The number one killer of vision loss in the elderly – age-related macular degeneration

  As people’s quality of life improves and life expectancy increases, age-related diseases are becoming increasingly important in the disease spectrum. This group of diseases is usually characterized by a slow onset and long duration, and early lesions may not cause severe functional impairment, but as the disease progresses, the associated function is significantly limited.  Age-related macular degeneration (AMD) is one such age-related fundus disease with a high prevalence and serious impact on vision and quality of life in the elderly. According to the results of three well-known international epidemiological surveys, the prevalence of this disease is 1.63% in the white population over 55 years old, and the prevalence increases significantly with age, reaching 16% in the elderly over 65 years old and 27.9% in the elderly over 75 years old, which is the most important cause of low vision and blindness in the elderly. A regional survey in 1998 found that the prevalence of AMD in people over 65 years old was 12%, and according to the results of a large-scale epidemiological survey of 100,000 people in Shanghai in the past 5 years, the prevalence of AMD in people over 45 years old was 16%, of which the prevalence of wet AMD accounted for 15%. The World Health Organization has published a report stating that at least 8 million people worldwide suffer from severe visual impairment due to advanced age-related macular degeneration. Corresponding to the severe blinding nature of AMD is the lack of effective treatment.  The macula is an important anatomical structure in the center of the retina at the base of the eye and is the site of the sharpest vision, so when problems with the macula occur, vision is affected and the quality of life is seriously affected. And age-related macular degeneration is precisely the aging change of retinal cells in the macula. In the early stage, due to ageing, light damage or genetic factors, an important cell of the retina, the retinal pigment epithelium, has reduced phagocytosis and digestion ability, resulting in the gradual appearance of yellowish-white dot-like changes called vitreous warts in the fundus of the eye in various forms, such as dot-like and vesicular-like. As the disease progresses, the function of macular cells further declines and degeneration worsens, gradually affecting vision. Severe degeneration will cause a serious decline in the patient’s ability to read and other daily life, significantly affecting the quality of life.  Age-related macular degeneration is divided into two types: atrophic type and exudative type according to its clinical manifestations. The atrophic type (also called dry or non-exudative) is mainly caused by choroidal capillary atrophy, vitreous membrane thickening and retinal pigment epithelial atrophy. The exudative type (also called wet or discoid) is mainly caused by the formation of choroidal neovascularization, which invades into the subretina and leads to optic plasma or hemorrhagic discoid detachment in the macula, eventually forming a mechanized scar, resulting in severe loss of central vision.  The exact cause of age-related macular degeneration is unclear, but the main risk factors are age, smoking, female gender, race, genetic family history, prolonged exposure to sunlight, and partial nutritional deficiency, among others. Among them, smokers are 6.6 times more likely to develop age-related macular degeneration than non-smokers, and ethnicity is also an important risk factor, with Caucasians being more likely to develop the disease than Blacks and Yellows.  For dry age-related macular degeneration, there is no definite effective treatment and the main focus is on regular follow-up. Some studies have shown some preventive effects of nutritional interventions, which include supplementation with macular pigments such as lutein and zeaxanthin, supplementation with DHA and ? -3, supplementation with antioxidant vitamins and trace elements, etc. For the more severe wet age-related macular degeneration, the cause is mainly due to the formation of choroidal neovascularization, so the treatment targets choroidal neovascularization. The traditional treatment method is mainly laser photocoagulation, but due to the high damage of laser and irreversible loss of vision after surgery, it has been replaced by photodynamic therapy with less damage and low side effects, which can effectively close the neovascularization, stop the further deterioration of the lesion and maintain the patient’s residual vision. In 2006, due to the breakthrough of scientific research, there was a new breakthrough in the treatment of wet age-related macular degeneration, and foreign countries started to use anti neovascular drugs to treat wet age-related macular degeneration. Intravitreal injection of anti neovascular drugs, or combined with photodynamic therapy has now completely replaced traditional laser treatment methods. At present, the latest research in dry age-related macular degeneration focuses more on nutrient intervention and prevention, while in wet age-related macular degeneration, more effective, easier to use, lower side effects and lower risks of anti-new blood vessel drops and oral drugs are also emerging, and it is believed that in the near future, with the breakthroughs in scientific research, it is expected that there will be greater progress in the treatment of macular degeneration for the benefit of We believe that in the near future, with the breakthrough of scientific research, it is expected that there will be more progress in the treatment of macular degeneration in the future, which will benefit millions of elderly patients, so that age-related macular degeneration will no longer be the first killer of vision loss in the elderly, and make their world clearer and brighter.