CLINICAL FEATURES, RISK FACTORS, AND THERAPEUTIC APPROACHES IN AGE-RELATED MACULAR DEGENERATION (AMD)

Аннотация

Age-related macular degeneration (AMD) is one of the leading causes of irreversible vision loss in individuals over 50 years of age in developed countries. It primarily affects the macula, the central region of the retina responsible for sharp, detailed vision. AMD is typically categorized into two forms: dry (atrophic) and wet (neovascular or exudative). The dry form is more common and progresses slowly, while the wet form is less prevalent but more severe and can lead to rapid vision loss. This article explores the clinical features, risk factors, diagnostic tools, and treatment strategies for AMD. Utilizing a structured methodological approach, it evaluates patient data, imaging results, and treatment outcomes across various stages of the disease. The findings emphasize the role of early diagnosis and the application of anti-VEGF therapies and lifestyle interventions in managing AMD progression and preserving visual function. Key words: Age-related macular degeneration (AMD),Dry AMD,Wet AMD, Geographic atrophy,Choroidal neovascularization,Optical coherence tomography (OCT),Anti-VEGF therapy,Visual acuity,Retinal imaging,Smoking and AMD,AREDS2 supplementation,Risk factors,Retinal pigment epithelium. Introduction: Age-related macular degeneration (AMD) is a chronic, progressive eye disease that primarily affects the macula, the central portion of the retina responsible for fine visual tasks such as reading, driving, and recognizing faces. As the global population ages, AMD has become an increasingly significant public health concern, particularly in industrialized nations. Current estimates suggest that over 190 million people worldwide are affected by some form of AMD, with numbers expected to rise substantially in the coming decades due to demographic shifts. AMD is broadly classified into two major types: dry (non-neovascular) AMD and wet (neovascular) AMD. The dry form accounts for approximately 85–90% of all AMD cases and is characterized by the presence of drusen—yellowish deposits under the retina—and gradual thinning of the macular retinal pigment epithelium (RPE). Over time, these changes can lead to geographic atrophy and central vision loss. Wet AMD, on the other hand, involves abnormal blood vessel growth (choroidal neovascularization) beneath the retina, resulting in fluid leakage, hemorrhage, and scarring. Although less common, wet AMD is responsible for the majority of severe vision loss associated with the disease. The pathogenesis of AMD is multifactorial, https://scientific-jl.com/wsrj 7 0 Volume-39_Issue-2_May-2025 World scientific research journal involving genetic predisposition, oxidative stress, chronic inflammation, and environmental influences. Several genes have been implicated in AMD susceptibility, including polymorphisms in the complement factor H (CFH) and ARMS2/HTRA1 loci. Oxidative damage to the RPE cells, largely driven by lifelong light exposure and high metabolic demand, plays a pivotal role in disease progression. Lifestyle factors, particularly smoking, poor diet, obesity, and lack of physical activity, are also well- established risk factors. Smoking, in particular, has been shown to double the risk of developing AMD and accelerate its progression. Clinically, AMD often presents insidiously. Patients with early AMD may be asymptomatic or report only mild visual disturbances, such as difficulty seeing in low light or blurring of central vision. As the disease advances, central vision becomes progressively distorted or lost, while peripheral vision remains largely unaffected. In cases of wet AMD, the onset of symptoms may be rapid and dramatic, necessitating urgent ophthalmologic evaluation. Diagnosis is primarily based on fundoscopic examination and confirmed using imaging modalities such as fundus photography, optical coherence tomography (OCT), and fluorescein angiography. OCT is particularly valuable for detecting subtle macular changes and monitoring disease progression or response to therapy. Fundus autofluorescence and indocyanine green angiography may also be used for more advanced assessment. The management of AMD varies according to disease stage and type. For dry AMD, there is currently no cure, but progression may be slowed with nutritional supplements containing antioxidants and zinc, as recommended by the AREDS2 study. In contrast, wet AMD can be treated with intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents such as ranibizumab, aflibercept, and bevacizumab, which have revolutionized outcomes and preserved vision in many patients. Despite these advances, challenges remain, including variable patient response, the burden of frequent injections, and limited access to care in some regions. AMD imposes a significant socioeconomic burden, affecting the quality of life, independence, and mental health of elderly individuals. Visual impairment can lead to increased rates of depression, falls, and difficulty performing daily task