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Neovascular AMD
Age-related macular degeneration (AMD) is a pathological condition 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.
Neovascular AMD is the most aggressive form of AMD and is characterized by phenomena of pathological neovascularization, i.e. the formation of pathological new blood vessels in the macula, due to the uncontrolled production of vascular endothelial growth factor (VEGF).
The growth of pathological neovessels causes exudation and in some cases hemorrhage within the macular tissue, with alteration of the structure of the macula and severe damage or loss of central vision.
What are the symptoms?
In patients suffering from neovascular AMD, symptoms can appear unexpectedly. Typical symptoms are blurred central vision, distorted and / or wavy central vision, appearance of a dark spot in the center of vision (central scotoma).
As in the case of the atrophic form, the symptoms of neovascular AMD interfere with people's ability to read and recognize faces and can prevent driving and precision work. Also in this case, the visual damage is all the more serious the larger the macular area involved.
What are the risks?
If action is taken promptly, central vision can be partially recovered and, in any case, residual vision can be safeguarded; on the contrary, late treatment or lack of treatment can result in irreversible loss of central vision.
How it is diagnosed?
Neovascular AMD can be diagnosed and monitored using instrumental tests such as high-resolution optical coherence tomography (HR-OCT), fluorescence angiography (FAG) and indocyanine green angiography (ICGA).
Since neovascular AMD can evolve suddenly from an asymptomatic atrophic form, after the age of 50 it is important to undergo regular eye checks with scrupulous monitoring of the retina: by doing so, it is possible to have an early diagnosis and promptly resort to the most appropriate treatment. avoiding irreversible damage to central vision.
Risk factors
There are several risk factors for AMD, among these the most important are older age, genetic susceptibility, cigarette smoking, excessive exposure to UV rays without adequate protection for the eyes, an unbalanced diet (too rich in animal fats 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
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.
Treatment
Once neovascular AMD has appeared, a prompt treatment with anti-VEGF drugs is necessary. Anti-VEGF drugs are administered directly into the vitreous cavity using a pharmaco-surgical technique known as intravitreal injection.
Treatment involves an initial loading dose of three injections one month apart, followed by maintenance injections, at intervals that can vary from 8 to 12 weeks depending on the drug used and the patient's individual response to the treatment.
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