Content

Introduction

Introduction

The term retinopathy refers to all those diseases that affect the retina. The retina is a thin layer of nerve tissue, which lines the inner surface of the eye, made up of neurons, sensitive to light, and blood vessels. The retina has the function of transforming light impulses into nerve signals which are then transmitted to the brain. through the optic nerve and converted into images.

Retinopathies can involve different areas of the retina, causing more or less serious effects depending on the affected areas. Injuries affecting the central area of ​​the retina (macula) can cause loss of central vision acuity, distortion of straight lines, and impaired color vision. Lesions affecting parts of the retina other than the macula can cause alterations in a part of the visual field or, in severe cases, lead to total blindness.

The retina can be affected by various types of vascular diseases or by degenerative diseases resulting from general pathologies such as atherosclerosis, arterial hypertension or diabetes.

In Italy, cases of retinopathy or retinal degeneration affect about 20,000 people every year.

There are various forms of retinopathy, some occur more frequently, others are less common or even rare and are classified into retinal vascular, inflammatory, degenerative and retinopathies associated with general (systemic) diseases such as diabetes or arterial hypertension.

The main forms of retinopathy are:

  • retinal detachment
  • macular degeneration
  • diabetic retinopathy
  • hypertensive retinopathy
  • arteriosclerotic retinopathy
  • retinitis pigmentosa
  • myopic retinopathy
  • infectious retinitis
  • macular hole
  • macular pucker, a disease in which an epiretinal membrane is formed, that is, a layer of cells that exerts traction on the retina
Symptoms

Symptoms

Symptoms caused by retinal disease can be numerous and different in intensity and precocity, related to the retinal area involved and its extension.

The most common symptoms are:

  • reduced vision
  • blurred vision
  • distortion of images (metamorphopsia)
  • alterations in the perception of colors
  • shadow covering part of the field of view (scotoma)
  • fixed black spots
  • flying flies or floating dark bodies (floaters)
  • short flashes of light (photopsies)
  • total blindness (amaurosi)
Causes

Causes

The retina can be affected by various types of vascular diseases or by degenerative diseases resulting from general diseases such as atherosclerosis, arterial hypertension or diabetes. Retinopathies can be caused by traumatic events, for example, retinal detachment can also occur as a result of direct trauma or a kickback, such as in a rear-end collision.

Inflammation of the retina due to bacteria, viruses or fungi can cause retinopathy. Even severe myopia can lead to retinal lesions.

As for age-related macular degeneration, a cause has not yet been identified but some risk factors have been identified, such as:

  • age
  • cigarette smoke
  • familiarity
  • arterial hypertension and cardiovascular disease
  • obesity
Diagnosis

Diagnosis

The diagnosis of any retinopathy is made during a "thorough eye examination in which the doctor performs a series of tests to both prevent or identify the presence of a disease, and to establish the appropriate therapy.

The main diagnostic tests are:

  • visual field examination, consists of the graphic representation of the portion of space that a person is able to see, keeping his gaze straight ahead. It is an essential test for the evaluation of glaucoma but it can also be very useful in the study of some diseases of the retina, the optic nerve and the central nervous system.
  • fundus examination (fundus oculi), allows you to explore the internal structures of the eyeball (in particular the vitreous body, retina and the initial part of the optic nerve). This test also allows you to view the veins and arteries of the retina and to evaluate their size and path, so as to be able to identify the possible presence of anomalies.
  • Amsler test (Amsler grid test or Amsler grid), is a very simple visual examination that uses the Amsler grid, a grid consisting of horizontal and vertical lines, to check the central field of view. This test is mainly used to identify the presence of a visual disturbance that causes distorted and deformed vision of objects (metamorphopsia), a typical sign of macular degeneration
  • computed optical tomography (OCT), a technique that allows obtaining excellent quality images of the retina and the optic nerve
  • ocular angiography (angiography with fluorescein and indocyanine green), these are tests that use special cameras capable of detecting the presence of the dye (fluorescein or indocyanine), previously injected into a vein, and obtaining images of the structures located in the back of the eye , in particular, of the blood vessels of the retina and those present in the deepest layer, the choroid
Therapy

Therapy

The treatment of retinopathies varies according to the type of disease, it will be the ophthalmologist specialist to identify the most appropriate therapy. Surely, the speed in intervening is of fundamental importance to solve or limit the damage that can be even serious.

Surgical treatment is used in cases of retinal detachment, in which the traction of the vitreous body on the retina is removed, and in the myopic or idiopathic macular hole or for the macular pucker.

THE macular holes they can be caused by trauma, by severe myopia, by venous occlusions, by hypertensive retinopathy. The treatment in this case is surgical and consists in the removal of the vitreous body (vitrectomy).

The macular pucker o epiretinal membrane (formation of a layer of cells that exerts traction on the retina) is a disease that causes image distortion. It generally occurs after the age of 50. The causes are unclear; its onset can also be linked to inflammatory processes or following surgery or laser treatments. The available therapy is surgical and is based on the excision of the vitreous body and the removal of the epiretinal membrane (pucker).

For the macular degeneration there are no resolutive therapies; in some cases it is possible to resort to drugs to be injected directly into the eye to counteract the formation of new blood vessels (angiogenesis).

For the vascular-based retinopathies the underlying disease (diabetes, arterial hypertension, dyslipidemia) must first be treated with medical therapy. If necessary, based on the damage of the retinal vessels, specific treatments are used: for example, lasers can be used in cases where there are areas of retinal ischemia (reduced blood supply), such as in the advanced stages of diabetic retinopathy and in some retinal vascular occlusions, or intravitreal injections (in the eye) of anti-VEGF (Vascular Endothelial Growth Factor) in the event that there is accumulation of fluid in the retinal tissue (retinal edema).

The bacterial infectious retinitis they are treated with antibiotics administered locally (through eye drops) or systemically.

There retinitis pigmentosa it is a degenerative form for which a therapy capable of blocking the disease is not yet available. The studies are mainly focused on stem cell testing and gene therapy which could, in the future, lead to positive results.

There myopic retinitis it does not have a specific therapy but complications that occur in the retina of an eye affected by severe myopia can be treated.

Prevention

Prevention

It is possible to counteract the appearance, or limit the damage, of forms of vascular retinopathy by adopting a healthy lifestyle, avoiding smoking, limiting the consumption of alcohol, favoring a "varied diet rich in fruit and vegetables and undergoing periodic medical checks. especially after 40 years of age.

Usually, people suffering from one form of retinopathy experience various visual discomforts. These discomforts vary according to the extent of the damage caused by the pathology and by the compromised retinal portion. The most common symptoms are reduced vision, blurred vision, distortion of images (metamorphopsia), alterations in color perception, presence of shadows that cover part of the visual field (scotoma), the fixed black spots, the "flying flies" or dark floating bodies (floaters), the short flashes of light (photopsies); in the most serious cases it can lead to total blindness.

There are, however, various devices and devices that can help in the normal functions of daily life, such as, for example, good lighting, the use of magnifying glasses, reading texts with large characters, magnification of the PC text, the use of telephones with large keyboards, the use of audio books.

Bibliography

Bibliography

Mayo Clinic. Retinal diseases (English)

International Agency for the Prevention of Blindness (IAPB Italia Onlus). Retina

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