Challenges in Age-Related Macular Degeneration: From Risk Factors to Novel Diagnostics and Prevention Strategies

Abstract

Age-related macular degeneration (AMD) is a chronic multifactorial eye disease representing the primary cause of vision loss in people aged 60 years and older. The etiopathogenesis of the disease remains uncertain, with several risk factors contributing to its onset and progression, such as genotype, aging, hypertension, smoking, overweight, and low dietary intake of carotenoids. Since the aging populations of the industrialized world are increasing rapidly, the impact of AMD in the socio-economical life-developed countries is expected to increase dramatically in the next years. In this context, the benefits of prevention and early disease detection for prompt and effective treatment can be enormous to reduce the social and economic burden of AMD. Nutritional and lifestyle changes, including dietary intake of xanthophyll pigments, such as lutein and zeaxanthin, no smoking, and regular exercise, are known to protect from risk of AMD progression from early to advanced disease stages. In this review, we present the clinical outcomes of a pilot study on trans-scleral iontophoresis delivery of lutein in patients with AMD. Topical delivery of lutein directly to the macula may provide a more efficient method for enriching the macular pigment and for achieving greater patient compliance to therapy than oral administration and thus enhancing prevention strategies. Modern diagnostic methodologies shall address the major problem of accurately detecting the risk of transition from intermediate AMD to advanced AMD stages. Adaptive optics retinal imaging and resonance Raman spectroscopy are two highly promising technologies for the objective assessment of patients with AMD. In this review, we present some of their clinical applications for collecting quantitative measurements of retinal cellular changes and macular content of xanthophyll pigments, respectively. In conclusion, there is great expectation that technological advancements in AMD management will deliver improved screening, therapeutic prevention, and diagnostic systems in the coming decade through a pro-active strategy of “treatment for prevention” that will aim to reduce the global burden of vision loss caused by AMD in the elderly.

Increased efficacy of dietary supplement containing wax ester-rich marine oil and xanthophylls in a mouse model of dry macular degeneration

“…Having in mind the potential antioxidant/anti-inflammatory properties of multicomponent mixtures including xanthophylls and fatty acids, we decided to run a study directly assessing the efficacy of one formulation using fish oil enriched in omega-3 plus lutein and zeaxanthin versus a novel formulation theoretically with a higher efficacy because of a different source of omega-3 and a higher content in xanthophylls. In particular, the novel formulation includes the COil, as an alternative source of omega-3, plus astaxanthin, in addition to lutein and zeaxanthin, whose antioxidant properties in ocular pathologies have been previously demonstrated ( Giannaccare et al, 2020 ; Lombardo et al, 2022 ). As pharmacological therapies against dry AMD are still lacking, treatments based on potentially innovative dietary supplementations remain as possible tools to solve unmet clinical needs.…”

Research progress on diagnosing retinal vascular diseases based on artificial intelligence and fundus images

“…Its incidence increases with age ( Thomas et al, 2021 ). At present, the etiology and pathogenesis of AMD are not clear, and the related risk factors include age, sex, race, heredity, smoking, malnutrition, metabolic disorders, and retinal light damage ( Lombardo et al, 2022 ; Tao et al, 2023 ). Most patients with AMD are more than 50 years old, have both eyes effected at the same time or successively, and have progressive visual impairment.…”

Age-Related Macular Degeneration: An Exponentially Emerging Imminent Threat of Visual Impairment and Irreversible Blindness

“…Adaptive optics (AO) retinal imaging is currently under study as it provides higher resolution and delineates intricate patterns of microstructural aspects of photoreceptor cells, microvasculature, and retinal nerve fibers. Resonance Raman spectroscopy (RRS) is another promising modality that precisely measures the levels of carotenoid and xanthophyll concentration in the macular region of the human retina [71][72][73][74].…”