What is It? La Degenerazione Maculare (AMD o DMLE) è una malattia cronica e progressiva che colpisce la macula, ossia la porzione centrale della retina con conseguente riduzione del visus ed impossibilità nel riconoscere i dettagli fini di un oggetto. La DMLE colpisce soprattutto individui con più di 60 anni ed è attualmente considerata la prima causa di cecità centrale nei Paesi di maggior benessere e la terza in assoluto. Macular Degeneration (AMD or DMLE) is a chronic and progressive disease that affects the macula, that is the central portion of the retina with consequent reduction of vision and the inability to recognize the fine details of an object. AMD mainly affects individuals over the age of 60 and is currently considered the first cause of central blindness in countries with the greatest prosperity and the third overall. Classification There are two forms of age-related macular degeneration: DRY and WET Dry (or atrophic) macular degeneration: it is the most common form and is characterized by a progressive thinning of the outer retinal layer, (where the photoreceptors and the cells of the retinal pigment epithelium reside) which is poorly nourished by the capillaries. In the initial stages of AMD, the presence of colloid bodies, called drusen, is observed, which are small agglomerates of "waste" with a roundish and yellowish color, which are deposited under the retina. Essentially two types can be distinguished: hard drusen (less severe) and soft drusen (potentially more harmful to sight). At the fundus, the characteristic lesion appears as one or more light areas that progressively tend to enlarge and merge, giving the retina the appearance of a map. Wet macular degeneration: it is the least frequent form and is characterized by the anomalous formation of new vessels under the retina that give rise to what is called choroidal neovascularization. These vessels, due to their fragility, tend to break easily causing the leakage of serum or blood, resulting in edema or hemorrhage of the macula, or detachment of the retinal pigment epithelium. Continuous attempts at tissue repair can also lead to the formation of scarring phenomena Risk Factors, Symptoms and Diagnosis Age-related macular degeneration is a multifactorial pathology whose pathogenesis is not completely clear, however it is believed that the main risk factors are age, smoking, genetic factors, oxidative stress, environmental factors. SYMPTOMS The initial phase of the disease, the one characterized only by the presence of drusen, can be asymptomatic or manifest itself with metamorphopsias ( distortion of straight lines ); in the most advanced stages, as well as in the case of wet maculopathy, the most evident symptoms are a reduction in vision, an altered sensitivity to contrast, and the formation of a central scotoma which manifests itself with the appearance of a dark spot in the center of the field of view.The involvement of both eyes can be very disabling and compromise autonomy in everyday life, altering both near vision ( reading, face recognition ) and distance vision. DIAGNOSIS An initial diagnosis can be made during the eye examination, by subjecting the patient to the visual examination, to the Amsler grid to detect any distortions of the straight lines, and to the fundus examination. In case of suspected maculopathy, the ophthalmologist may request more in-depth examinations such as Optical Coherence Tomography (OCT) and Angiographic examinations (Fluorangiography and Indocyanine Green Angiography) to study the retinal layers and retinal vascularization.
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