Age-related macular degeneration: an overview / Degeneração macular relacionada à idade: um panorama geral

ABSTRACT Age-related macular degeneration is the most important cause of irreversible vision loss in the elderly and has been considered a severe public health problem. Current treatments have only been successful in delaying the loss of central vision. Due to increased life expectancy, governments and researchers have been challenged to seek more efficient and successful treatments for age-related macular degeneration. Considering its relevance for public health and the need of further research, this article aims to address age-related macular degeneration objectively, tackling on the current knowledge about its pathophysiology, potential molecular biomarkers, main prevention procedures and treatments, as well as introducing possible molecules that may be a therapeutic target in this disease.

RESUMO Degeneração macular relacionada à idade é a causa mais importante de perda irreversível da visão em idosos, e é considerada um sério problema de saúde pública. Os tratamentos atuais são bem-sucedidos apenas ao postergar a perda da visão central. Devido à maior expectativa de vida, os governos e pesquisadores têm dificuldade de encontrar tratamentos mais eficientes e exitosos para degeneração macular relacionada à idade. Considerando sua relevância para saúde pública e a necessidade de mais pesquisas, este artigo procura abordar a degeneração macular relacionada à idade de forma objetiva, abordando os conhecimentos atuais sobre sua fisiopatologia, potenciais biomarcadores moleculares, principais procedimentos de prevenção e tratamentos, e apresentar possíveis moléculas que podem ser alvo terapêutico nessa doença.

Revisión Bibliográfica: Degeneración Macular Relacionada con la Edad. Prevención y Tratamiento Temprano / Bibliographic Review: Prevention and early treatmen

La degeneración macular relacionada con la edad es una de las enfermedades que afecta a la mácula en personas mayores de 50 años, por la existencia de diferentes cambios neurodegenerativos multifactoriales que pueden llevar a la pérdida de la visión central. Según la Organización mundial de la salud existe una prevalencia, del 4 % a nivel mundial, afecta especialmente, en personas mayores de 50 años; se relacionada del 7 % de la ceguera y el 3 %. Clínicamente se manifiesta por dos formas, la atrófica o seca y la exudativa o húmeda. Se ha demostrado que los alimentos ricos en antioxidantes, ácido fólico y el zinc ayudan a reducir esta enfermedad en etapas tempranas. Esta revisión pretende actualizar al personal de salud acerca de la prevención y tratamiento de la degeneración macular relacionada con la edad.

Age-related macular degeneration is one of the diseases that affect the macula in people over 50 years of age, due to the existence of different multifactorial neurodegenerative changes that can lead to the loss of central vision. According to the World Health Organization there is a prevalence of 4 % worldwide; it is related of 7 % of the blindness and 3 %; Clinically it is manifested by two forms, the atrophic or dry and the exudative or wet. It has been shown that foods rich in antioxidants, folic acid and zinc help reduce this disease in early stages. This review aims to update health personnel about the prevention and treatment of age-related macular degeneration.

Approach of Turkish ophthalmologists to micronutrition in age-related macular degeneration / Abordagem dos oftalmologistas turcos em relação a micronutrição na degeneração macular relacionada à idade

Purpose: To evaluate the knowledge and behaviors of ophthalmologists in Turkey concerning micronutrition support in patients with age related macular degeneration (ARMD). Methods: This study involved 1,845 ophthalmologists. A scientific poll was sent to all participants by email. The survey covered the following: demographic features, subspecialty knowledge about micronutrition preference for prescribing micronutrition to age related macular degeneration patients, and the reason for this preference. If a participant indicated that he or she prescribed micronutrition, the participant was also asked to indicate the source of the treatment and supplemental treatments. Results: Of 1,845 ophthalmologists, 249 responded to the survey. Of the respondents, 9% (22) never, 43% (107) sometimes, 37% (92) frequently, and 11% (27) always used micronutrition. The most frequent prescribing subgroup was general ophthalmology (22%), followed by the retina-uvea subspecialty (13.9%). The micronutrition prescribing ratio was 54.8% in retina-uvea specialists when the "frequent" and "always" responses were combined. There was no statistically significant difference between subgroups with respect to prescribing micronutrition. Among the ophthalmologists prescribing micronutrition, 57.1% of them did not use the Age-Related Eye Disease Study-1 (AREDS) criteria, and only 31.3% prescribe micronutrition according to AREDS criteria. The results for the general ophthalmologist and retina-uvea specialist subgroups were similar, 56.3% vs 20.2%, and 54.1% vs 36.1%, respectively. Micronutrition was not recommended for the following reasons: expensive (55.4%), low patient expectancy (40%), no effect (30%), and low patient drug compliance (25.4%). Moreover, 55.2% of the clinicians recommended physical activities, dietary changes, and smoking cessation; 7.3% did not recommend these behavioral changes. Conclusion: This survey demonstrated that micronutrition preference in ...

Objetivo: Avaliar o conhecimento e comportamento dos oftalmologistas na Turquia sobre o suporte micronutricional em pacientes com degeneração macular relacionada à idade (DMRI). Métodos: Este estudo continha 1.845 oftalmologistas, e uma pesquisa científica foi enviado a todos os participantes por e-mail. O levantamento abrangeu as seguintes informações: características demográficas, conhecimento na subespecialidade sobre a preferência micronutricional para a prescrição micronutrientes a pacientes com degeneração macular relacionada à idade, e a razão por trás dessa preferência. Se um participante respondeu que prescreveu micronutrientes, foi solicitado que indicasse a origem do tratamento, bem como tratamentos suplementares. Resultados: Duzentos e quarenta e nove de 1.845 oftalmologistas responderam à pesquisa. Destes oftalmologistas 9% (22) nunca haviam usado micronutrição, 43% (107), utilizava eventualmente, 37% (92) usavam com frequência, e 11% (27) sempre usou. O subgrupo de prescrição mais frequente era composto por oftalmologistas gerais (22%), seguido por subespecialistas em retina e/ou úvea (13,9%). A frequência de prescrição de micronutrientes foi de 54,8% dentre os subespecialistas em retina e/ou úvea quando resultados de resposta foram combinados em "frequente" e "sempre." Não houve diferença estatisticamente significativa entre os subgrupos com relação à prescrição de micronutrientes. Entre os oftalmologistas que prescreviam micronutrição, 57,1% deles não usavam os critérios The Age-Related Eye Disease Study-1 (AREDS) e 31,3% deles prescreviam de acordo com critérios AREDS. A utilização dos critérios teve distribuição semelhante entre os oftalmologistas gerais e os especialistas, 56,3% vs 20,2%, e 54,1% vs 36,1%, respectivamente. A micronutrição não era recomendada pelas seguintes razões: preço (55,4%), baixa expectativa de paciente (40%), nenhum efeito (30%), e baixa aderência do paciente à droga (25,4%). Além disso, 55,2% ...

Alternativas terapêuticas para o tratamento da degeneração macular relacionada à idade: um desafio para a saúde pública / Therapeutic alternatives for the treatment of age-related macular degeneration: a public health challenge

A degeneração macular relacionada à idade (DMRI) é uma das maiores causas de redução da capacidade laborativa, devida à perda da visão central e evolução para cegueira legal, impossibilitando inclusive atividades básicas como ler, escrever, cozinhar, dirigir e reconhecer a fisionomia de pessoas. A incidência desta doença vem aumentando significativamente nos últimos anos e são muitas as dúvidas sobre a escolha do tratamento mais adequado. O objetivo desta revisão é apresentar a fisiopatologia da DMRI e discutir as dificuldades do tratamento desta doença, relacionadas principalmente às vias de administração de fármacos e à escolha do procedimento clínico. Neste contexto, o uso da terapia antiangiogênica na DMRI parece ser, atualmente, o tratamento mais eficaz, devido a sua alta especificidade, pois atua de forma direta no desequilíbrio entre os fatores pró e antiangiogênicos. Entretanto, com base nas evidências atuais, o grande desafio para a saúde pública ainda está na prevenção desta doença e em seu diagnostico precoce.

Age-related macular degeneration (AMD) is a leading cause of reduced work capacity due to the loss of central vision and progression to legal blindness, with the subsequent impedance of basic activities such as reading, writing, cooking, driving and recognizing faces. The incidence of AMD has increased significantly in recent years and many questions remain regarding the most appropriate form of treatment. The aim of the present review was to address the pathophysiology of AMD and discuss difficulties in treating the disease, primarily with regard to drug administration routes and the choice of clinical procedure. The use of anti-angiogenic therapy seems to be the most effective treatment for AMD due to its high specificity, acting directly on the imbalance between pro-angiogenic and anti-angiogenic factors. However, current evidence indicates that the major challenge for public health remains the prevention and early diagnosis of AMD.

SIRT1 negatively regulates amyloid-beta-induced inflammation via the NF-B pathway

Chronic inflammation induced by amyloid-beta (Aβ) plays a key role in the development of age-related macular degeneration (AMD), and matrix metalloproteinase-9 (MMP-9), interleukin (IL)-6, and IL-8 may be associated with chronic inflammation in AMD. Sirtuin 1 (SIRT1) regulates inflammation via inhibition of nuclear factor-kappa B (NF-κB) signaling, and resveratrol has been reported to prevent Aβ-induced retinal degeneration; therefore, we investigated whether this action was mediated via activation of SIRT1 signaling. Human adult retinal pigment epithelial (RPE) cells were exposed to Aβ, and overactivation and knockdown of SIRT1 were performed to investigate whether SIRT1 is required for abrogating Aβ-induced inflammation. We found that Aβ-induced RPE barrier disruption and expression of IL-6, IL-8, and MMP-9 were abrogated by the SIRT1 activator SRT1720, whereas alterations induced by Aβ in SIRT1-silenced RPE cells were not attenuated by SRT1720. In addition, SRT1720 inhibited Aβ-mediated NF-κB activation and decrease of the NF-κB inhibitor, IκBα. Our findings suggest a protective role for SIRT1 signaling in Aβ-dependent retinal degeneration and inflammation in AMD.

Carotenoides y su función antioxidante: Revisión / Carotenoids and their antioxidant function: A review

Los antioxidantes naturales presentes en los vegetales y en algunos animales han sido estudiados por su papel en la protección de diversas enfermedades como ciertos tipos de cáncer, enfermedades del corazón y la degeneración macular relacionada con la edad. Evidencia experimental sugiere que estos compuestos son importantes en la protección de macromoléculas biológicas contra el daño oxidativo. La búsqueda de nuevos y más eficientes antioxidantes al parecer va dirigida a los carotenoides, que han demostrado que a través de su consumo puede disminuir la incidencia de ciertas enfermedades. Además representan una fuente de provitamina A, y presentan una actividad antioxidante en la célula al actuar en la neutralización de especies reactivas de oxígeno y nitrógeno producidas como parte del metabolismo celular. Esta publicación tiene como objetivo revisar aspectos básicos y clínicos de investigaciones realizadas que asocian la ingesta de carotenoides con cáncer, enfermedades del corazón y la degeneración macular relacionada con la edad. Primero se identificaron los conceptos básicos sobre el papel que desempeñan los carotenoides en el metabolismo; posteriormente se revisó la evidencia clínica que muestra como la ingesta de carotenoides reducen ciertas enfermedades. Por último se discuten algunos de los resultados de investigaciones.

Natural antioxidant in vegetables, and in some animals have been studied by their action in the protection of a considerable number of diseases, such as, certain types of cancer, cardiovascular diseases, and age-related macular degeneration. Experimental evidences suggest that these compounds are important for protecting biological macro-molecules against oxidative damage. The search of new and more efficient antioxidants appears to be directed with carotenoids which have demonstrated that their consumption may reduce the incidence of certain diseases. In addition they represent a provitamin A source, and their actual antioxidant activity in the cell by participating in the neutralization of reactive oxygen species, and nitrogen produced, as a part of the cellular metabolism. This paper is focused to review basic and clinical aspects of investigations which have been associated with the intake of carotenoids with cancer, heart diseases, and age-related macular degeneration; the above all, we have tried to identify basic concepts of the role of the carotenoids and their metabolism; after that, we have reviewed clinical evidence that show how the intake of carotenoids reduces certain diseases. Finally, we discuss some of the results of investigation.

Fatores modificáveis da degeneração macular relacionada à idade / Modifiable risk factors for age-related macular degeneration

Os autores apresentam os principais fatores modificáveis considerados de risco para o desencadeamento e/ou agravamento da degeneração macular relacionada com a idade. São abordados os mecanismos de ação destes fatores, assim como medidas preventivas e eficácia de eventuais intervenções.

The authors present the main modifiable risk factors that may trigger and/or worsen age-related macular degeneration. Mechanisms of action related to these factors as well as preventive measures and intervention effectiveness are discussed.

effect of nutririon and supplements on ocular health

Nutrition is a subject of interest in many fields of medicine. So ophthalmologists have also attempted to find possible ways to preserve vision through diet and supplements. Ocular disorders such as cataracts, age-related macular degeneration and glaucoma are the leading causes of visual impairment and blindness in the world, so most of the studies have focused on these major disorders and nutritions containing antioxidant such as vitamin C and E. Zexanthin/luteins and omega 3 have been the main substances studied in this relation. Although benefits of the regimens with high amounts of antioxidants were observed in reducing progression of cataract, agerelated macular degeneration and so on, as many of these studies have been observational, the cause and effect relationship cannot be definitely concluded and multiple cohort prospective studies will be desired to evaluate the exact role of nutrition. Somehow, a healthy diet which means the diet which increases our health can be achieved in regimens with low saturated fatty acids and rich in fresh fruits, vegetables and fish. On the whole, even though they may not affect disease progression, they are generally good for overall health

Serum Lp [a] and Hey concentrations on dry type age related macular degeneration

Age-related macular degeneration usually affects people 50 years of age or older and is a most common cause of central visual loss. In this study the alterations in the levels of plasma lipoprotein [a] [Lp [a]] a Homocysteine [Hcy] and malondialdehyde [MDA] were investigated, and their serum Levels qua age related macular degeneration risk factors compared between patient and control groups. In a case-control study, 44 dry type AMD patients from Nikookari eye hospital of Tabriz and 54 normal subjects, were studied. The serum levels of Lp [a] were assayed by immunoturbidimetric method, serum Hcy was analyzed by ELISA method. MDA and lipid profile concentrations were determined by tiobarbituric acid and spectrophotometric methods respectively. Levels of Cho, TG, LDL-C, Lp [a] and Hcy were significant and higher in patients than in control group [p<0.05 in all cases]. Level of TG, HDL-C and MDA were not significant and similar in the two groups [p>0.05 in both cases]. Increased Lp [a], Hcy, MDA and lipid profiles seems to be associated with AMD and may be involved in the pathogenesis of this disease. Therefore, alterations af serum level of these factors may effectual way for prevention and progression of AMD

Vitaminas e antioxidantes na degeneração macular relacionada à idade / Vitamins and antioxidants in age-related macular degeneration

O autor descreve os efeitos bioquímicos e estruturais das vitaminas e antioxidantes na retina. Apresenta as principais substâncias presentes na dieta alimentar e na suplementação vitamínica envolvidas na gênese da degeneração macular relacionada à idade. Relata ainda os resultados de estudos prospectivos multicêntricos relacionados ao assunto, por meio de revisão bibliográfica.

Antioxidantes en oftalmología / Antioxidants in ophthalmology

Ya a medidos de siglo, los hermanos Shute editaban en Canadá una revista dedicada exclusivamente a este tema, que incluía también importantes aportes en el área veterinaria. Por ese entonces, en la Argentina, Hector Nano mencionaba los conceptos de antioxidantes, prooxidantes y la vitamina E

Degeneración mucular relacionada con la edad clínica oftalmológica 1985-1990 / Macular degeneration related to age at ofthalmologic clinic

Se realizó un estudio en 45 pacientes con DRME, en todos los pacientes se tomo en cuenta la edad, presentación de la enfermedad, sexo, oftalmoscopía y RFG. La prevalencia y edad de presentación fueron similares, en cuanto a formas de presentación se notó un incremento de la forma educativa, explicable por la pérdida aguda y catastrófica de visión que sufren estos pacientes que los lleva a la consulta inmediata a diferencia de la forma seca donde la pérdida de la visión es paulatina y que no alarma demasiado al paciente. El 10 de los pacientes presentaron drusas blandas con cambios pigmentarios, 23 atrofia geografica; 23 desprendimiento del epitelio pigmentario, 24 tenian membrana neovascular de las cuales en 68 por ciento había invasión sufoveal y sólo en el 27.3 por ciento la localización era paracentral con posibilidad de tratamiento por fotocoagulación. La importancia del presente estudio fué el de poder determinar la prevalencia del grupo susceptibles de tratamaiento que son los pacientes con desprendimiento del epitelio pigmentario y membrana neovascular paracentral, que en nuestro estudio llegan al 29 de pacientes con DMRE.