What are our eyes telling us?

This story is part of a series on current advances in regenerative medicine. This work begins a series dedicated to the eye and improving vision recovery.

In 1999, I defined regenerative medicine as a set of interventions that restore normal function to tissues and organs that have been damaged by disease, damaged by trauma, or worn out over time. I include the full range of chemical, genetic and protein-based pharmaceuticals, cell-based therapeutics and biomechanical interventions to achieve that goal.

The field of regenerative medicine is advancing rapidly, bringing new hope to people suffering from visual impairment. Specifically, breakthrough treatments have the potential to restore vision and change lives.

The human eye is a complex sensory organ that is responsible for our ability to perceive the world and has many complex structures including the cornea, iris, lens, retina and optic nerve. These complex structures can lead to diseases and disorders that can lead to blindness and visual impairment.

Cataracts, glaucoma, diabetic retinopathy and age-related macular degeneration are the most common optical diseases affecting millions of people worldwide. Cataracts cause blurry vision due to clouding of the lens, while glaucoma is caused by damage to the optic nerve, leading to loss of peripheral vision. Diabetics can also develop diabetic retinopathy, which affects the blood vessels in the retina and causes vision loss if left untreated.

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recent reviews We explored age-related macular degeneration and the role of regenerative medicine in its treatment. Age-related macular degeneration, the leading cause of vision loss in people over the age of 50, affects the center of the retina, causing blurred or distorted vision.

Age-related macular degeneration and disease burden

Age-related macular degeneration (AMD), a chronic eye disease, affects 196 million people worldwide as of 2020 and is expected to rise to 288 million by 2040 and its prevalence is on the rise. The impact of AMD is far-reaching, causing a decline in people’s quality of life, mobility and independence. As a result, the incidence of falls and depression increases.

The disease is a significant contributor to the global burden of disease and a major contributor to inequalities in health outcomes, disproportionately affecting low-income and low Human Development Index countries. increase.

The burden of disease in Africa is more than double that of the Americas. Additionally, Asia, which accounts for approximately 60% of the world’s population, is projected to account for more than one-third of all AMD cases. Despite significant advances in treatment, age-related macular degeneration remains a major public health challenge.

Classification of macular degeneration

Age-related macular degeneration is a medical condition that causes loss of central vision in the affected eye. This can make daily activities such as reading and driving difficult. It occurs when the cells of the macula, a small area in the center of the retina, begin to deteriorate over time.

The Beckman Initiative for Macular Research proposed a clinical classification system for AMD in 2013 and is now commonly used in research and clinical practice. This classification system requires only clinical examination or color fundus images, so it is accessible and applicable to everyone.

Color fundus images capture the intricate details of the fundus. Photographs provide insight into the retina, blood vessels, macula, and optic disc. This allows doctors to identify vascular abnormalities, monitor disease progression, and assess treatment efficacy. These images are essential for the diagnosis and treatment of AMD.

Neovascular AMD, also known as exudative macular degeneration, is defined as the presence of neovascularization beneath the retinal pigment epithelium.

Geographic atrophy, also known as dry macular degeneration, is accompanied by loss of photoreceptors and retinal pigment epithelium and appears as sharply defined pale areas with exposed underlying choroidal blood vessels.

Both types of age-related macular degeneration (AMD) may be asymptomatic in the early stages, but can cause night blindness and difficulty adjusting to dim light. Early detection and monitoring are critical to identify angiogenic complications and ensure timely medical intervention.

What Causes Macular Degeneration?

Age-related macular degeneration is a chronic retinopathy that develops due to oxidative damage to the retina over time. This damage affects various eye structures such as photoreceptors, Bruch’s membrane, choriocapillaris, and retinal pigment epithelium.

Retinal pigment epithelial (RPE) cells accumulate intracellular debris, mainly lipofuscin or drusen, with aging. This build-up causes oxidative damage and debris clumps into deposits below her RPE, manifesting as drusen, a hallmark of AMD. The reason age is the main risk factor for this condition is that it accumulates over time.

Aging is a significant risk factor for macular degeneration, but other factors such as diet and genetics may also play a role. Lifestyle factors such as diet fall under the modifiable risk factors, whereas less controllable factors such as genetics are not easily modifiable.

Smoking poses the most significant risk of all preventable factors, increasing your chances of developing the condition by a factor of three. Nonetheless, smoking cessation can help reduce this risk. Regular physical activity offers some protection, but studies have shown it to be an important factor in reducing the development of macular degeneration.

Research provides insight into future treatments

Despite advances in the treatment of age-related macular degeneration, the disease and its management are still poorly understood. Research is currently focused on early intervention trials to slow or prevent disease progression.

Regulatory-approved primary endpoints play a key role in improving the accessibility and efficiency of clinical trials. However, to date, no such indicators of disease progression have been recognized, with late age-related macular degeneration being a notable exception. Contrast sensitivity, best-corrected visual acuity, and rate of growth of geographic atrophic lesions are still the only benchmarks recognized by these institutions.

Researchers are actively investigating ways to streamline the progression of early intervention trials. They collect patient feedback and focus on developing clinical endpoints through anatomical and functional markers. To this end, experts collaborated to form a consensus group to establish a more comprehensive grading of age-related macular severity that considers early biomarkers and surrogate endpoints.

Innovations in technology and strategies, such as the integration of AI into screening tools, the development of advanced home monitoring tools, and prioritization of marginalized and vulnerable groups, will help in the fight against age-related macular degeneration and other retinal diseases. Promising.

Effective treatments for macular degeneration have the potential to usher in a new era of breakthrough achievements and significantly reduce the burden of disease on older adults. Investing in developing treatments for age-related macular degeneration could have far-reaching implications that benefit millions of people around the world.

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