Late retinal degeneration, also known as age-related macular degeneration (AMD), is a chronic progressive disease of the central retina characterized by degenerative changes in the macular region. The pathology develops mainly in people over 50 years of age and is one of the leading causes of irreversible loss of central vision in developed countries. The disease is characterized by a gradual decrease in visual acuity, distortion of the perception of straight lines (metamorphopsia) and the appearance of scotoma in the central field of vision. According to the modern classification, there are two main forms of pathology: dry (atrophic) and wet (exudative or neovascular).
History of the disease and interesting historical facts
The study of late retinal degeneration began in the 19th century, when the German ophthalmologist Karl Stargardt first described in detail the characteristic changes in the macular region. However, only by the mid-20th century, thanks to the development of ophthalmoscopy and fluorescent angiography, it was possible to study in detail the pathogenetic mechanisms of the disease. An interesting fact is that the first attempts at surgical treatment date back to the 1970s, when laser coagulation techniques for newly formed vessels were developed. “Modern advances in gene therapy open up new prospects for the treatment of AMD,” the researchers note in a 2021 paper.
Epidemiology
According to the World Health Organization, age-related macular degeneration affects about 8.7% of the population over 45 years of age. Moreover, the prevalence rate increases significantly with age: among people over 75 years of age, the disease occurs in 25-30% patients. Statistics indicate a higher incidence among representatives of the Caucasian race compared to African Americans and Asians. According to the results of a large population study AREDS (Age-Related Eye Disease Study), approximately 1.75 million Americans suffer from advanced forms of AMD.
Genetic predisposition to this disease
The genetic component plays a key role in the development of late retinal degeneration. The most significant mutations are in the genes:
- CFH (Complement Factor H)
- ARMS2 (Age-related maculopathy susceptibility 2)
- HTRA1 (High-temperature requirement A serine peptidase 1)
- C3 (Complement Component 3)
The risk of developing the disease increases with the presence of specific polymorphisms Y402H in the CFH gene and rs10490924 in the ARMS2 gene. Studies show that carriers of these mutations have a 2-4 times higher risk of developing AMD.
Risk factors for the development of this disease
The main risk factors include:
- Chronic exposure to ultraviolet radiation
- Smoking (increases risk by 2-4 times)
- Arterial hypertension
- Obesity and Metabolic Syndrome
- Insufficient antioxidant intake
Oxidative stress and chronic inflammation play a special role. “The level of C-reactive protein correlates with the risk of developing neovascular AMD,” modern research confirms.
Diagnosis of this disease
The main symptoms include:
- Progressive decrease in visual acuity
- Metamorphopsia
- The emergence of central scotomas
Laboratory tests include determination of antioxidant concentrations in the blood. Radiological methods include optical coherence tomography (OCT) and fluorescent angiography. Differential diagnosis is made with diabetic retinopathy, central serous chorioretinopathy and other macular pathologies.
Treatment
General treatment is aimed at modifying risk factors and includes smoking cessation, blood pressure control, and a special diet. Pharmacological treatment is represented by VEGF inhibitors (ranibizumab, aflibercept). Surgical treatment is indicated for severe subretinal hemorrhages. Alternative methods include photodynamic therapy and telescopic lens implantation.
List of drugs used to treat this disease
- Ranibizumab (Lucentis)
- Aflibercept (Eylea)
- Bevacizumab (Avastin)
- Pegaptanib (Macugen)
Disease monitoring
Control stages include regular OCT every 3-6 months. The prognosis depends on the form of the disease: with a dry form, progression is slower than with a wet form. Complications can include massive subretinal hemorrhages and retinal detachment. "Early detection and timely treatment allow preserving visual functions in 90% patients," the experts emphasize.
Age-related features of the disease
In younger patients (50-60 years), the dry form with slow progression predominates. At the age of 60-70 years, a mixed picture is observed, and after 70 years, the wet form with rapid vision loss is more often diagnosed. In young patients, the disease is more benign.
Questions and Answers
- How often should you be examined for AMD? An annual examination is recommended after 50 years of age, and every 6 months if risk factors are present.
- Is it possible to completely cure the disease? Unfortunately, a complete cure is impossible, but modern methods can slow down the progression.
- What foods are good for AMD? Green leafy vegetables, fatty fish, nuts and berries are recommended.
Advice from Dr. Oleg Korzhikov
Patients often ask if the disease can be prevented. I recommend the following:
- Have your eyes checked regularly using the Amsler chart.
- Take AREDS antioxidant complex
- Protect your eyes from ultraviolet radiation
“It is important to remember that early consultation with a specialist can significantly slow down the progression of the disease,” emphasizes Dr. Korzhikov.
