Inflammatory mechanisms of age-related macular degeneration

JE Knickelbein, CC Chan, HN Sen… - International …, 2015 - journals.lww.com
JE Knickelbein, CC Chan, HN Sen, FL Ferris, RB Nussenblatt
International ophthalmology clinics, 2015journals.lww.com
Late age-related macular degeneration (AMD), specifically central geographic atrophy (GA)
and choroidal neovascularization (CNV), 1 is the leading cause of irreversible vision loss in
the elderly in the developed world. 2 AMD is categorized as either (i) non-neovascular, or
dry, when CNV is not present, or (ii) neovascular, or wet, when CNV is present. Increasing
age is the most significant risk factor for AMD development. 3 In the United States, AMD is
more common in whites, and smoking is strongly associated. The hallmark of AMD clinically …
Late age-related macular degeneration (AMD), specifically central geographic atrophy (GA) and choroidal neovascularization (CNV), 1 is the leading cause of irreversible vision loss in the elderly in the developed world. 2 AMD is categorized as either (i) non-neovascular, or dry, when CNV is not present, or (ii) neovascular, or wet, when CNV is present. Increasing age is the most significant risk factor for AMD development. 3 In the United States, AMD is more common in whites, and smoking is strongly associated. The hallmark of AMD clinically is the presence of drusen situated under the retinal pigment epithelium (RPE). Drusen size is categorized as small (r62μm), medium (63 to 124μm), or large (Z125μm), with presence of large drusen being a significant predictor of progression to late AMD and associated vision loss. 4 The Age-Related Eye Disease Studies (AREDS and AREDS2) have shown that high-dose antioxidant and zinc supplementation delay the progression of AMD in moderate-risk and high-risk patients. 5, 6 Antivascular endothelial growth factor (VEGF) treatment is the mainstay of therapy for wet AMD. 7 Currently, there is no treatment for GA. While AMD pathogenesis is undoubtedly multifactorial, including the effects of aging and oxidative stress as well as genetic and environmental factors, significant evidence has emerged implicating inflammation and the immune system. The major role of the immune system is to identify and respond to physiological insults, such as infection, malignancy, and tissue damage. Often this takes the form of robust
Lippincott Williams & Wilkins