INTERVIEW WITH DR. FERRARO, OPHTHALMOLOGIST SPECIALISED IN DISEASES OF THE MACULA, RETINA AND VITREOUS
“Although only central vision is lost, the AMD patient fears being left completely in the dark”08/04/2018 · News
What is the retina and what is the macula?
The retina is a nerve tissue in the eye that collects the light signals transmitted to the brain. It cannot be replaced or transplanted. We are conducting trials with stem cells but there is still a long way to go. The macula is only a small part of the retina but it is much more sensitive to detail than the rest (what is called the peripheral retina) and it is what allows us to perform precision tasks, like reading, facial recognition and driving.
What is Macular Degeneration?
It is the leading cause of vision loss in the western world in patients of over fifty years old. There is a single form of AMD and all patients would eventually have the atrophic form. Some develop a repairing mechanism to compensate for the cells that die; this is what we call the wet form. Conversely, this compensation does not occur in other patients and here we are talking about the atrophic form. This disease is our concern and one of our challenges. This pathology produces a very fast reduction of visual acuity. The most effective therapy are anti-VEGF intravitreal injections with very good results obtained in most patients. In the dry form, which still lacks a treatment, cells die progressively and are not regenerated. Although its evolution is slower than in the wet form, it also ends up seriously damaging vision. We at the Institut and the BMF continue researching to find out more about this disease and to discover therapies as quickly as possible.
What are the main forms of diagnosis?
Firstly, we assess visual acuity. Then we perform an OCT scan (Optical Coherence Tomography), a technique that enables us to see the sections of the retina in vivo and observe all its layers in detail. On a case-by-case basis, we can also undertake other complementary tests like OCT-A (OCT-angiography), a non-invasive vascular diagnostic test, which in recent times has led to a change in the way we understand the retina. We also use fluorescein angiography or indocyanine green angiography and all this gives us sufficient information to decide how to act.
How long do these tests take?
At the Institut, we are keen to do everything on the same day. This is very important for patients as they find out quickly what is happening to them and treatment can start, if possible, without delay.
What are the main symptoms?
There are three: distortion of images (straight lines appear curved); appearance of scotomas (a lack of part of the visual field) and reduction in visual acuity. At first, these changes may be very subtle and for this reason we recommend regular check-ups from a certain age. These check-ups enable us to spot, for example, the appearance of drusen (material deposits under the retina that are produced naturally during the ageing process) that can be the precursors of AMD.
What are patients’ main concerns?
The patient’s principal fear is going blind. In the case of macular diseases, we explain to them that they will never be left totally in the dark. They will have a lack of vision in the central visual field (the scotoma) but they will continue to see through the periphery.
Is it important for AMD treatments to be personalised?
Every patient is different. In the case of wet AMD, there should be a minimum of seven intravitreal injections in the first year, according to scientific studies. From then on, we prefer to adjust the number in an individualised manner according to the patient’s response. At many centres in France, Germany, Italy or Spain, fewer injections than are desirable are administered (LUMINOUS Holz FG et al. BJO 2013). This is particularly serious because if the disease is not treated, its advance cannot be halted and the consequence is vision loss.
Why is it important to keep researching?
Our vocation as doctors is to help people. Therefore, research forms an important part of trying to cure diseases that are impossible to do so at present. It is also a way of giving hope to patients because they know that while there is research they have a chance to be cured.
The International Day of Women and Girls in Science was celebrated in February.
These are fine initiatives for publicising the scientific work of women. Personally, I admire Dr. Rita Levi-Montalcini, who was an Italian scientist and the winner of the Nobel Prize for Medicine in 1986. For her, talent was not a gender issue because women and men have the same intellectual capacity but different approaches to research that complement each other. At the Institut de la Màcula and the Barcelona Macula Foundation, there is parity in the presence of female doctors and health professionals, which is unquestionably a great advantage.