“The macula is located in the central part of the retina and is responsible for clear and detailed vision, such as reading, driving or recognizing faces. Age-related macular degeneration usually develops over many years,” says Mr Mr. Pantelis A. Papadopoulos MD, PhD, FEBO, FEBOS-CR, Ophthalmologist Surgeon, Director of the First Ophthalmology Clinic Metropolitan Hospital, who then explains the forms, risk factors and treatment of age-related macular degeneration:

Age-related macular degeneration occurs in 2 forms:

• Xiri: It is the most common form, accounting for approximately 85-90% of cases. It is characterized by the gradual deterioration of the photoreceptors and the pigment epithelium in the area of ​​the macula. It is related to the accumulation of retinal cell waste under the macula. Patients experience a gradual decline in vision, with the most common symptoms being blurriness and the sensation of dark spots in their field of vision
• The Liquid: Although less common, it is more serious and can lead to sudden vision loss. In this form, abnormal blood vessels develop under the macula and leak blood or plasma, causing damage to the retina.

Causes and Risk Factors

The etiology of age-related macular degeneration is not fully understood, however several factors have been identified:

• Age: It is the strongest risk factor, with the incidence increasing after the age of 50.
• Genetic predisposition: Certain genes, such as CFH and ARMS2 variants, are associated with increased risk.
• Smoking: Smoking doubles the risk of developing the disease.
• Diet: A diet low in antioxidants and high in saturated fat may increase the risk.
• Excessive exposure to sunlight: UV rays are considered an aggravating factor for the macular.

Symptoms and Diagnosis

“The early stages of age-related macular degeneration can be asymptomatic. As the condition progresses, the most common symptoms include difficulty reading or recognizing faces, the presence of dark or blurry spots in the central visual field, and distortion of straight lines, appearing wavy. The Amsler chart or grid is a simple diagnostic tool used to monitor and diagnose problems in the central visual field. It is particularly useful for identifying early signs of age-related macular degeneration, especially the wet form, where vision can suddenly change. With this table, the patient self-examines at home 1-2 times a week and as soon as he notices any change, he should contact his ophthalmologist.

The diagnosis of age-related macular degeneration is made only by an ophthalmologist via examination and photography of the fundus of the eye, optical coherence tomography (OCT), bloodless OCT angiography, and more rarely, with fluorescein angiography and ICG angiography after injecting a contrast agent intravenously,” emphasizes the expert.

The Treatment of the Dry Form

The options available to treat age-related macular degeneration aim to slow the progression of the disease and preserve vision.

1. Nutritional Interventions and Healthy Lifestyle

• Eating foods rich in antioxidants, vitamins (C, E), zinc, and lutein/zeaxanthin can help protect the retina.
• Dietary supplements according to the AREDS2 guidelines have been shown to slow the progression of the disease in moderate and advanced stages.
• Avoiding smoking, which worsens AMD.
• Daily use of sunglasses to protect against ultraviolet radiation.
• Balanced diet with an emphasis on green leafy vegetables, fish and nuts.

2. Photobiostimulation (PBM)

“Photobiostimulation (PBM) is one of the newest and most innovative treatments for dry age-related macular degeneration. It uses specific wavelengths of low-energy light to enhance cell function and reduce oxidative stress, which is a critical factor in the progression of the condition.

Photobiostimulation improves energy production in retinal cells and targets mitochondria. Energy stimulates mitochondrial activity, increasing production ATP (adenosine triphosphate)which provides energy for cell repair and regeneration.

Age-related macular degeneration is linked to free radical-induced oxidative stress in the retina. PBM neutralizes these free radicals, reducing damage to retinal cells. This slows down or prevents the progression of cellular degeneration.

Photobiostimulation improves blood flow and oxygenation to the retina, supporting macular tissue health. It preserves the photoreceptors and pigment epithelium of the retina, which are vital for maintaining vision,” he points out.

The Advantages of Photobiostimulation

• It is a non-invasive method
• Does not cause pain
• Can be applied in early stages of dry AMD
• Has minimal side effects

Treatment Indications

The Metropolitan Hospital has the Valeda Light Delivery Systemdeveloped by Lumithera and is a new, non-invasive treatment to treat it Age-related Macular Degenerationmainly in the early stages of the dry form. The Valeda system is specifically aimed at treating early and intermediate form of dry age-related macular degeneration, where the degeneration is progressive and patients experience mild to moderate vision loss. It is not used for its liquid form, which is associated with the development of abnormal blood vessels.

The Benefits of PBM Therapy

• Vision Improvement: Many patients report improvements in contrast sensitivity, visual acuity and reading ability.
• Slowing Disease Progression: By reducing mitochondrial dysfunction and oxidative stress, Valeda may slow the progression of dry age-related macular degeneration.
• Safety and Non-Invasiveness: Unlike injections or surgery, PBM with Valeda is comfortable and has minimal risk of complications.
• Complementary Therapy: It can be used alongside other treatments, such as dietary supplements for age-related macular degeneration (eg AREDS formulations).

Effectiveness

The treatment is carried out in short sessions lasting approximately 5 minutes per eye. Each cycle consists of 9 sessions that must take place within a month. More than one cycle may be needed at least four months apart. The procedure is non-invasive and painless.

Clinical studies such as LIGHTSITE I and IIhave shown encouraging results:

• Significant improvement of visual function.
• Good safety profile, no serious side effects.
• Reduction of biomarkers related to the progression of HEOC.

It is noted that the Valeda it is a management method, not a definitive cure for HEC and that not all patients respond the same.

The Valeda Light Delivery System offers an innovative, safe and non-invasive approach to the treatment of dry age-related macular degeneration, harnessing the power of light of different wavelengths. Although it is not a definitive cure, it offers an important opportunity to preserve and improve vision, especially when applied in the early stages of the condition.

Dealing with Liquid Form

The liquid form of AMD is more severe and can quickly lead to significant vision loss if left untreated. Fortunately, there are more effective treatments for this form.

1. Intrabulbar Anti-VEGF Injections

• The most common treatments for wet AMD
• Aim to inhibit angiogenic growth factor (VEGF), which causes abnormal blood vessels to grow
• Administered by intravitreal injections at regular intervals (eg every 4-8 weeks).

2. Photodynamic Therapy (PDT)

• Combination of injectable medicine (Verteporfin) with a special laser.
• The drug is activated by the laser and destroys the abnormal blood vessels without harming the surrounding tissue. It is rarely used due to the low success rate.

“Proper treatment and monitoring are critical to preserving vision in age-related macular degeneration. Early diagnosis and cooperation with a specialized ophthalmologist is the first step in protecting your vision,” concludes Mr. Papadopoulos.

*The 1st Ophthalmology Clinic of the Metropolitan Hospital has all the means and the specialized scientific staff for the correct diagnosis, monitoring and treatment of age-related macular degeneration with the new Photostimulation method (PBM) and all modern types of anti-VEGF injections.