Earliest Symptoms of Diseases of the Macula *†

FROM whichever side it is approached, the question of diseases of the macula presents great interest and merits attention, because macular diseases are both common and serious. Diseases of the macula are common. In the first place I am thinking of senile maculopathy in its various forms. It is beyond doubt that the demographic trend of progressive ageing of the population is producing a very real increase in the number of cases of senile macular degeneration: to such a degree that we find ourselves-as ophthalmologists-involved in the science of " gerontology " and " geriatrics ". I am thinking, too, of myopia of medium and high degrees, the complications of which frequently compromise central vision long before advanced age is reached. Even though exudative maculopathies in adults are less widespread, and juvenile and familial macular degeneration is relatively rare, this is not the case in those lesions of the macula which occur in the course of retinopathies associated with hypertension, diabetes, periphlebitis, venous thrombosis, and so on, or again as a complication of chronic iridocyclitis. Diseases of the macula are serious. In injuring one of man's most precious functions, maculopathies attack him in one of his very sensitive spots, making him not only an invalid, but a particularly unfortunate one. It is certainly not an exaggeration to say that a central scotoma can destroy a professional career and disturb the normal activity of any life. And what can our therapeutic agents avail against one or other of these progressive lesions of the central retina ? The seriousness of a maculopathy is a direct measure of our impotence to restore vitality to tissues already destroyed, especially to the delicate, highly differentiated sensory or pigmentary epithelium. METHODS OF INVESTIGATION Since the invention of Helmholtz (whose centenary we have just celebrated), four or five generations of ophthalmologists have concerned themselves with observing, describing, drawing, and photographing a multitude of morbid conditions of the macula. We have differentiated various ophthalmoscopic pictures, out of which have emerged a corresponding number of morbid