Macular Degeneration of Age, Unknown Visual Disease Affecting 40,000 People a Year

By: António Campos, ophthalmologist

With regard to World Sight Day, celebrated on October 10th, the World Health Organization (WHO) warns that 80% of the causes of visual impairment are preventable or can be treated by appropriate prevention methods. Given the aging of the population, one of the diseases to consider is age-related macular degeneration (AMD), which is cited as the most common cause of irreversible vision loss in people over 60.

Speaking with Vital Health, António Campos, an ophthalmologist at the Leiria Hospital Center, defined age-related macular degeneration (DMI) as an aging retinal disease characterized by accumulation of metabolic products, which translates into loss of central vision. Thus, patients “always have peripheral vision, but in the center they see nothing, so they develop legal blindness,” he explains.

IMD develops in different phases, with the greatest risk factor being age. Still, dietary imbalances, family factor and tobacco are also factors to be taken into account. The early stage can affect up to 13% of people over 70 years of age, with an asymptomatic period. Only a visit to the doctor allows the existence of ocular, multiform and yellowish lesions that appear at the back of the eye. This is followed by an intermediate phase in which symptoms present, where lesions increase in size, number and complexity. Finally, there is an advanced symptomatic phase in which vision loss or distortion develops, “where people’s faces appear laughable, distorted, and the vertical and horizontal lines curl,” says the ophthalmologist.

“There is a very easy way for patients to understand if they have a problem, which is to hand them a grid, like those in math books. If you see these crooked lines, it means you have a serious problem. It is a test that anyone can do and it shows if they have an already symptomatic form ”, says António Campos. In these cases, it is advisable to go to the doctor immediately, because if the disease is not treated, “every two weeks people lose a line of letters on a visual acuity scale, which may never recover,” he warns.

People over 55 and with family members who have proven or suffered from the condition and are undergoing treatment should go to the ophthalmologist once a year, the doctor advises. When there are lesions, they may perform retinography, and repeat the retinal photographs in a serial manner to monitor its evolution.

Although the disease has no cure and there is no way to stop it, since 2006 several treatments have been in place. One form of prevention is the daily intake of dietary supplements, which, the need to be taken for a long time, the high cumulative price and the questionable efficacy, are unattractive to patients, according to Antonio Campos. However, when the forms of the disease are symptomatic, they are treated by intraocular injections.

According to the doctor, “We should have about a thousand new cases a year of advanced forms of the disease to treat or already without treatment, if we have delayed diagnosis or treatment. Regarding the prevalence of the disease indicated for treatment as a whole, we have about 7,000 cases. It will be reasonable to think that we should walk around 40,000 individuals with the disease, and about 7-10,000 will need treatment. The relationship between patients on treatment and those to whom the treatment window has passed, having developed irreversible vision loss, will vary between 1: 1 or 1: 4, depending on each country’s best or worst treatment strategy, ”he concludes.

According to António Campos, the incidence of IMD will increase, not because its general occurrence in Europe is increasing, but due to the aging of the population and underdiagnosis due to the lack of knowledge about the disease. “Many Portuguese should not know that they have the disease, as there is not yet a perception in people of the danger of this disease as diabetes, for example, nor are there many associations of patients with the disease, as there is also for diabetes.” Thus, as people’s awareness and involvement increases, so does their known incidence, the ophthalmologist suggests.