AMD: These acronyms encompass a set of degenerative changes of the macula, constituting the first cause of irreversible legal blindness in the developed world.
These disorders can be very varied, from atrophy of the neurosensorial retina over the macular pigmented epithelium, to the growth of choroidal vessels in that area, producing exudation, inflammation, bleeding and scarring. The result is a non-functional retina, losing central vision and incapacitating the patient for most daily activities.
The forms of AMD are varied, although they can be summarized as follows:
Risk factors for macular degeneration.
Age is the most determining factor, and after 55 years of age, the incidence of the disease increases exponentially. Although other factors that influence the risk of suffering AMD are exposure to ultraviolet radiation, toxins (smoking, malnutrition,…) clear irises and microcirculation alterations.
Genetic characterization conditions the evolution of AMD, in the form, aggressiveness and response to treatments.
Diagnosis of AMD
Both the diagnosis and, above all, the detailed follow-up of the disease is vital in cases with treatment possibilities: fundoscopy and optical coherence tomography (OCT), with which to analyze the changes in the layers of the macula involved. Angiographies are essential to characterize the lesions.
Treatment of AMD
In wet forms, we have had several treatment possibilities, all of them insufficient. However, since 2000, we have had better solutions. Photodynamic therapy was the first step to control vision loss, and later intravitreal antiagiogenic drugs have been the ones that have really allowed us to reverse the loss curves and preserve useful vision. These treatments, however, have some disadvantages, such as the need to inject them into the vitreous with a high frequency, from 6-8 in the first year to 2-5 in the following years. To date the reference is Ranibizumab and recently Afilbercept.
Surgery and other drugs remain as options for very specific and/or coadjuvant cases.