Åldersrelaterad makuladegeneration (AMD)
Senast uppdaterad: Publicerad:
Sakkunnig:Fredrik Ghosh
Definition:
Degeneration av pigmentepitelceller och fotoreceptorer i makulaområdet i retina. Åldersbetingad makulopati, genetiska faktorer, oxidativ stress och UV-ljus predisponerar för tillståndet.
Förekomst:
Prevalens är 2–3 % bland personer >65 år.
Symtom:
Smärtfri och gradvis synförlust. Ofta med förvrängning av synintrycken, lässvårigheter, suddig syn med blinda fläckar och i sen fas centralt skotom.
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 med kontrast och OCT (Optical Coherence Tomography).
Behandling:
Ingen behandling vid torr typ, VEGF-behandling vid våt typ.
- Chopdar A, Chakravarthy U, Verma D. Age related macular degeneration. BMJ 2003; 326: 485-8. PubMed
- Smith W, Assink J, Klein R, Mitchell P, Klaver CCW, Klein BEK et al. Risk factors for age-related macular degeneration: pooled findings from three continents. Ophthalmology 2001; 108: 697 - 704. PubMed
- 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
- Arnold J, Sarks S. Macular degeneration. In: Clinical Evidence, BMJ Publishing Group, 2001; 5: 425-35.
- Seland JH. Aldersrelatert maculadegenerasjon. Tidsskr Nor Lægeforen 2004; 124: 52-4. PubMed
- Bunce C, Wormald R. Causes of blind certifiications in England and Wales: April 1999-March 2000. Eye 2008; 22: 905-11. PubMed
- Vingerling JR, Dielemans I, Hofman A, et al. The prevalence of age-related maculopathy in the Rotterdam study. Ophtalmology 1995; 102; 205-10. PMID: 7862408. PubMed
- Zhao J, Frambach DA, Lee PP. Delayed macular choriocapillary circulation in age-related macular degeneration. Int Ophthalmol 1995; 19: 1 - 12. PubMed
- Remulla JF, Gaudio AR, Miller S. Foveal electroretinograms and choroidal perfusion characteristics in fellow eyes of patients with unilateral neovascular age-related macular degeneration. Ophthalmology 1995; 79: 558 - 61. PubMed
- Ciulla TA, Harris A, Chung HS. Color Doppler imaging discloses reduced ocular blood velocities in nonexudative age-related macular degeneration. Am J Ophthalmol 1999; 128: 75 - 80. PubMed
- Ross RD, Barofsky JM, Cohen G. Presumed macular choroidal watershed vascular filling: choroidal neovascularization, and systemic vascular disease in patients with age-related macular degeneration. Am J Ophthalmol 1998; 125: 71 - 80. PubMed
- Stockholms Läns Landsting. Janusinfo. Behandling av makuladegeneration. 2018. www.janusinfo.se
- 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. PubMed
- Neuringer M. Effects of carotenoid depletion and N-3 fatty acid status on macular defects in Rhesus monkeys. (ARVO Abstract). Invest Ophthalmol Vis Sci 1999; 40: S164. PubMed
- 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
- 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
- Pieramici DJ, Bressler SB. Age-related macular degeneration and risk factors for the development of choroidal neovascularization in the fellow eye. Curr Opin Ophtalmol 1998; 9: 38-46. PubMed
- Topouzis F, Anastasopoulos E, Augood C, et al. Association of diabetes with age-related macular degeneration in the EUREYE study. Br J Opthalmol 2009; 93: 1037-41. PubMed
- Lawrenson JG, Evans JR. Omega 3 fatty acids for preventing or slowing the progression of age-related macular degeneration. Cochrane Database of Systematic Reviews 2015, Issue 4. Art. No.: CD010015. DOI: 10.1002/14651858.CD010015.pub3 DOI
- Fletcher AE, Bentham GC, Agnew M, et al. Sunlight exposure, antioxidants, and age-related macular degeneration. Arch Opthalmol 2008; 126: 1396-403. PubMed
- Régnier S, Malcolm W, Allen F, et al.. Efficacy of anti-VEGF and laser photocoagulation in the treatment of visual impairment due to diabetic macular edema: a systematic review and network meta-analysis.. PLoS One. 2014 Jul 16;9(7):e102309. . PMID: 25029255 PubMed
- Rosenfeld PJ, Brown DM, Heier JS, et al. Ranabizumab for neovascular age-related macular degeneration. N Engl J Med 2006; 355: 1419. New England Journal of Medicine
- Sjögren P, Ayala M, Jonsdottir E et al. Efficacy and safety of intraocularly administered vascular endothelial growth factor inhibitors for macular disease. Effekt och säkerhet vid intraokulär behandling med vaskulär tillväxtfaktorhämmare för makulasjukdom. Göteborg: Region Västra Götaland, Sahlgrenska Universitetssjukhuset, HTA-centrum; 2017. Regional activity-based HTA 2017:96
- Bashshur ZF, Haddad ZA, Schakal A, et al. Intravitreal bevacizumab for treatment of neovascular age-related macular degeneration: A one-year prospective study. Am J Ophtalmol 2008; 145: 249. PubMed
- Martin DF, Maguire MG, Ying G, for the CATT research group. Ranabizumab and bevacizumab for neo-vascularf age-related macular degeneration. N Engl J Med 2011; : e-pub.
- Thulliez M. Angoulvant D, Pisella P, Bejan-Angoulvant T. Overview of Systematic Reviews and Meta-analyses on Systemic Adverse Events Associated With Intravitreal Anti-Vascular Endothelial Growth Factor Medication Use. JAMA Ophtalmol 2018. pmid:29566105 PubMed
- FDA News Release. FDA approves Eylea for eye disorders in older people. FDA news release, nov. 2011. www.fda.gov
- Sjølie AK, Mortensen KK, Hansen MH. Antiangiogenesebehandling til alderselateret maculadegeneration. Ugeskr Læger 2005; 167: 3267. PubMed
- Wormald R, Evans J, Smeeth L, et al. Photodynamic therapy for neovcascular age-related macular degeneration (Cochrane Review). In: The Cochrane Library, issue 3, 2003. The Cochrane Library
- Aisenbrey S, Lafaut BA, Szurman P, Grisanti S, Lüke C, Krott R et al. Macular translocation with 360° retinotomy for exudative age-related macula degeneration. Arch Ophthalmol 2002, 120: 451 - 9.
- Hall NF, Gale CR, Syddall H, Phillips DIW, Martyn CN. Risk of macular degeneration in users of statins: cross sectional study . BMJ 2001; 323: 375-6. PubMed
- 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
- 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
- Chong EW, Wong TY, Kreis AJ, Simpson JA, Guymer RH. Dietary antioxidants and primary prevention of age-related macular degeneration: systematic review and meta-analysis. BMJ 2007; 335: 755-763. British Medical Journal
- Evans JR, Henshaw KS. Antioxidant vitamin and mineral supplements for preventing age-related macular degeneration. Cochrane Database of Systematic Reviews 2008; Isuue 1: CD000253. Cochrane (DOI)
- Sarks JP, Sarks SH, Killingsworth M. Evolution of geographic atrophy of the retinal pigment epithelium. Eye 1988; 2: 552-77. PubMed
- Macular Photocoagulation Study Group. Laser photocoagulation for juxtafoveal choroidal neovascularisation. Five-year results from randomized clinical trials. Arch Ophtalmol 1994; 112: 500-9. PubMed
- 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
- Evans JR. Antioxidant vitamin and mineral supplements for age-related macular degeneration (Cochrane Review). In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software. The Cochrane Library
- Brown DM, Michels M, Kaiser PK, et al. Ranabizumab versus verteporfin photodynamic therapy for neovascular age-related macular degeneration: Two year results of the ANCHOR study. Ophtalmology 2009; 116: 57. PubMed
- Solomon SD, Lindsley K, Vedula SS, et al. Anti-vascular endothelial growth factor for neovascular age-related macular degeneration. Cochrane Database Syst Rev. 2014 Aug 29;8:CD005139. DOI: 10.1002/14651858.CD005139.pub3. DOI
- Fredrik Ghosh, docent och överläkare, Ögonkliniken, Skånes universitetssjukhus
Tidigare sakkunniga
- Johan H. Seland, professor emeritus, Universitetet i Bergen
- Knut A. Holtedahl, professor i allmänmedicin, Institutt for samfunnsmedisinske fag, Universitetet i Tromsø