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Graefe's Archive For Clinical and... May 2024
Topics: Humans; Stargardt Disease; Macular Degeneration; Fluorescein Angiography
PubMed: 37934290
DOI: 10.1007/s00417-023-06292-x -
Postgraduate Medical Journal May 2007Age-related macular degeneration (AMD) is the commonest cause of blindness in the population over 60 years of age and accounts for over 50% of those registered blind in... (Review)
Review
Age-related macular degeneration (AMD) is the commonest cause of blindness in the population over 60 years of age and accounts for over 50% of those registered blind in the UK. The incidence is increasing and as older generations live longer a growing number of patients will be affected in the future. Affected patients lose central vision, important in all aspects of everyday life. This review outlines risk factors for AMD, clinical features, treatment and management strategies for patients, families and physicians caring for those with AMD. Recent trials are included along with practical clinical advice. While there is no curative treatment at present, intervention can reduce the risk of developing AMD and limit disease progression if it occurs. These modalities are discussed here. As new discoveries in the field of genetics and novel therapies emerge, a brighter future seems certain for the ageing population.
Topics: Humans; Macular Degeneration
PubMed: 17488857
DOI: 10.1136/pgmj.2006.052944 -
EBioMedicine Dec 2018Age-related macular degeneration (AMD) is the leading cause of blindness in the elderly in developed countries. Neovascular AMD (nAMD) accounts for 90% of AMD-related... (Review)
Review
Myofibroblasts in macular fibrosis secondary to neovascular age-related macular degeneration - the potential sources and molecular cues for their recruitment and activation.
Age-related macular degeneration (AMD) is the leading cause of blindness in the elderly in developed countries. Neovascular AMD (nAMD) accounts for 90% of AMD-related vision loss. Although intravitreal injection of VEGF inhibitors can improve vision in nAMD, approximately 1/3 of patients do not benefit from the therapy due to macular fibrosis. The molecular mechanism underlying the transition of the neovascular lesion to a fibrovascular phenotype remains unknown. Here we discussed the clinical features and risk factors of macular fibrosis secondary to nAMD. Myofibroblasts are key cells in fibrosis development. However, fibroblasts do not exist in the macula. Potential sources of myofibroblast precursors, the molecular cues in the macular microenvironment that recruit them and the pathways that control their differentiation and activation in macular fibrosis were also discussed. Furthermore, we highlighted the challenges in macular fibrosis research and the urgent need for better animal models for mechanistic and therapeutic studies.
Topics: Animals; Biomarkers; Fibrosis; Humans; Macula Lutea; Macular Degeneration; Myofibroblasts; Neovascularization, Pathologic; Retinal Neovascularization; Risk Factors; Signal Transduction
PubMed: 30473378
DOI: 10.1016/j.ebiom.2018.11.029 -
BioMed Research International 2017Studies have investigated the association between age-related macular degeneration (AMD) and subsequent risks of mortality, but results have been equivocal. We conducted... (Meta-Analysis)
Meta-Analysis
Studies have investigated the association between age-related macular degeneration (AMD) and subsequent risks of mortality, but results have been equivocal. We conducted a comprehensive analysis of prospective cohort studies to assess the association of AMD and the risk of mortality in the general population. We searched PubMed and EMBASE for trials published from 1980 to 2016. We included 11 cohort studies that reported relative risks with 95% confidence intervals for the association of AMD and mortality, involving 57,069 participants. In a random-effects model, the adjusted RR (95% confidence interval) associated with AMD was 1.09 (1.02-1.17) for all-cause mortality. Findings from this research provide support that persons with AMD had a higher subsequent risk of mortality than persons without AMD.
Topics: Cohort Studies; Female; Humans; Macular Degeneration; Male; Prospective Studies; Risk Factors
PubMed: 28607930
DOI: 10.1155/2017/3489603 -
BMJ Open Jun 2022In order to better understand the continued barriers to the provision of vascular endothelial inhibitor therapy, this study aims to investigate patients' experiences...
OBJECTIVES
In order to better understand the continued barriers to the provision of vascular endothelial inhibitor therapy, this study aims to investigate patients' experiences with neovascular age-related macular degeneration (nvAMD) in Germany during the injection process and how they deal with it.
DESIGN AND PARTICIPANTS
This analysis is part of the qualitative arm of a wider mixed-methods study. We recruited participants all over Germany via ophthalmologists, eye clinics, general practitioners, care bases and support groups between June 2018 and December 2020 and selected a subsample of study participants with nvAMD who were either undergoing or had previously undergone vascular endothelial growth factor inhibitor therapy. We conducted narrative, semistructured, face-to-face interviews at the participants' homes, which were audio-recorded. The interviews were thematically analysed.
RESULTS
Twenty-two participants were included in this analysis. Experiencing neovascular macular degeneration was dominated by the injection experience. Study participants perceived the treatment with vascular endothelial inhibitor injections as uncomfortable, and they described undergoing varying levels of anxiety during the whole injection process. After some years of receiving multiple injections, the pain and not experiencing any positive effects made participants with significant vision loss want to discontinue therapy. Furthermore, they narrated negative injection experiences in association with their interactions with medical staff and doctors.
CONCLUSION
Although time in the medical setting is limited, efficient and good doctor-patient relationships seem crucial for satisfying care experiences. A respectful and humane relationship may be one key to achieving treatment adherence.
Topics: Angiogenesis Inhibitors; Germany; Humans; Intravitreal Injections; Macular Degeneration; Qualitative Research; Ranibizumab; Vascular Endothelial Growth Factor A; Wet Macular Degeneration
PubMed: 35705348
DOI: 10.1136/bmjopen-2021-058266 -
Survey of Ophthalmology 1988Age-related macular degeneration (AMD) is the leading cause of irreversible severe visual loss in the United States in people over 50 years of age. The nonexudative... (Review)
Review
Age-related macular degeneration (AMD) is the leading cause of irreversible severe visual loss in the United States in people over 50 years of age. The nonexudative stage includes hard drusen (associated with localized dysfunction of the retinal pigment epithelium [RPE]), soft drusen (associated with diffuse dysfunction of the RPE), and geographic (areolar) atrophy. These fundus changes may predispose the eye to develop the neovascular/exudative stages of AMD. Most patients who develop severe visual loss from AMD have this exudative stage. Treatment for AMD has been shown to be effective for only a small proportion of patients who have a well-defined choroidal neovascular membrane (CNVM) more than 200 microns from the foveal center. Even in successfully treated cases, severe visual loss is postponed only for about 18 months because of the high rate of recurrent CNVMs that extend into the fovea. Thus, despite recent breakthroughs in laser treatment for AMD, most patients who develop the exudative form of AMD will develop central visual impairment. At the present time, the only available treatments for the majority of patients who develop the exudative form of AMD are low vision aids. Investigators are currently evaluating whether treatment is effective for membranes within 200 microns of the foveal center. Future studies need to be directed toward further understanding of the pathogenesis, treatment and prevention of the blinding complications of AMD.
Topics: Aged; Aging; Choroid; Eye Diseases; Forecasting; Humans; Laser Therapy; Light Coagulation; Macular Degeneration; Neovascularization, Pathologic; Pigment Epithelium of Eye; Sensory Aids; Terminology as Topic; Vitreous Hemorrhage
PubMed: 2457955
DOI: 10.1016/0039-6257(88)90052-5 -
Gerontology 2022Age-related macular degeneration(AMD) has become a major cause of visual impairment worldwide, especially in the elderly. Estimates of incidence, progression rates, and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Age-related macular degeneration(AMD) has become a major cause of visual impairment worldwide, especially in the elderly. Estimates of incidence, progression rates, and risk factors of AMD vary among studies, complicating the understanding of its epidemiology.
METHODS
For this systematic review and meta-analysis, literature published up to March 1, 2021, was searched in both English and Chinese databases. Hierarchical Bayesian approaches were used to estimate pooled incidence, progression, and 95% credible intervals (CrIs).
RESULTS
Thirty studies were included. The pooled annual early and late AMD incidence rates were 1.59 (95% CrI: 1.18-2.11) and 0.23 (95% CrI: 0.14-0.34) per 100 person-years, respectively. The annual progression rate of AMD was 5.5 (95% CrI: 2.3-8.8) per 100 person-years. Smoking was an independent risk factor for both early and late AMD, whereas age, high-density lipoprotein cholesterol, and alcohol consumption were risk factors for early AMD incidence only. The projected number of new cases of early and late AMD in 2050 would be 39.05 million (95% CrI: 23.12-63.57) and 6.41 million (95% CrI: 3.37-13.22), respectively.
CONCLUSION
The prediction the number of new cases of AMD is not equal across the globe. Our findings indicate the need for more rigorous control and prevention measures in AMD focus on its risk factors for early intervention. The epidemiological estimates reported in this study could inform to identify effective strategies for preventing AMD worldwide.
Topics: Aged; Bayes Theorem; Disease Progression; Forecasting; Humans; Incidence; Macular Degeneration; Risk Factors
PubMed: 34569526
DOI: 10.1159/000518822 -
Reviews in the Neurosciences Apr 2024Age-related macular degeneration (AMD) is a complex, multifactorial disease leading to progressive and irreversible retinal degeneration, whose pathogenesis has not been... (Review)
Review
Age-related macular degeneration (AMD) is a complex, multifactorial disease leading to progressive and irreversible retinal degeneration, whose pathogenesis has not been fully elucidated yet. Due to the complexity and to the multiple features of the disease, many efforts have been made to develop animal models which faithfully reproduce the overall AMD hallmarks or that are able to mimic the different AMD stages. In this context, light damage (LD) rodent models of AMD represent a suitable and reliable approach to mimic the different AMD forms (dry, wet and geographic atrophy) while maintaining the time-dependent progression of the disease. In this review, we comprehensively reported how the LD paradigms reproduce the main features of human AMD. We discuss the capability of these models to broaden the knowledge in AMD research, with a focus on the mechanisms and the molecular hallmarks underlying the pathogenesis of the disease. We also critically revise the remaining challenges and future directions for the use of LD models.
Topics: Animals; Humans; Macular Degeneration
PubMed: 38153807
DOI: 10.1515/revneuro-2023-0130 -
Acta Ophthalmologica Jun 2012Age-related macular degeneration (AMD) is attributed to a complex interaction of genetic and environmental factors. It is characterized by degeneration involving the... (Review)
Review
Age-related macular degeneration (AMD) is attributed to a complex interaction of genetic and environmental factors. It is characterized by degeneration involving the retinal photoreceptors, retinal pigment epithelium (RPE) and Bruch's membrane, as well as alterations in choroidal capillaries. AMD pathogenesis is strongly associated with chronic oxidative stress and inflammation that ultimately lead to protein damage, aggregation and degeneration of RPE. Specific degenerative findings for AMD are accumulation of intracellular lysosomal lipofuscin and extracellular drusens. In this review, we discuss thoroughly RPE-derived mechanisms in AMD pathology.
Topics: Humans; Lipofuscin; Lysosomes; Macular Degeneration; Oxidative Stress; Phenotype; Retinal Pigment Epithelium
PubMed: 22112056
DOI: 10.1111/j.1755-3768.2011.02179.x -
Graefe's Archive For Clinical and... May 2023Patients with extensive submacular hemorrhage (SMH) caused by age-related macular degeneration (AMD) have a poor visual prognosis despite surgical intervention. Systemic... (Review)
Review
PURPOSE
Patients with extensive submacular hemorrhage (SMH) caused by age-related macular degeneration (AMD) have a poor visual prognosis despite surgical intervention. Systemic blood-thinning drugs, which are commonly prescribed in the same age group, are known to increase the risk of severe hemorrhage in many parts of the body. This study aimed to investigate whether systemic blood-thinning drugs have an impact on the severity of SMH and if there are differences between the different types of blood-thinning medication.
METHODS
We reviewed the medical records of patients who suffered from surgically treated SMH between 2020 and 2022. All patients received a full ophthalmologic examination upon presentation including best-corrected visual acuity (BCVA) and optical coherence tomography. Other characteristics that were recorded included size of hemorrhage, blood-thinning therapy, and reason for intake.
RESULTS
A total of 115 patients with a mean age of 82 years were included in this retrospective analysis. Eighty-three patients (72.2%) were on blood-thinning therapy. The mean size of SMH was 32.01 mm. Mean BCVA at initial presentation was 1.63 logMAR and 1.59 logMAR 1 year after surgery. The size of SMH was significantly larger in patients on blood-thinning medication (35.92 mm vs. 21.91 mm) (p = 0.001) and their BCVA postoperatively was worse with 1.68 logMAR compared to 1.30 logMAR after 1 year (p = 0.503). Patients with vitamin K antagonists had larger SMH size and worse outcomes regarding BCVA compared to direct oral anticoagulants.
CONCLUSION
Blood thinners in patients with AMD affect the severity of SMH. Consequently, the indication for their intake should be critically evaluated.
Topics: Humans; Aged, 80 and over; Retrospective Studies; Retinal Hemorrhage; Fibrinolytic Agents; Macular Degeneration; Anticoagulants; Fluorescein Angiography; Tomography, Optical Coherence; Intravitreal Injections; Wet Macular Degeneration
PubMed: 36445445
DOI: 10.1007/s00417-022-05885-2