Past, present and future of retinal pathologies

The retina is the inner layer of the eye in which the images we receive from our environment are transformed into nerve impulses that are sent to the brain through the optic nerve, where vision is produced at the back of the optic nerve, in the occipital area.

How can we prevent the main retinal pathologies?

At the moment, three of the four main causes of legal blindness are due to retinal problems: age-related macular degeneration (AMD), diabetic retinopathy and myopia magna.

Thus, there are unavoidable factors, such as age (in AMD) and the genetic load of each person, but there are also controllable factors, such as smoking and blood pressure. In the case of diabetes, for example, strict control of diabetes will improve the prognosis and evolution of diabetic retinopathy, and in the case of myopia magna, a periodic fundus examination will allow us to detect lesions in the peripheral retina or in the macula and treat them early.

In general, those at risk, such as direct relatives of people with AMD over the age of 50, diabetics and myopic myopes should have their fundus checked periodically.

Have retinal pathologies increased in recent years?

The increase in survival with longer life expectancy means that there is a greater number of patients with AMD, since the main factor is age (aging); every day there are more diabetics due to changes in lifestyle and eating habits and therefore more diabetic retinopathy; and in the case of myopia magna, in our environment there is a significant number of high myopes, as in the entire Mediterranean basin.

Has the diagnosis of retinal pathologies improved?

New technologies allow us to have a better knowledge of the diseases and a much more effective treatment, therefore, ophthalmologists will diagnose them earlier, treat them more effectively and control them better.

What are the most effective techniques to treat retinal pathologies?

Optical Coherence Tomography (OCT) has revolutionized the diagnosis and monitoring of macular diseases. Diagnosis and follow-up is much more precise; we have a better understanding of some retinal diseases, their mechanism of production and their evolution. It also allows us to better follow patients and know how they respond to treatment.

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What does the new angio-OCT consist of?

The new angio-OCT is used to study circulatory diseases of the retina, such as those mentioned above: AMD, diabetic retinopathy and myopia magna, although the latter two can also be influenced by other factors; and also other diseases such as venous obstructions, etc.

A test called fluorescein or indocyanine green angiography is frequently used, which consists of injecting a substance (fluorescein or indocyanine green) into the bloodstream to analyze the retina as it passes through it.

These are invasive tests that require more time and means; they have some risk but are infrequent. With modern OCTs we can obtain images of the retinal and choroidal circulation without the need for injection, with more detail, more information, in three dimensions, in a few minutes and repeatable over time as many times as we need due to their safety and speed, improving the information we have about the disease. The better we know the diseases, the better we will be able to treat them.

What impact do new technologies have on retinal pathologies?

There is a myth and many people say that eyesight “wears out” with computers, screens, etc… It is not true. The use of screens forces us to make a greater visual effort and we get more tired, but it does not harm our eyesight. On the contrary, it is important to have a good posture, avoid reflections, keep the screen at the right height and rest periodically. They do not affect the retina in a special way.

What is your prognosis for retinal health in the coming years?

New diagnostic techniques such as the new OCTs mentioned above, angio-OCT, new anti-angiogenic medications, sustained-release corticosteroid devices injected into the vitreous cavity and improved surgical microscopes and instrumentation for vitreoretinal surgery (vitrectomy) have greatly advanced and will continue to improve the diagnosis and treatment of retinal diseases.

On the other hand, as we have already mentioned, the increase in life expectancy and the increase in the prevalence of diabetes will cause AMD and diabetic retinopathy to increase significantly.

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