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Åldersrelaterad makuladegeneration, AMD

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Sakkunnig:
Definition:
Åldersrelaterad makuladegeneration, AMD, innebär degeneration av pigmentepitelceller och fotoreceptorer i makulaområdet (gula fläcken) i retina.
Förekomst:
Prevalensen ökar med stigande ålder. Prevalensen för sen (allvarlig) AMD har uppskattats till 7 % bland personer >75 år.
Symtom:
Smärtfri och gradvis synförlust. Ofta med förvrängning av synintrycken, lässvårigheter, suddig syn med blinda fläckar och i sen fas centralt skotom. Vid våt typ kan symtomen komma relativt plötsligt.
Kliniska fynd:
Vid fundusundersökning ses i tidigare stadier hyalina drusen som små vita fläckar framförallt kring fovea, senare pigmentförändringar, eventuellt blödningar och ödem.
Diagnostik:
Utredning hos ögonläkare omfattar angiografi och OCT (Optical Coherence Tomography).
Behandling:
Ingen behandling vid torr typ, VEGF-behandling vid våt typ.
  1. Mitchell P, Liew G, Gopinath B, Wong TY. Age-related macular degeneration. Lancet. 2018 Sep 29;392(10153):1147-1159. PMID: 30303083. PubMed  
  2. Bourne RR, Jonas JB, Flaxman, et al. Prevalence and causes of vision loss in high-income countries and in Eastern and Central Europe: 1990-2010. Br J Ophtalmol 2014. pmid:24665132 PubMed  
  3. Klein R, Klein BE, Linton KL. Prevalence of age-related maculopathy. The Beaver Dam Eye Study. Ophthalmology. 1992 Jun;99(6):933-43. doi: 10.1016/s0161-6420(92)31871-8. PMID: 1630784 PubMed  
  4. Bunce C, Wormald R. Causes of blind certifiications in England and Wales: April 1999-March 2000. Eye 2008; 22: 905-11. PMID: 17332762 PubMed  
  5. Buschini E, Piras A, Nuzzi R, Vercelli A. Age related macular degeneration and drusen: neuroinflammation in the retina. Prog Neurobiol 2011;95:14–25. PMID: 21740956 PubMed  
  6. Ennis A, Jomary C, Mullins R, et al. Association between the SERPING1 gene and age-related macular degeneration: a two-stage case-control study. Lancet 2008; 372: 1828-34. PMID: 18842294 PubMed  
  7. Haddad A, Chen CA, Santangelo SL, Seddon JM. The genetics of age-related macular degeneration: a review of prgress to date. Surv Ophtalmol 2006; 51: 316-63. PubMed  
  8. Augood CA, Vingerling JR, deJong PTVM, Chacravarthy U, et al. Prevalence of age-related maculopathy in older europeans - The European Eye Study (EUREYE). Arch Ophtalmol 2006; 124: 529-35. PubMed  
  9. Tan JS, Wang JJ, Liew G, et al. Age-related macular degeneration and mortality from cardiovascular disease or stroke. Br J Ophthalmol 2008; 92:509-12. PMID: 18310310 PubMed  
  10. Lambert NG, ElShelmani H, Singh MK, et al. Risk factors and biomarkers of age-related macular degeneration. Prog Retin Eye Res. 2016;54:64-102. PMID: 27156982. PubMed  
  11. Fletcher AE, Bentham GC, Agnew M, et al. Sunlight exposure, antioxidants, and age-related macular degeneration. Arch Opthalmol 2008; 126: 1396-403. PubMed  
  12. Seland JH. Aldersrelatert maculadegenerasjon Age-related macular degeneration. Tidsskr Nor Laegeforen. 2004 Jan 8;124(1):52-4. Norwegian. PMID: 14716396. PubMed  
  13. Solomon SD, Lindsley K, Vedula SS, Krzystolik MG, Hawkins BS. Anti-vascular endothelial growth factor for neovascular age-related macular degeneration. Cochrane Database Syst Rev. 2019 Mar 4;3(3):CD005139. doi: 10.1002/14651858.CD005139.pub4. PMID: 30834517 PubMed  
  14. Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Arch Ophthalmol. 2001 Oct;119(10):1417-36. doi: 10.1001/archopht.119.10.1417. Erratum in: Arch Ophthalmol. 2008 Sep;126(9):1251. PMID: 11594942 PubMed  
  15. Bressler NM, Bressler SB, Congdon NG, Ferris FL 3rd, Friedman DS, Klein R, Lindblad AS, Milton RC, Seddon JM; Age-Related Eye Disease Study Research Group. Potential public health impact of Age-Related Eye Disease Study results: AREDS report no. 11. Arch Ophthalmol. 2003 Nov;121(11):1621-4. doi: 10.1001/archopht.121.11.1621. PMID: 14609922 PubMed  
  16. Evans JR, Lawrenson JG. Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration. Cochrane Database Syst Rev. 2017 Jul 31;7(7):CD000254. doi: 10.1002/14651858.CD000254.pub4. PMID: 28756618 PubMed  
  17. Christen WG, Glynn RJ, Chew EY, et al. Folic acid, pyridoxine, and cyancobalamin combination treatment and age-related macular degeneration in women. Arch Intern Med 2009; 169: 335-41. PubMed  
  18. Evans JR, Lawrenson JG. Antioxidant vitamin and mineral supplements for preventing age-related macular degeneration. Cochrane Database Syst Rev 2017 Jul 30; 7: CD000253. pmid:28756617 PubMed  
  19. Sarks JP, Sarks SH, Killingsworth M. Evolution of geographic atrophy of the retinal pigment epithelium. Eye 1988; 2: 552-77. PubMed  
  20. Wong TY, Chakravarthy U, Klein R, et al. The natural history and prognosis of neovascular age-related macular degeneration; a systematic review of the literature and meta analysis. Ophtalmology 2008; 115: 116-26. PubMed  
  21. Macular Photocoagulation Study Group. Risk factors for choroidal neovascularisation in the second eye of patients with juxtafoveal or subfoveal choroidal neovascularisation secondary to age-related macular degeneration. Arch Ophtalmol 1997; 115: 741-7. PubMed  
  • Anna Nager, docent och specialist i allmänmedicin, Karolinska institutet