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Degenerescenta Maculara Clinica Oftalmologica Dr. Munteanu

- 28th September 2022

Macular Degeneration

Age-related macular degeneration:
the main cause of blindness in industrialised countries

Degenerescenta maculară legată de vârstă este o afecțiune oculară progresivă care afectează vederea centrală și este cel mai frecventă cauză a orbirii în rândul persoanelor în vârstă. Această boală, cunoscută și sub denumirea simplă de degenerescenta maculară, se caracterizează prin deteriorarea maculei, o mică zonă centrală a retinei responsabilă de claritatea vederii.

Simptomele degenerescentei maculare includ distorsiuni ale imaginilor, scăderea acuității vizuale și dificultatea de a recunoaște fețe sau de a citi textele mici. Chiar dacă nu există încă un remediu complet pentru această afecțiune, există opțiuni de tratament precum chirurgia pentru degenerescenta maculară și tratamentul cu laser, care pot încetini progresia bolii și pot ameliora simptomele.

1. What is age-related macular degeneration (AMD)?

Age-related macular degeneration is an acquired retinal degeneration that causes significant central visual impairment through a combination of tissue changes (abnormalities of the drusen and retinal pigment epithelium) and neovascular disorders (formation of a choroidal neovascular membrane). Affects people over the age of 55. The genetic component is implicated in the development of this disease, although environmental, nutritional and developmental (i.e., ageing) processes interact to influence the onset and progression of macular degeneration.

AMD is the leading cause of blindness in industrialised countries. Globally, the number of people with AMD is expected to increase from 196 million in 2020 to 288 million by 2040. By this time, Asia is predicted to have the highest number of people with the disease. Distinct patterns of prevalence and phenotype are observed between geographical areas, but the causes cannot be fully explained.

2. How is it classified?

MLVD is classified into early, intermediate and advanced/late stages. Early and intermediate stages, when visual symptoms are usually absent or mild, are characterised by macular deposits (drusen) and abnormalities of the retinal pigment epithelium.

Late AMD is divided into neovascular and atrophic forms, although these can coexist. The defining lesions are macular neovascularization and geographic atrophy, respectively. At this stage, visual symptoms are often severe and irreversible and may include marked decrease in central vision in both eyes. For these reasons, the condition has major implications for individuals and society, as affected individuals may experience a substantial decrease in quality of life and independence.

Recent advances in retinal imaging have led to the recognition of an expanded set of disease phenotypes, including retinal pseudodrusen, non-exudative macular neovascularization and various subtypes of atrophy.

3. What are the risk factors involved in developing this disease?

1. Age - The risk of the disease increases with age, with some authors considering ageing to be the main risk factor in the development of the disease. The risk increases more than threefold in patients aged over 75 compared to the 65-74 age group (according to the Beaver Dam Eye Study; Framingham Eye Study).

2. Smoking - a ten-year smoking history is associated with increased development of exudative age-related macular degeneration. According to complex studies, smokers were twice as likely to lose vision due to age-related macular degeneration compared to non-smokers, and those who quit smoking more than 20 years ago were not at increased risk for visual acuity loss due to AMD.

3. Genetic predisposition and susceptibility - Certain genetic loci have been associated with both increased risk of developing MLVHD and different responses to treatment, such as intravitreal anti-VEGF agents. Complement factor H plays an important genetic role in the pathogenesis of DMLV.

4. Other risk factors in the occurrence of this disease are: cardiovascular disease, hypertension, hypercholesterolemia, obesity, female sex, white race, hyperopia, family history.

Degenerescenta maculara este o afectiune oculara progresiva

4. How can we influence the occurrence of this disease?

Smoking cessation, reduction in body mass index and treatment of hypertension are modifiable risk factors that should be addressed in patients at risk or at various stages of LVSD. Based on scientific studies, the prevalence of LVSD in ex-smokers is lower than in smokers, arguing for a possible benefit of smoking cessation. Studies on the beneficial effect of dietary antioxidants and omega-3 fatty acids on the prevention of AMD have not provided sufficiently consistent results.

5. What are the symptoms of this disease?

  • Decreased visual acuity that may be insidious or sudden onset
  • Dry form DMLV constitutes 85-90% cases of DMLV and usually does not cause severe vision loss.
  • Exudative or wet AMD accounts for 10-15% of AMD cases and is the major cause of severe vision loss.
  • Blurred vision
  • Observing a black spot in the centre of the field of view
  • Visual distortions, metamorphopsia, micropsia

6. What investigations can be carried out to establish the diagnosis and therapeutic management?

Fluorescein angiography and tomografia in coerență optică are useful in assessing the presence of both exudative and dry disease. Fluorescein angiography is performed when there is suspicion of choroidal neovascular membrane formation.

Optical coherence tomography (OCT) provides a method of obtaining high-resolution optical cross-sections. OCT has become indispensable in the evaluation of patients with AMD. Imaging helps to assess and classify lesions, as well as monitor responses to treatment.

7. Disease management

Treatment differs depending on the type of lesion, dry or exudative.

CT monitoring of lesions associated with modification of risk factors and nutritional supplementation is the main treatment for the dry form of the disease. However, current studies are ongoing to evaluate inhibition of the complement pathway for the treatment of geographic atrophy in patients with dry AMD. Currently, no treatment modality is approved for the treatment of geographic atrophy. The exudative form of VMLD is managed with more frequent examinations and intravitreal injections with anti-VEGF agents or laser treatments.

Optical coherence tomography and intraocular injection therapy with anti-VEGF agents) have revolutionized the treatment of exudative AMD. Ranibizumab (Lucentis, Genentech, San Francisco, CA), bevacizumab (Avastin, Genentech, San Francisco, CA) and aflibercept (Eylea, Regeneron Pharmaceuticals Inc., Tarrytown, NY), are commonly used in the treatment of the exudative form of the disease. The latest anti-VEGF agent to be approved recently was brolucizumab (Beovu, Novartis, Cambridge, MA), which is a single-chain antibody fragment against VEGF that has been shown to be similar in outcome to aflibercept.

Injectiile intraoculare pot salva sau ameliora acuitate vizuala, insa trebuie repetate la un anumit interval de timp intre1-3 luni in functie de raspunsul tesuturilor oculare. Complianta pacientului la tratament scade cu timpul, iar in anumite situatii, desi structural observam efectul injectiei, acuitatea vizuala nu se imbunatateste.

Very important to remember is that this disease can lead to blindness. We therefore recommend frequent ophthalmological check-ups and strict adherence to medical advice.

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medic primar oftalmolog

Head of Work Dr. Alexandra Preda, PhD

Dr. Alexandra Preda is a primary ophthalmologist at Prof. Dr. Munteanu Ophthalmology Center since 2017, with experience in clinical examinations and investigations of eye diseases, specializing in cataract surgery, laser surgery for glaucoma, diabetic retinopathy, dry eye, intraocular injections for retinal pathology. He is also Head of the Department of Ophthalmology at the University of Medicine and Pharmacy "Victor Babes" in Timisoara and Doctor of Medical Sciences. Dr. Preda is an elite doctor with European credentials, following specialization courses in the field, in Austria, Bulgaria, Slovenia or Turkey, that we are proud to have in our team of experts completely dedicated to ophthalmology.

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