Understanding Age-Related Macular Degeneration: A Comprehensive Guide
Introduction: The Impact of Age-Related Macular Degeneration
Age-related macular degeneration (AMD) is a prevalent eye disease that affects millions of people worldwide. Initially taken for granted in our youth, the macula plays a crucial role in transforming light into vivid colors and high visual clarity. However, as we age, the development of AMD can lead to significant vision impairment, affecting central vision and causing a range of symptoms.
Causes and Risk Factors
AMD is influenced by a combination of age and genetics, with certain genetic factors predisposing individuals to the disease. As our population ages and diagnostic tools improve, the prevalence of AMD is expected to rise significantly in the coming years. Regular eye exams play a vital role in early detection and management of AMD.
Dry AMD vs. Wet AMD: Understanding the Differences
AMD can manifest in two forms: dry AMD, affecting a majority of patients, and wet AMD, which poses a more rapid risk to vision loss. While geographic atrophy characterizes dry AMD, the growth of abnormal blood vessels distinguishes wet AMD. Timely treatment is crucial to prevent irreversible damage in wet AMD cases.
Current Treatment Approaches
Therapies for AMD aim to address the underlying causes and symptoms of the disease. While treatments for wet AMD, such as injections into the eye, offer promising results in preserving vision, managing dry AMD remains a challenge. Ongoing research seeks to develop new interventions to slow the progression of AMD and improve patient outcomes.
Novel Approaches and Future Directions
Recent FDA approvals of drugs targeting geographic atrophy represent significant advancements in AMD treatment. Complement inhibitors have shown promise in slowing the progression of AMD, offering hope for improved outcomes in affected individuals. Combination therapies and further research are needed to enhance treatment efficacy and reduce vision loss associated with AMD.
Wellness Strategies and Preventive Measures
Alongside medical interventions, vitamin therapy and lifestyle modifications can help reduce the risk of AMD progression. Studies have demonstrated the benefits of specific vitamin combinations in slowing degeneration and preserving vision in high-risk individuals. Educating patients on early detection and self-care practices is crucial in managing AMD effectively.
Summary:
Age-related macular degeneration (AMD) poses a significant threat to vision health, affecting millions of individuals globally. While the disease’s causes and progression are multifactorial, advancements in treatment options offer hope for preserving vision and improving patient outcomes. Timely diagnosis, regular monitoring, and a combination of medical and lifestyle interventions are essential in managing AMD effectively. By staying informed and proactive, individuals can empower themselves in the fight against AMD and maintain healthy vision for years to come.
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May 10, 2024: When we are young, we take our taint for granted. At the center of our retina, the deepest layer of the eye that is packed with photoreceptors and gives color to our world, the macula is like a high-resolution camera. When light hits our eyes, the retinal macula transforms our world into an explosion of color with astonishingly high visual clarity.
But as we age, our vision becomes more opaque. What once stood out clearly becomes hazy, like condensation on a window pane. After a while, a charcoal-black spot or cloudy circular area begins to affect your central vision.
This effective blind spot widens over time if left untreated. What remains is a “macular hole” in the center of the retina.
This unfortunate series of events marks the advanced stage of Macular degeneration associated with agea dangerous retinal disease that affects about 20 million people in the U.S. and nearly 200 million people worldwide.
And it’s not getting better. It is estimated that by 2040 the disease could affect almost 300 million people worldwide. Our ability to treat or prevent it is very limited. Read on to find out what to know.
First, what causes age-related macular degeneration?
The causes of AMD are varied, and whether it affects you depends primarily on age and genetics, said Marco Alejandro González, MD, an ophthalmologist and vitreoretinal specialist in Delray Beach, FL.
Because of the different cocktails we have in terms of our genetic makeup, the photoreceptor cells in some people’s macula “basically start to shut down,” he said.
The development of AMD involves more than 30 genes, and if you have a first-degree relative (parent, brother, child) who has the disease, you are three times more likely to get it too.
González explained that the expected increase to 300 million cases by 2040 is mainly due to better diagnostic tools, along with the fact that the world is aging and living longer. (Usually, an optometrist can detect signs of AMD during a routine eye exam).
Eye experts are still struggling to stop the most damaging sign of AMD: the cause of those cloudy, milky, or even charcoal-colored circles in central vision: geographic atrophy.
Geographic atrophy can occur in either of two forms of age-related AMD: “dry” AMD and “wet” AMD.
Almost all cases of AMD starts as the dry typewhich affects 80% to 90% of patients with AMD.
Retinal disease expert Tiarnán Keenan, MD, PhD, offered a vivid picture of geographic atrophy for dry AMD sufferers.
“As time goes by, GA’s circular patches spread like wildfire, taking more and more vision with them, often to the point of legal blindness,” he said.
Keenan, a researcher in the Division of Epidemiology and Clinical Applications at the National Eye Institute, recently led a study which tested the effectiveness of the antibiotic minocycline in slowing the spread of geographic atrophy in dry AMD. The study was based on the fact that the body’s immune system could influence the development of the disease.
When your body’s immune system is overactive, microglial cells (immune cells of the central nervous system) can enter the subretinal space and possibly devour the macula and its sensitive photoreceptors.
Although minocycline had been shown to reduce inflammation and microglial activity in the eye in diabetic retinopathy, it did not slow the spread of geographic atrophy or vision loss in patients with dry AMD during Keenan’s study.
When asked if microglial activity might have very little to do with the spread of atrophy, Keenan said it’s something to consider: “Maybe the microglia are just there as spectators cleaning up the debris…so it’s less likely.” that inhibiting them will slow down the progression.
In future drug trials, “minocycline or another method of targeting microglia may be useful, but it would be necessary in combination with some other therapy and would be ineffective on its own,” he said.
Two faces of the same disease
In dry AMD, González compares macular degeneration to the loss of pixels on a screen. “Some of those pixels burn out… and that’s the classic way you lose dry vision.”
Wet AMD is a more progressive form of the disease. It causes abrupt loss of vision due to abnormal growth of blood vessels.
“If wet AMD is not treated quickly, it’s game over,” Gonzalez warned. “Wet macular degeneration is the most rapid process of vision loss because these blood vessels wreak havoc.” These new blood vessels bleed, causing fluid to build up in the macula, ultimately resulting in scarring.
González shed light on why wet AMD develops. “The wet form, for some reason, is the body’s last ditch effort to try to ‘help’ a dying macula. … When these blood vessels begin to grow under the retina, they quickly destroy the architecture of the macula.”
Stop bleeding in wet AMD
Although wet AMD is rarer, it is more treatable than dry AMD. Signs and symptoms can be relieved with various therapies. injected into the eye.
Simply put, González said these therapies for treating wet AMD “basically do the same thing. “They cause these new blood vessels to temporarily recede before causing damage to the macula.”
The injected medication cleanses those blood vessels and restores the architecture of the macula. People can regain some vision this way, but it is only a temporary tune-up and injections must be given once a month.
“Cell degeneration continues to be the main problem. You’re not going to stop that. But the degeneration itself is much slower than the actual vision loss associated with these blood vessels.”
The fight to develop new treatments
According to Keenan, “no one has been able to prevent geographic atrophy from occurring” in any form of AMD. “So, that’s the main work in the field with trials.”
In December 2023, the FDA approved two new drugs: Syfovre and Izervay, which only slow geographic atrophy. Regardless, degeneration still occurs.
Keenan explained that these two new drugs are “complement inhibitors… given by injection into the eye about once a month.”
“Complement” refers to the body complement pathway, a trigger that activates a protein cascade to enhance the immune response.
Clinical trials showed that Syfovre reduces the rate of geographic atrophy by up to 22% in 2 yearsand Izervay up to 14% in 1 year.
Although these medications are a new weapon against this problematic disease, they are not free of complications.
“Every time you give an injection to the eye, there is always a risk of infection because something from the outside is introduced. So that is the biggest risk,” González explained.
An infection is rare, but potentially devastating, as you can lose your eye completely. There is also the possibility of a harmful reaction to the shot.
“You have to choose your patients,” González said. “Not everyone is a good candidate for these new vaccines… and the patient will never see better. … It’s harder to sell than the wet AMD ones.”
A common protection measure
Keenan and Gonzalez are fairly confident in reducing the risk of AMD with vitamin therapy.
As a bit of context on how vitamins were found to act as a sort of preventive measure, Gonzalez said, “In the early and late ’90s, there were a number of studies that were called age-related eye disease studies.” . These are now known as AREDS 1 and AREDS 2.
Researchers showed that a certain vitamin cocktail slowed down degeneration. The ultimate is a combination of antioxidants: vitamins C and E, lutein and zeaxanthin, all of which are found in the AREDS 2 formula.
People who took these vitamins were less likely to lose vision over the next 2 to 5 years. “[The combo] “It appears to be complementary and additive… with a combined treatment effect of 55% to 60%, an excellent safety record and a very low cost,” Keenan said.
González recommends the AREDS 2 vitamin formula to all of his patients. “It’s very easy to accept and the inconvenience is minimal.”
Unfortunately, if your genes make you more prone to this condition, a change in diet or the use of vitamins may have no effect.
Terrible? Possibly. But all is not lost in this fight.
Surveillance with AMD and what to do next if you are diagnosed
González is adamant about educating his patients before time runs out to treat AMD. Recognition is key. “The most common reason many of these people contact me ‘too late’ is that they don’t realize there is a problem.”
He explained a typical scenario: “Let’s say you have macular degeneration in both eyes at different stages. “One of your eyes starts to develop wet macular degeneration… so the better eye takes over and you may not notice there is a problem.”
Even after a patient is diagnosed with AMD, he or she typically visits a specialist only twice a year. Gonzalez often tells his patients to cover one of their eyes to ensure their vision is intact in both eyes. “You’ll be able to detect subtle differences” in each eye, she said.
This type of self-care and vigilance can make the difference between living successfully and treating the disease for the rest of your life, and trying to get help when it is simply too late.
For wet AMD, as mentioned above, one round of injections is basically what everyone does. Without prompt, invasive treatment, the point of no return is quickly approaching.
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