Index
Age-related macular degeneration (Age-related Macular Degeneration, AMDatrophic type) or more commonly called atrophic maculopathy is a serious eye disease that affects the macula, that is the portion of the retina richest in photoreceptors and responsible for central visionfine and detailed that allows us to recognize a face, read, perform precision work, drive the car etc.
In technologically advanced countries, the incidence of atrophic maculopathy has increased strongly and continues to increase due to the increase in the average life span. In fact, AMD affects about 11% of people between the ages of 65 and 74 and this percentage increases significantly as older age groups are considered. Atrophic maculopathy today, in the most industrialized countries, is the most common cause of legal blindness and low vision in people over the age of 55.
Usually the waste material that forms drusen is phagocytosed and digested by the RPE cells, but as we age and cellular activities slow down, this material is no longer properly eliminated and settles under the RPE.
Symptoms
People with atrophic AMD in initial phase they usually have no symptoms; in intermediate stageon the other hand, they can report a blurred vision, altered color perception, distorted or wavy vision, difficulty in visual adaptation in the transition from a bright environment to a less illuminated environment, intolerance to very strong sunlight. Nello terminal stage geographical atrophy leads to the loss of central vision, which manifests itself with the appearance of a central scotoma, a dark or missing area in the center of vision, which prevents reading and sometimes the ability to recognize faces. The damage is all the more serious the greater the retinal area involved in the structural alteration.
The times from the initial phase of atrophic AMD to its terminal phase are sufficiently predictable and can vary greatly from patient to patient.
Risk factors
Several risk factors for AMD have been recognized, the most important being theold age, familiarity, smoke, excessive exposure to sources of UV rays without eye protection, the unbalanced diet (too rich in animal fats and low in vegetables and antioxidants), the lack of exercise,hypercholesterolemia,hypertension not controlled, etc.
Given the danger of AMD, it is very important to keep in mind the risk factors for this pathology and try to adopt a lifestyle as healthy and careful as possible from an early age, allowing to prevent or at least delay its onset.
A major clinical study called AREDS2 has shown that taking high doses of certain dietary supplements (Vitamin C, Vitamin E, lutein, zeaxanthin, zinc e copper) is effective in reducing by 25% the risk of evolution of AMD towards the most advanced form of the disease, that is the geographic atrophy or the exudative form. Patients diagnosed with atrophic AMD should take these supplements as prescribed by their eye doctor.
It is good to remember that taking these food supplements reduces the risk of progression of atrophic AMD, but it has neither a preventive effect in healthy people nor is it able to restore vision already lost in patients with AMD.
Diagnosis
The patient usually in the initial stages of the disease has no symptoms and for this reason it is very important to undergo eye examinations periodically, especially in the case of familiarity with the disease and in these cases it is also useful to undergo a predictive genetic test. In the more advanced stages of the disease, the patient reports more precise symptoms, a blurred vision in the central area, with a normally preserved peripheral vision and sometimes the presence of a blind spot that progresses and becomes larger and larger over time. Precisely in these medium-advanced stages of atrophic AMD, the presence of confluent drusen can give rise to localized phenomena of inflammation, which can trigger the transformation from atrophic AMD to Neovascular AMD, a much more aggressive and dangerous form than the atrophic one, which has a slow progression.
For this reason, it is important that patients with atrophic AMD undergo regular clinical and instrumental monitoring through diagnostic tests such as optical coherence tomography (OCT) high resolution to be able to analyze every single retinal layer and therefore every micrometric change, thefluorescence angiography (FAG) and theindocyanine green angiography (ICGA) to analyze the anatomy and integrity of blood vessels and identify any abnormalities. A careful and scrupulous monitoring of the retina, in fact, can prevent the onset of the exudative form leading in a very short time to the loss of central vision, helping the patient to preserve vision for as long as possible.
Treatment
Until recently, patients with atrophic maculopathy could only be recommended an improvement in lifestyle, wearing protective ultraviolet (UV) eyewear, and taking dietary supplements, as evidenced by the AREDS2 study, which they proved to be effective in slowing the evolution of the disease, but in addition to this preventive treatment, there were no treatments with proven efficacy to offer to patients. In recent times, however, new treatments are emerging capable of slowing the evolution of atrophic AMD.
Recently, as confirmed by a complex multicentre randomized study (LEAD), a new nanosecond laser has been introduced which, with a sub-treshold irradiation of the posterior retinal area, is capable of inducing the release of some specific enzymes (metalloproteinases) that can induce Anatomical changes at the level of the Bruch-choriocapillary membrane retinal pigment epithelium complex such as to reduce the progression of diseases in selected patients.
2RT laser treatment
An expansion and further awaited confirmation of the data issued so far will allow us to extend the use of the 2RT® nanosecond laser in correct clinical and therapeutic practice. The use of this type of laser (2RT®) it has also been successfully applied for the first time in the therapy of a hereditary retinal disease (Leventinese disease) demonstrating how physical therapy (laser) can induce a functional improvement in patients affected by hereditary retinal diseases.
In addition to this laser technology, numerous drugs are being studied that can inhibit the complement factor cascade responsible for the onset of the disease, which is injected into the eyeball via an intravitreal injection, and which hopefully will being able to slow the progression of atrophic AMD from the late stage to the terminal stage represented by geographic atrophy (GA).
We hope that ongoing clinical trials will soon confirm the safety and efficacy of these new treatments, so that they can soon be used to safeguard vision in people with atrophic AMD.
Pathology and treatment on video
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