Age-related macular degeneration

AMD: This acronym enclose a set of degenerative changes of the macula, constituting the leading cause of irreversible legal blindness in the developed world.

These disorders can be very varied, from atrophy of the neurosensory retina onmacular pigment epithelium, to the growth of choroidal vessels in this area, causing exudation, inflammation, bleeding and scarring. The outcome is a non-functional retina, losing central vision and would incapacitate to their daily activities.

AMD forms are varied, although we could summarize them in:

Risk factors

Age is the most decisive, and from age 55, the incidence of the disease increases exponentially. Other factors that influence the risk of developing AMD: UV exposure, toxic radiation (smoking, malnutrition ...) clear iris and impairment of microcirculation.

Genetic characterization, conditions the evolution of AMD, in form, aggressiveness and response to treatment.

Diagnosis

Both the diagnosis and especially the detailed monitoring of the disease is vital in cases with treatment possibilities: fundoscopy, and optical coherence tomography (OCT), with which to analyze the changes of the layers of the macula involved. Angiograms are essential to characterize the lesions.

Treatment

In humid forms, we have had several treatment options, all inadequate. However, since 2000, we have better solutions, photodynamic therapy, was the first step to control vision loss, and subsequently antiagiogénicos intravitreal drugs, which have been those that have allowed us to really reverse the loss curves and get retain useful vision. These treatments, however have some drawbacks such as the need to inject in vitreous with a high frequency, from 6-8 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 adjuvants cases.