Degenerescência Macular da Idade

Age-Related Macular Degeneration (ARMD)

ARMD is the main cause of irreversible visual loss among elderly people all over the world, affecting 30 to 50 million individuals. It is a progressive degenerative disorder of the macula; it has a chronic nature and includes loss of visual acuity typically resultant of photoreceptors’ degeneration, retinal pigment epithelium (RPE) and choriocapillaris. Advanced forms of this disease are characterised by macular choroidal neovascularisation (CNV), geographical atrophy (RPE), coriocapillaris and photoreceptors’ atrophy) or both.

When neovascularisation occurs, there is fluid accumulation, hemorrhage and lipid exudation inside the macula that may culminate in fibrosis described as disciform scar. AMD’s evolution to an advanced stage in one of the eyes increases probability of developing the same progression in the other eye.

Nowadays, no therapy is proven to interrupt ARDM’s progression. Vitamin supplementation, diet changes and smoking cessation are current recommendations known to delay the progression of visual acuity loss.

Several CNV treatments (also described as exudative or neurovascular ARMD) have been extensively studied in large randomised prospective studies. Nowadays, standard treatment involves an intravitreal injection of anti-VEGF agents that have revolutionised these patients’ prognosis. For the first time in medical history, patients are now expected to improve their vision after treatment.

Genetics offers the best hope in identifying future ways of using pharmacotherapy to avoid visual acuity loss. Although eternal promises about embryonic stem-cells treatment as a way to recover lost vision, prevention is still the best strategy to treat this illness.

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