Abstract: Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss among the elderly population worldwide. This article provides a thorough review of AMD, covering its epidemiology, pathophysiology, clinical manifestations, diagnostic approaches, treatment modalities, and recent advancements. By elucidating the complexities of AMD, ophthalmologists can implement evidence-based strategies to mitigate disease progression and preserve visual function.

Introduction: Age-related macular degeneration (AMD) is a progressive retinal disease characterized by degenerative changes in the macula, leading to central vision impairment. As the global population ages, the prevalence of AMD continues to rise, necessitating a comprehensive understanding of its etiology, risk factors, and management strategies.

Epidemiology: AMD represents a significant public health concern, affecting over 196 million individuals worldwide. Its prevalence increases with age, with estimates indicating that approximately 8.7% of individuals aged 45-85 years have some form of AMD. Geographic and ethnic variations exist, with higher prevalence rates reported in developed countries and among Caucasians.

Pathophysiology: The pathogenesis of AMD is multifactorial, involving complex interactions between genetic predisposition, environmental factors, and aging-related changes in the retinal microenvironment. Key molecular pathways implicated in AMD pathophysiology include oxidative stress, inflammation, complement dysregulation, and angiogenesis.

Clinical Manifestations: AMD manifests clinically as either non-neovascular (dry) or neovascular (wet) forms. Dry AMD is characterized by drusen deposition, retinal pigment epithelium (RPE) atrophy, and photoreceptor loss, whereas wet AMD is typified by choroidal neovascularization (CNV) and associated exudative changes such as subretinal fluid and hemorrhage.

Diagnostic Approaches: Fundus examination, optical coherence tomography (OCT), fluorescein angiography (FA), and indocyanine green angiography (ICGA) are instrumental in diagnosing and staging AMD. Advances in imaging technologies, including OCT angiography (OCT-A), facilitate the non-invasive assessment of CNV activity and vascular perfusion.

Treatment Modalities: The management of AMD aims to prevent disease progression, alleviate symptoms, and optimize visual outcomes. In dry AMD, nutritional supplements containing antioxidants and zinc (e.g., AREDS formulation) may slow disease progression, while intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents represent the mainstay of treatment for wet AMD.

Recent Advancements: Ongoing research efforts continue to elucidate the underlying mechanisms of AMD and identify novel therapeutic targets. Promising avenues include gene therapy, stem cell-based approaches, and sustained drug delivery systems designed to enhance treatment efficacy and reduce treatment burden for patients.

Conclusion: Age-related macular degeneration poses significant challenges to ophthalmologists due to its multifactorial etiology and heterogeneous clinical presentation. By leveraging advances in diagnostic imaging, therapeutic interventions, and personalized medicine, clinicians can optimize visual outcomes and enhance the quality of life for patients affected by AMD.

For further reading and reference:

• National Eye Institute – Age-Related Macular Degeneration: https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/age-related-macular-degeneration
• American Macular Degeneration Foundation: https://www.macular.org/