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Atrophic AMD

Age-related macular degeneration (AMD) is a disease that affects the macula, the most central part of the retina and the richest in photoreceptors, therefore responsible for central vision, i.e. the fine and detailed vision that allows us to read, recognize people's faces, perform precision work and drive a car.

Atrophic AMD is the most common form of AMD and is characterized by the presence of drusen, which can be observed in a fundus examination as small yellowish spots.

Atrophic AMD causes a progressive alteration of the macula and atrophy and cell death of photoreceptors(cones and rods).

What are the symptoms?

In patients with early atrophic AMD, symptoms may be absent or mild. In the intermediate stage, however, symptoms may appear such as: 
  • Blurry, distorted or wavy vision;
  • Altered perception of colors;
  • Loss of contrast;
  • Difficult visual adaptation in the passage between light and shadow;
  • Photophobia.
At the end-stage, known as geographic atrophy, a dark or missing area (central scotoma) is perceived in the center of vision and central vision loss occurs. At this stage it is difficult, if not impossible, to perform precision work, to drive and, often, to recognize people's faces. 

What are the risks?

Atrophic AMD causes the progressive loss of central vision. The visual damage caused by this pathology is unfortunately irreversible and is all the more serious the greater the macular area involved in the structural alteration.In some cases, atrophic AMD can give rise to localized inflammation phenomena that trigger the onset of neovascular AMD, which is much more aggressive and rapidly evolving than the atrophic form.

How it is diagnosed?

Atrophic AMD can be diagnosed and monitored using instrumental tests such as high-resolution optical coherence tomography (HR-OCT).

Any evolution towards the neovascular form can be highlighted by performing fluorescence angiography (FAG) and indocyanine green angiography (ICGA).

After the age of 50 it is very important to undergo regular eye checks with accurate monitoring of the retina. In this way, it is possible to highlight the possible presence of atrophic AMD, which in the initial stages may be asymptomatic, monitor its progression and, in the event of evolution towards the exudative form, immediately resort to the most appropriate treatment, thus safeguarding vision.

Risk factors

There are several risk factors for maculopathy, among these the most important are older age, genetic susceptibility, cigarette smoking, excessive exposure to UV rays without adequate eye protection, an unbalanced diet (too rich in animal fats and low in vegetables and antioxidants), hypercholesterolemia, uncontrolled systemic hypertension, lack of physical exercise.

The presence of a genetic risk factor can be highlighted by a genetic test capable of detecting the possible presence of genetic susceptibility. In this case, a consultation with an expert geneticist can offer the patient a personalized prevention program aimed at lowering the risk of onset of the disease.

Prevention and treatment

The AREDS2 clinical study has shown that the intake of food supplements containing high doses of vitamin C, vitamin E, lutein, zeaxanthin, zinc and copper is effective in reducing by 25% the risk of progression of atrophic AMD towards the advanced stage (atrophy geographic or neovascular AMD).The LEAD clinical study demonstrated the effectiveness of the sub-threshold nanosecond laser in slowing the progression of early and intermediate atrophic AMD towards the more advanced stages of geographic atrophy or neovascular AMD. The laser is effective in 76% of the treated patients, selected for eligibility to treatment and for the absence of reticular pseudodrusen.

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