In summary
Macular disease affects the macula, the central area of the retina that allows sharp, detailed vision. Its most common form is age-related macular degeneration (AMD). It affects everyday tasks such as reading, driving and recognising faces. Early diagnosis is essential to slow its progression.
- Risk factors
- Age over 50, smoking, family history, high blood pressure, dyslipidaemia, high myopia.
- Diagnosis
- Eye examination (fundus), Amsler grid test, OCT, OCT angiography, fluorescein angiography.
- Treatment
- Anti-VEGF injections (wet form), AREDS2 supplements (dry form at risk), photodynamic therapy in selected cases.
- Prevention
- Quit smoking, a diet rich in antioxidants and omega-3, UV protection, regular check-ups.
What macular disease is
How macular disease affects the macula
The macula is the central area of the retina, rich in photoreceptors specialised in fine vision. When the macular cells are damaged — by drusen, atrophy or the growth of abnormal new blood vessels — central vision becomes blurred or distorted, while peripheral vision remains intact.
Learn more about macular diseaseWhat is macular disease?
Macular disease is a condition that affects the macula, the central area of the retina responsible for sharp, detailed vision. Its most frequent form is age-related macular degeneration (AMD), which occurs in two forms: dry AMD (80-90% of cases, slow progression with build-up of drusen) and wet AMD (less common but more aggressive, growth of abnormal new blood vessels). There are also myopic, hereditary and diabetic forms.
Learn more about macular diseaseWhat to do if you have macular disease
- See your ophthalmologist straight away and follow the prescribed treatment consistently and regularly.
- Do the Amsler grid test at home every day to monitor your central vision.
- Eat a diet rich in antioxidants and omega-3 (fish, leafy green vegetables, fruit).
- Stop smoking and protect your eyes from the sun with UV-protective sunglasses.
- Keep blood pressure, diabetes and cholesterol under control.
- Use any recommended visual aids to improve your quality of life.
Symptoms and progression
Early stage — early AMDAsymptomatic
Small yellowish deposits (drusen) begin to build up under the macula. There are no symptoms: central vision remains sharp and the person does not notice any problem. Diagnosis is made only through a routine fundus examination.
Intermediate stage — dry AMDVisual distortion
The number and size of the drusen increase, and changes appear in the retinal pigment. The first symptoms begin: straight lines look wavy or broken, reading becomes more tiring, and changes in colour perception appear. Peripheral vision remains intact.
Advanced stage — wet or atrophic AMDLoss of central vision
In the wet form, abnormal new blood vessels grow under the retina and can bleed and leave scars. In the atrophic form (advanced dry AMD), an area of atrophy develops. In both cases a scotoma appears — a dark spot at the centre of the visual field — which seriously affects reading and the recognition of faces.
Diagnosis
Early diagnosis is essential: macular disease is progressive and largely irreversible, but timely treatment can slow or halt its progression. It is based on a full eye examination with fundus examination, supported by specific instrumental tests.
- Fundus examination
- assesses the condition of the retina and identifies changes in the macula.
- Amsler grid test
- can be done at home and detects visual distortions and early signs.
- OCT (optical coherence tomography)
- shows the retinal layers in detail.
- OCT angiography / fluorescein angiography
- study the retinal and choroidal blood vessel network.
Treatment options
The treatments available vary according to the type and stage of macular disease. The three main groups — intravitreal injections, laser and photodynamic therapy — are chosen and combined based on the form (dry or wet) and the patient's response.
Anti-VEGF injections
Intravitreal injections of anti-VEGF medicines (bevacizumab, aflibercept, ranibizumab) are the first-choice treatment for wet AMD: they block the growth of abnormal new blood vessels and reduce retinal oedema. The starting schedule is three monthly injections, then tailored to the response.
Find out about the medicines
Laser
In wet AMD, laser photocoagulation is now reserved for selected cases: anti-VEGF injections are more effective. In dry AMD, no laser, including the nanosecond laser (2RT), has been shown in controlled studies to slow the disease.
Laser treatments
Photodynamic therapy (PDT)
PDT combines a light-sensitive medicine, injected into a vein, with a low-power laser that activates it selectively on the abnormal new blood vessels. It is currently used in selected cases, such as polypoidal choroidal vasculopathy, usually together with anti-VEGF injections.
Surgical proceduresPrevention
Important
After the age of 50, do the Amsler grid test at home regularly: distortions or dark spots at the centre of the visual field are warning signs that require an immediate eye examination.
- 01
Lifestyle
Stopping smoking is the single most effective step to reduce your risk. A diet rich in antioxidants and omega-3 (leafy green vegetables, oily fish, fruit), along with controlling weight, blood pressure and cholesterol, supports the health of the macula.
- 02
Protection from the sun
The role of sunlight in macular disease is still debated, but protecting your eyes is a simple precaution: sunglasses with certified UV filters, especially in the mountains, at the beach and in all situations with strong glare.
- 03
Early diagnosis
Regular eye examinations with fundus examination after the age of 50 — or earlier if there is a family history, high myopia or other risk factors. The Amsler grid test done at home helps detect distortions and scotomas early.