Atrophic AMD

PATHOLOGY

The age related macular degeneration (atrophic type AMD) or more commonly known as maculopathy is a serious eye pathology involving the macula, i.e. the portion of the retina that is richer of photoreceptors and responsible for a fine detailed central vision, which enables us to recognize a face, read, carry out precision works, drive a car and very likely to che ci permette di riconoscere un volto, leggere, eseguire lavori di precisione, guidare e probabilmente di  l’auto etc.

In technologically advanced countries, the incidence of the AMD has strongly increased and continues increasing due to the lengthening of the average lifespan. The AMD strikes, in fact, approximately 11% of the individuals aged between 65 and 74 years and such percentage considerably increases when older age ranges are taken into consideration. As of today’s date the AMD, in more industrialized countries, represents the most common cause of legal blindness and low vision in individuals older than 55 years.

The AMD can have two forms: atrophic AMD (also referred to as non-neovascular or dry) and exudative AMD (also referred to as neovascular or wet). The AMD usually starts in the atrophic form (90% of the cases) and seldom (10% of the cases) in the exudative form. In some patients the atrophic AMD can evolve into the exudative form.

The atrophic AMD is characterized by the presence of drusen, very small yellow or white spots under the retina deriving from the accumulation of waste material mainly originating from the metabolism of retinal cells, which are located between the retinal pigment epithelium (RPE) and the Bruch membrane. The drusen can be detected upon examination of the eye fundus and have the aspect of small yellow formations.

TRATTAMENTO

Until a short time ago, patients suffering from atrophic AMD could only be recommended to improve their lifestyle, to use protective ultraviolet (UV) glasses and to take food supplements, as pointed out by the AREDS2 trial. Such recommendations have proved to be effective in slowing down the evolution of the pathology, but other than this preventive treatment no other treatments existed with proved effectiveness to be proposed to the patients. Recently, conversely, new treatments have been disclosed that are able to slow down the evolution of atrophic AMD.

Recently, as confirmed by a complex randomized multicentre study (LEAD), a new nanosecond laser was introduced, which by means of a sub-threshold irradiation of the posterior retinal area is able to induce the release of certain specific enzymes (metalloproteinasis) that can induce anatomic changes at the level of the complex retinal pigment epithelium membrane capillary lamina of choroid or Bruch’s choriocapillaris such as to reduce the progression of the diseases in selected patients.  An enlargement and a further expected confirmation of the data issued until now will permit to extend the use of the nanosecond laser 2RT® in correct clinical and therapeutic practice. The use of this type of laser (2RT®) was applied also with success for the first time in the therapy of an hereditary macular degeneration disease (Leventinese disease) proving that a physical therapy (laser) can induce a functional improvement in patients suffering from hereditary retinal diseases.

In addition to this laser technology, several drugs are being studied that are able to inhibit the complex cascade factor responsible for the onset of the pathology; the drug is injected in the eyeball through an intravitreal injection, and it is hoped that it is able to slow down the progression of the atrophic AMD in the advanced phase to the terminal phase represented by the geographic atrophy (GA).

We trust that the clinical trials currently under way can soon confirm the safety and effectiveness of these new treatments, so that they can be soon employed for the protection of the vision in individuals affected by atrophic AMD.

Recently, as confirmed by a complex randomized multicentre study (LEAD), a new nanosecond laser was introduced, which by means of a sub-threshold irradiation of the posterior retinal area is able to induce the release of certain specific enzymes (metalloproteinasis) that can induce anatomic changes at the level of the complex retinal pigment epithelium membrane capillary lamina of choroid or Bruch’s choriocapillaris such as to reduce the progression of the diseases in selected patients.  An enlargement and a further expected confirmation of the data issued until now will permit to extend the use of the nanosecond laser 2RT® in correct clinical and therapeutic practice. The use of this type of laser (2RT®) was applied also with success for the first time in the therapy of an hereditary macular degeneration disease (Leventinese disease) proving that a physical therapy (laser) can induce a functional improvement in patients suffering from hereditary retinal diseases.

In addition to this laser technology, several drugs are being studied that are able to inhibit the complex cascade factor responsible for the onset of the pathology; the drug is injected in the eyeball through an intravitreal injection, and it is hoped that it is able to slow down the progression of the atrophic AMD in the advanced phase to the terminal phase represented by the geographic atrophy (GA).

We trust that the clinical trials currently under way can soon confirm the safety and effectiveness of these new treatments, so that they can be soon employed for the protection of the vision in individuals affected by atrophic AMD.

WE CAN HELP YOU

If you believe that you are suffering from this pathology or you have any doubts that you wish to be clarified you can contact us.

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