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AGE-RELATED MACULAR DEGENERATION
Age-related macular degeneration is a common, chronic, progressive, degenerative disease that causes central loss of vision due to abnormalities that occurs in the pigment, neural and vascular layers of the macula.
The macular disorder may have one or more of the following:
- Formation of drusen which are localized deposits of extracellular material usually concentrated in the macula
- Abnormalities in the retinal pigment epithelium (eg hypopigmentation or hyperpigmentation)
- Retinal pigment epithelium and choriocapillaris geographic atrophy
- Neovascular (exudative) maculopathy
Decreased central vision and distortion of seeing straight lines are the most common symptoms.

Pharmacotherapy

Antioxidant Vitamin and Mineral Supplements

  • Daily dose of combination of 500 mg Vitamin C, 400 iu Vitamin E, 15 mg Beta-carotene and 80 mg Zinc was found to reduce the risk of progression to advanced age-related macular degeneration (AMD)
  • Indicated in patients with either intermediate AMD or advanced AMD in one eye
  • Contraindicated in smokers or those who recently quit smoking as beta-carotene is associated with increased risk for lung cancer

Ranibizumab

  • A recombinant humanized immunoglobulin that binds and inhibits the action of all isoforms of vascular endothelial growth factor-A (VEGF-A) administered intravitreally
  • Indicated for active subfoveal choroidal neovascularization (CNV) as shown by studies it
    • Improves visual acuity and,
    • Prevents leakage and progression of neovascularization

Pegaptanib sodium

  • A ribonucleic acid (RNA) oligonucleotide that is a selective VEGF antagonist administered intravitreally
  • Indicated for all subtypes of neovascular AMD

Photodynamic therapy (PDT) with Verteporfin

  • A photosensitizing dye given by intravenous (IV) before laser light administration in PDT for predominantly classic neovascular AMD
  • Photodynamic therapy has minimal damage to the overlying retina than laser photocoagulation therapy because the energy from the laser is taken up by the Verteporfin causing damage to the vascular endothelial cells and thrombotic occlusion of the blood vessels within the CNV lesion
  • Reduces the risk of moderate and severe visual loss
    • Most patients will still have loss of vision and visual improvements are unusual

Non-Pharmacological Therapy

Rehabilitation

  • Low vision rehabilitation by using magnifiers and low vision aids are recommended for advanced non-neovascular age-related macular degeneration (AMD) patients
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