Age related macular degeneration – challenge for future: Pathogenesis and new perspectives for the treatment

The authors presents the review of the literature concerning the pathogenesis, classification, risk factors as well as perspectives for the treatment of age-related macular degeneration (AMD). AMD is a progressive illness, which is the most common cause of blindness in developed countries. The degenerative changes associated with both forms (dry and wet AMD) occur in the central part of retina, the macula, but the exact aetiology is still not unclear. The pathogenesis of AMD includes: lipofuscine genesis, drusogenesis, and local inflammatory state, as well as neoangiogenesis. Multiple studies have assessed the role of genetic variants on AMD development and progression, especially with complement factor H (CFH) and age-related maculopathy susceptibility 2 (ARMS2) genes, the two major susceptibility genes for AMD. The disease has been associated with light-induced oxidative damage, accumulation of cholesterol and other lipids, and has been linked to systemic factors such as smoking, hypertension and atherosclerosis. Also female gender, and a high body-mass index (BMI > 30) have been reported as the important demographic and environmental risk factors in AMD. The neovascular form of AMD is characterized by the formation of subretinal choroidal neovascularization (CNV) and is the cause of most cases of blindness in the elders. Currently, the only approved treatment for dry AMD is the use of AREDS formulation. In the near future, it is likely that the treatment of dry AMD will be a combination of different drugs that will target the different pathways involved in the pathogenesis and progression of dry AMD. Exudative AMD is treated through injections of anti-VEGF A drugs as pegaptanib or ranibizumab and bevacizumab, which are considered the standard drugs. Aflibercept, or VEGF Trap-eye, is a novel compound derived from the native VEGF receptor (VEGFR) that binds to all VEGF and VEGF-B isoforms as well as to PlGF. It may be considered an attractive alternative to other anti-VEGF agents.