The non-mydriatic camera as a screening method in diabetics in Tarragona

ObjectiveThe aim of the study is to present the results of the first year of using a non-mydriatic fundus camera. We performed an evaluation of its usefulness and problems.MethodsDuring the first year of using the non-mydriatic fundus camera we evaluated 3,272 type II diabetic patients who were not being controlled in the hospital.ResultsThe diabetic retinopathy was observed in 164 patients (5.01%), the mild form in 70 patients (2.14%). Diabetic macular oedema was observed in 41 patients (1.25%). In 119 patients (3.63%) the retinography could not be interpreted and were referred to the hospital; 113 patients also were referred due to other pathologies; the largest group of these patients had age-related macular disease or age-related macular degeneration (42 patients). Finally, 458 patients (13.99%) required mydriatic eye-drops.ConclusionsThe non-mydriatic fundus camera is a useful technique for assessing the presence of diabetic retinopathy, particularly in patients with poor ophthalmic control. This technique may enable us to diagnose these patients who need laser treatment.     

老年黄斑变性的治疗研究进展

老年黄斑变性是一种严重威胁老年人视功能的眼底疾病,针对其危险因素、早期诊断及治疗,国内外展开了大量的研究。本文将总结近年来国内外对老年黄斑变性的新的治疗手段和方法。     

CX3CL1-CX3CR1与年龄相关性黄斑变性发病机制的研究进展

年龄相关性黄斑变性（age-related macular degeneration，AMD）是临床老年人常见的致盲性眼病，病因复杂，可造成不可逆的视力损伤。CX3CL1-CX3CR1是一组趋化因子及其特异性受体，通过对机体免疫系统的调控参与全身各项生理功能及病理变化。近年来文献报道CX3CL1及其受体CX3CR1与AMD的发病密切相关，在AMD发病过程中的免疫调节及炎症反应、新生血管生成过程及光损害与氧化应激反应等关键环节起到了调节作用，CX3CR1基因的两个单核苷酸多态性可能导致AMD易感性增加。本文将趋化因子CX3CL1及受体CX3CR1的结构、功能及其在AMD发生、发展中的作用机制研究进行综述，为今后研究及治疗AMD提供新的思路及方向。     

Evaluación de signos tomográficos no exudativos en casos de degeneración macular asociada a la edad de tipo exudativo

ObjectiveTo analyze the prevalence of non-exudative tomographic signs (onion sign, pseudoswelling, external retinal tubulation, pseudocysts, subretinal clefts and macular atrophy) in patients with neovascular age-related macular degeneration.Material and methodsA total of 174 eyes of patients with neovascular age-related macular degeneration who had not received previous treatment were included in the study. Visual acuity, neovascularization activity, and the appearance or not of the different signs under study were assessed at times 0 (initial visit), 4 months, one year, year and a half, and at 2 and 3 years of follow-up. The following were also evaluated: age, sex, affected eye and type of neovascularization (1, 2, 3, polypoid or mixed). The analysis were performed using the statistical software R (version 3.3.2) and the glmmADMB package (version 0.8.3.3).ResultsThe presence of pseudocysts and external retinal tubulation increases throughout the follow-up. The onion sign begins with an ascending frequency up to 12 months, then decreases at 18 months and increases again at 24 months. Regarding pseudowelling, it maintains an increase until 18 months to finally decrease. Subretinal clefts is the rarest sign, presenting in 1.1% on the first visit. Finally, macular atrophy, present in 12.6% of the eyes initially, is found in 25% after 2 years.ConclusionPseudocysts, external retinal tubulation and macular atrophy were the most prevalent signs, while subretinal clefts were the most infrequent.     

HMG CoA reductase inhibitors (statins): do they have a role in age-related macular degeneration?

Age-related macular degeneration is a progressive late onset disease affecting central vision. It is the leading cause of irreversible blindness in developed countries, and with the aging population the problem is increasing. Current treatment options are limited to the late stage of the disease when central vision is already under great threat, and even new treatments make little impact on the rate of blindness. Intervention earlier in the disease may prove more rewarding, but to date little progress has been made with this approach. Epidemiologic, genetic, and pathological evidence continues to accumulate, suggesting a possible link between risk factors for cardiovascular diseases and age-related macular degeneration. This article reviews the evidence and discusses the rationale behind the recent suggestions that cholesterol-lowering agents may be useful in the treatment of early age-related macular degeneration. The cholesterol-lowering family of drugs called statins are 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) inhibitors with pleiotropic actions. Their therapeutic effects in cardiovascular disease and dyslipidaemia have been well proven. In this review we will outline the known actions of statins and discuss possible ways that they may impact on age-related macular degeneration.     

Association analysis of genetic polymorphisms and expression levels of selected genes involved in extracellular matrix turnover and angiogenesis with the risk of age-related macular degeneration

ABSTRACT

Background: Age-related macular degeneration is a progressive eye disease affecting the macula and causing acute visual loss particularly in elder people. The aim of the study was an attempt to discern an influence of expression levels and functional genetic polymorphisms of selected genes related to the extracellular matrix turnover or neovascularization on age-related macular degeneration occurrence and progression.

Methods: We conducted a case-control study of 200 polish patients with recognized age-related macular degeneration (dry and wet) and compared the results with those obtained from matched 100 healthy control subjects. TaqMan Genotyping Assays were employed to examine the following single nucleotide polymorphisms: matrix metalloproteinase (MMP)-2 ?735C/T, MMP-7 ?181A/G, MMP-9 ?1702T/A, and ?1562C/T; tissue inhibitors of metalloproteinase (TIMP)-2 ?418G/C; vascular endothelial growth factor (VEGF) +405 G/C and +936 C/T, VEGFR-2 +1719 T/A and ?271 G/A. Real-time polymerase chain reaction was assessed to determine the mRNA quantity. Serum levels of proteins were measured using enzyme-linked immunosorbent assay.

Results: The single nucleotide polymorphism genotyping showed that TT genotype for MMP-9 ?1702T/A and CC genotype for VEGF +936C/T increase markedly the risk of age-related macular degeneration but do not influence on its progression. Additionally, the possible protective effect of CC genetic variant in MMP-9 ?1562C/T polymorphism against progression of age-related macular degeneration was observed. We also found significant differences in systemic expression levels of MMP-2, -7, -9, TIMP-2, vascular endothelial growth factor, VEGFR-2, and pigment epithelium-derived factor between studied group. The research demonstrated evident differences in serum levels of MMP-2, -7, -9, TIMP-2, vascular endothelial growth factor, and pigment epithelium-derived factor between wet and dry age-related macular degeneration patients.

Conclusions: We can conclude that disturbances in angiogenic homeostasis and processes of extracellular matrix turnover occurring in age-related macular degeneration-affected ocular tissues may be reflected in changes in systemic expression levels of the investigated genes.     

Pharmacogenetics of the Treatment Response of Age-Related Macular Degeneration with Ranibizumab and Bevacizumab

Abstract

Introduction: Age-related macular degeneration is a major cause of blindness among people aged 50 and older in industrialized countries. Anti-VEGF therapy has been tremendously successful in the treatment of neovascular macular degeneration. Examining the pharmacogenetics of patients’ response to the anti-VEGF molecules could allow for a tailored treatment strategy based on patients’ underlying genetics rather than the “one-size fits all” approach currently used. Methods: Review of the English literature for papers examining the pharmacogenetics of treatment response of neovascular macular degeneration to either ranibizumab or bevacizumab. Polymorphisms in CFH, ARMS2, HTRA1 and VEGF A were examined and reviewed. Results: Patients with the high-risk CC genotype in complement factor H (CFH) had a worse response to therapy with ranibizumab and bevacizumab. No clear trends were found with ARMS2, HTRA1 and VEGF A. Conclusions: The goal of personalized medicine is to craft a treatment program that is ideally suited to an individual patient’s disease and genetic make-up rather than simply what works for a large population who share similar disease characteristics. Continued research is needed to achieve this goal for the treatment of age-related macular degeneration.     

Treatment of neovascular age-related macular degeneration: past, present and future directions

PURPOSE OF REVIEW: The treatment options of choroidal neovascularization due to age-related macular degeneration have expanded. Prior to ocular photodynamic therapy the only available treatment was laser photocoagulation. Clinicians and patients were not particularly enthusiastic despite its ability to stabilize vision. The purpose of the review is to review the past and current concepts of neovascular age-related macular degeneration therapy and to provide a short overview of upcoming treatments. RECENT FINDINGS: Photodynamic therapy provided us with the first realistic means to address subfoveal choroidal neovascularization lesions from age-related macular degeneration. Antivascular endothelial growth factors now allow better visual outcomes than mere stabilization of vision and other promising treatments are undergoing study at this time. SUMMARY: Age-related macular degeneration therapy has undergone a significant revolution in recent years. Understanding the historical perspective of treatment provides a better appreciation of current therapies. Still there is no cure for this disease and more promising treatments are currently under investigation.     

Automated detection of age-related macular degeneration in color fundus photography: a systematic review

The rising prevalence of age-related eye diseases, particularly age-related macular degeneration, places an ever-increasing burden on health care providers. As new treatments emerge, it is necessary to develop methods for reliably assessing patients' disease status and stratifying risk of progression. The presence of drusen in the retina represents a key early feature in which size, number, and morphology are thought to correlate significantly with the risk of progression to sight-threatening age-related macular degeneration. Manual labeling of drusen on color fundus photographs by a human is labor intensive and is where automatic computerized detection would appreciably aid patient care. We review and evaluate current artificial intelligence methods and developments for the automated detection of drusen in the context of age-related macular degeneration.     

The burden of age-related macular degeneration: a value-based analysis

PURPOSE OF REVIEW: The quality-of-life loss and the financial consequences associated with age-related macular degeneration are assessed. RECENT FINDINGS: The quality-of-life loss associated with macular degeneration is markedly underestimated by the general public, nonophthalmic physicians, and ophthalmologists who treat patients with this condition. Mild age-related macular degeneration causes a 17% decrement in the quality of life of the average patient, similar to that encountered with moderate cardiac angina or symptomatic human immunodeficiency virus syndrome. Moderate age-related macular degeneration causes a 40% decrease in the average patient's quality of life, similar to that associated with severe cardiac angina or renal dialysis. Very severe age-related macular degeneration causes a large 63% decrease in the average patient's quality of life, similar to that encountered with end-stage prostatic cancer or a catastrophic stroke that leaves a person bedridden, incontinent and requiring constant nursing care. The return on investment is high for both treatment with current age-related macular degeneration therapies and the research costs invested in the development of age-related macular degeneration treatment modalities. SUMMARY: Age-related macular degeneration is a major public health problem that has a devastating effect upon patients and marked adverse financial consequences for the economy.