Age-related Macular Degeneration AMD - Age-related Macular Degeneration (AMD) is a disease of the retina caused by a progressive degeneration of the macula, the central part of the retina, which mostly appears from the age of 50 years.
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The AMD is as its name indicates a degenerative pathology whose prevalence ( % of the pathology in the population) is age-related and which increases gradually with age.
So if it is only 1 to 2 % before 60 years, it is superior to 50 % after 80 years.
This degeneration, touches in a selective way the central part of the retina or macula and thus even at a very advanced stage, the patients will never lose completely eyesight : they can no longer read, can no longer watch TV or recognize people, but they will always keep a peripheral field of vision what will allow them all the same to move.
We actually distinguish three major forms: the precocious stage, atrophic and exudative forms and two other rarer forms.
The risk of evolution towards atrophic or exudative forms can be estimated at about 50% after 10 years evolution of the precocious stage.
This early stage is characterized by the appearance, visible when the doctor examines the ocular fundus, white deposits of variable size and shape on the macula of the retina : that drusen..which are a sign of aging of the retina.
After several years of evolution may appear what is called macular syndrome and which is characterized by:- A decline of the visual acuteness especially closely, in the most precocious stages
The appearance of one or more of these disorders requires to consult an ophthalmologist urgently so that it tracks as early as possible the eventual transition to a exudative form with neovessel risking to evolve very quickly towards a lower significant visual acuity and a definitive central scotoma.
In certain cases a treatment realized in urgency may indeed avoid, at best, or mostly, slow down spontaneously this evolution very serious for the visual prognosis.
In another large majority of cases, the onset of this syndrome Macular will not impose emergency treatment but he will sign the passage, visible also in the examination of the fundus, the atrophic form is characterized by the onset ranges pigment epithelial atrophy, ie gradual disappearance of the cells composing this coat where the projected image is converted into electrical signals to the brain and give visual sensation.
This form is changing very gradually but inexorably towards an extension of the lesions and thus to a severe drop of the visual acuity and a scotoma, or definitive blind central spot.
Again though the cause of AMD is not well understood, studies, particularly in animals indicate that damage from oxygen free radicals is generated by repeated exposure without adequate protection, of ultra- violet B (especially if the iris is clear colored) and / or also by tobacco smoke are certainly involved.
Are also implicated as risk factors: arterial hypertension, an underlying vascular disease.
But also certainly, the importance of the genetic factors: increased risk to AMD if a parent is affected. Hence importance in these cases of precocious ophthalmologic monitoring and especially a preventive treatment.
Also, in the early stages ie at the stage where there are deposits (drusen),
even a beginning of atrophy, but not central, at one or both eyes, and even advanced AMD with loss of central vision but in one eye, a randomized study on a large number of patients has shown the beneficial effect of supplementation involving Vit. C, vitamin E, zinc and beta-carotene. (Study or AREDS: Age Related Eye Disease Stud).
These molecules indeed compose the major part of the macular pigment and reduces the amount of blue light, toxic, received by the photoreceptors in the fovea.
This property add to their anti-oxidant effect indicates particularly their use, or at least use one of them, in AMD.
Before this study AREDS many studies have shown that :
- People who had the highest blood levels in anti-oxidants had less risk of developing a AMD.
- Those with the highest levels in : selenium, vit.C and vit.E had a decreased risk of 70% to have a AMD.
- The carotenoids lutein and zeaxanthin more anti-oxidants to eye level as beta-carotene are found in high concentrations in spinach and cabbage.
- Lutein is found in high concentration outside the fovea, whereas the zeaxanthin is concentrated near the fovea.
- People who eat spinach and cabbage have a decreased risk of developing AMD.
- Two important enzymes necessary for the retinal functioning require some zinc.
- A double-blind study showed that 80 mg of zinc two years before, allowed to decrease by 42% loss of vision for patients with AMD compared to those taking only placebo. (Study)
However, subsequent studies have not confirmed these facts.
- The anthocyanosides Vaccinium Myrtillus acts as anti-oxidants in the retina.(10)
- Extracts of bilberry have been shown capable of enhancing the retinal capillaries and hence to reduce the risk of bleeding.(11)
- The quantities recommended are the order of 240-480 mg of extract standardized to 25% of anthocyanosides.
- Additional research has shown the beneficial and promising effects of ginkgo biloba to prevent or treat disorders secondary to macular degeneration.(12)
So currently the best preventive and curative treatment in early stages of AMD is:
- carotenoids such as lutein and zeaxanthin
- vitamins C and E
- Extracts of bilberry and ginkgo
Daily Protocol for Macular Degeneration Age-related