Age-Related Macular Degeneration (AMD)

The Age-Related Macular Degeneration (AMD) is one of the most important etiology of elderly people’s blindness in developed countries. Classicaly there were descibed two AMD types: a dry and a wet form, but the newest classifications consider an early (and intermediate) stage correlated with drusen in diferent sizes and/or pigmentary anomalies and a late stage also, divided in two different fenotypes: geographic atrophy and macular exudation going on a disciform scar. The macula involvement obviously induces a central vision loss with a progressive deterioration of the quality of life for the patients involved. Besides clinical examination with the slit-lamp and special lenses, there are several diagnostic techniques (optical coherence tomography, angiography by optical coherence tomography, fluoresceine angiography, indocyanine green angiography, fundus autofluorescence, retromode imaging) included in the general term of multimodal investigations. Historically the AMD treatment consisted in laser photocoagulation, radiotherapy, subretinal surgery, retinal pigment epithelium transpantation, transpupillary thermotherapy, photodynamic therapy, but nowadays the mainstay is the antiangiogenic therapy with antiVEGF agents. Since 2005 there have been used bevacizumab, ranibizumab, aflibercept, brolucizumab, faricimab with excellent results, but all of these had adressed only the wet AMD types. New classes of complement inhibitors were created to slow or to stop the progression of geographic atrophy in its insidious way to the fovea, but this dry AMD treatment is still under evaluation. The genetic treatments with different kind of viral vectors sound extremely promising and quite soon We’ll have new solutions for this debilitating disease.