Is the age-related macular degeneration (AMD) vascular disease, part of vasculopathy, respectively? Novel considerations on AMD arising from the newest pathophysiological, clinical and clinical- pharmacological observations (Preliminary Communication)

Abstract

In the genesis and later development of age-related macular degeneration (AMD), endothelial dysfunction (ED) has a crucial role. AMD-risk factors, which play a decisive role in AMD, are in a close connection, correlate with, and often are identical wih the risk factors (RFs) of cardiovascular diseases (CVDs), so that it can reasonably be presumed that the two conditions have a similar pathogenesis. These risk factors, which seem essentially different, lead to chronic vascular injury based on the same mechanism of action: by inducing oxidative stress (OS). ED itself is a consequential-consecutive phenomenon (OS→ED!), and is a clinico-pathophysiologically important connecting link between harm(s)/noxa and vascular injury (harm [noxa] → oxidative stress (OS) → endothelial activation (EA), endothelial dysfunction (ED), respectively → vacular injury, vascular disease). Disordered function of endothelium in the vessels supplying the affected ocular structures with blood (ED) have a key role in the genesis and development of age-related macular degeneration. Changes in blood vessels including those in choroids may be triggered by several repeated and/or prolonged mechanical, physical, chemical, microbiological, immunologic, and genetic influences/impacts/noxa (in fact, the risk factors!), against which protracted response 1 **) (increased ROS formation → oxidative stress → endothelial activation/dysfunction → aftermath of EA/ED) may develop, and in consequence of this, (chronic) vascular damage (functional and then structural alteration [remodelling] of the blood vessel), pathological consecutive changes ending in AMD, ultimately, may develop (choriocapillaris degenerates in exudative AMD, choriocapillaris degeneration precedes retinal pigment epithelial atrophy in wet AMD). All this goes to show that AMD may be a local manifestation of systemic (vascular) disease, undoubtedly. AMD is the disease of the aging body. Normal aging processes can lead to structural and blood flow changes that can predispose patients to AMD. Advancing age is a privotal and independent risk factor for vascular disease as can be understood from the fact that aging individuals often demonstrate dysfunctional blood vessel repair after vascular injury and aging per se, in the absence of other risk factors is associated with oxidative/nitrosative stress and inflammatory changes in the phenotype of blood vessels (primary abnormalities in ocular perfusion worsen with age, secondarily causing dysfunction of the retinal pigment epithelial cells, predisposing eyes to AMD), these changes together with individual's (environmental) risk factors set the stage for the development Fischer 43 of AMD. Regarding therapy/preventive treatment/prevention of AMD: (I) Non-medicinal (preventive) treatment such as lifestyle modifications of AMD patients (modifying lifestyles behavours of diet, smoking and physical activity) is of indispensable importance; they influence strongly and very beneficially the established vascular risk factors and also advantageously affect ...

Adalékok az időskori maculadegeneráció – etiopatogeneziséből fakadó – gyógyszeres intervenciójához

“…A korszerű nagy szöveti affi nitással rendelkező RAASgátló angiotenzinkonvertálóenzim-inhibitorok (ACEI) [1] (captopril, enalapril, perindopril, ramipril stb.) és angiotenzinreceptor-blokkolók (ARB) [2,3] (candesartan, irbesartan, losartan, telmisartan, valsartan stb.)…”

“…Mivel az emberi ér-rendszer egységes egész, annak minden -központi és környéki -része egylényegű mind élettanilag, mind kórélettanilag, valamint abban a képességében, hogy reagál és elhárít, ezért az ED kezelése az AMD terápiájá-nak is integráns része kell, hogy legyen. Ezen az úton az AMD mind primer, mind szekunder prevenciója megvalósítható [1,2].…”

Systemic endothelial function in cases with wet-type age-related macular degeneration

“…Vascular endothelium regulates retinal arteriolar tone, circulation in the ophthalmic and ciliary arteries, that is, the eye including ophthalmic microcirculation. The disordered function of endothelium, in the vessels supplying the affected ocular structures with blood, endothelial dysfunction, plays key role in the genesis and development of AMD [4]. Abnormalities in choroidal circulation predispose development of wet AMD [5].…”

Neovaskulinės amžinės geltonosios dėmės degeneracijos gydymo ranibizumabu 24 mėnesių morfologiniai ir funkciniai pokyčiai

“…AMD is a disorder of unknown cause and pathogenesis causing decrease or loss of the ability to read in the elderly age-group and affecting about 180 million people all over the world [2]. Although the incidence of legal blindness resulting from AMD is decreasing [3].…”

“…3. 2) of new blood vessels in the choroid layer of the eye. It also involves the macular area and when it progresses, vision get worse and because of that, quality of life also become worse.…”