form, less common but more severe with a more rapid onset, characterized by the formation of new, anomalous blood vessels under the retina: “The symptoms – continues the specialist – appear rather abruptly when the disease evolves towards the neovascular form. The growth of neovasi in the central part of the retina generates a sudden and sharp visual drop accompanied by distortion of the images, difficulty reading and performing work that requires close eye contact. Since these neovases raise the retina, they determine all this symptomatology.

These vessels may also lose liquids, including blood. The pharmacological treatment will be able to reduce the number of these neoformations. A therapeutic intervention that can be useful in case of “dry” macular degeneration is the intake of vitamin or mineral supplements (from vitamin C to lutein to zinc).

Prevention and treatment

Age-related macular degeneration is one of the eye diseases that has a certain correlation with lifestyle. The chances of meeting this disease, after the age of 55, increase if you are overweight or obese as well as having a family history with this disease: “Certainly physical activity, a diet rich in fruit and vegetables and not smoking help to prevent and slow down the evolution of the disease. It is a good rule, after the age of 50, to carry out periodic check-ups, especially if there is someone in the family who has been affected by senile macular degeneration,” the expert points out.

In the early stages of treatment, it is preferred to give the patient supplements based on lutein, zeaxanthin, omega 3 useful to maintain a good trophism of the retina. In the wet form, on the other hand, the therapy of choice consists in the use of anti-angiogenic drugs (anti-VEGF) injected directly into the vitreous body”.

Photodynamic therapy (Photodynamic therapy – PDT) can sometimes be used in combination with these to enhance the anti-VEGF effect. The treatment involves intravenous injection of verteporfin to the patient, a photosensitive substance that binds to abnormal capillaries responsible for the disease. Subsequently, thanks to a laser of specific wavelength, abnormal vessels are highlighted: the laser activates the drug causing closure or reduction of abnormal vessels. After a few days after this treatment, intravitreal injection is carried out. In some cases, PDT can also be used alone,” recalls Dr. Romano.

Another treatment instrument is the “2RT laser that acts through a photostimulation that stimulates retinal regeneration. It is especially useful in the initial and intermediate stages of the disease, i.e. when medium and large drusen are evident and the patient is at high risk of progression. It is a brand new generation laser that tends to stabilize the clinical picture”.

“All these procedures described above can stop or slow the loss of vision, but unfortunately they do not represent a definitive therapy and many patients continue to suffer significant loss of vision over time,” concludes the specialist.