Age-Related Macular Degeneration
The primary cause of vision loss in older people is Age-Related Macular Degeneration (AMD), a degenerative eye disorder that predominantly affects those over 50. An in-depth explanation of AMD is intended by this extensive reference, which examines the condition's etiology, risk factors, symptoms, diagnosis, and current therapies.
Age-Related The macula, a tiny but vital portion of the retina that oversees central vision, is affected by macular degeneration, a degenerative eye condition. The macula allows humans to see minute details clearly, which is necessary for tasks like reading, driving, and facial recognition. AMD can severely impair central vision as it advances, which can have an impact on everyday activities and quality of life.
Types of Macular Degeneration Associated with Age
· About 80% of AMD cases are of the more prevalent kind, known as dry AMD. It is distinguished by the progressive degeneration of light-sensitive macula cells, resulting in the development of drusen, tiny yellow deposits beneath the retina. Dry AMD often develops slowly and can lead to progressive visual loss.
· Wet AMD: Although less frequent, wet AMD is more severe. It happens when aberrant blood vessels develop underneath the retina and burst, quickly damaging the macula with blood and fluid. Compared to dry AMD, wet AMD frequently causes a more abrupt and noticeable loss of vision.
Factors at Risk and Causes
Although the precise etiology of AMD is unknown, several variables seem to have a role in its development. Among the crucial elements are:
· Aging: Being older is the main risk factor for AMD. Growing older raises the risk of acquiring the illness, especially beyond the age of 50.
· Genetics: Having a family member with AMD increases an individual's risk. Family history also plays a part. To learn more about how certain genetic variables affect AMD development, more research is being done on them.
· Smoking: One important modifiable risk factor for AMD is smoking. It can quicken the condition's progression and double the chance of developing it.
· Nutrition and Diet: Antioxidants, vitamins (especially A, C, and E), and minerals (like zinc) are linked to a decreased risk of AMD. On the other hand, a diet heavy in saturated fats could raise the chance.
Age-Related Macular Degeneration Symptoms
AMD symptoms, particularly in the early stages, might not be obvious right away. As the illness worsens, people might encounter:
· hazy or distorted eyesight in the center
· inability to read or recognize faces.
· areas of the inner vision that are dark or vacant.
· Modifications in the way one perceives color.
Identification and Diagnosis
Frequent ocular examinations are essential for AMD early diagnosis. Eye care specialists employ a range of diagnostic instruments, such as:
The Visual Acuity Test
· Amsler Grid
A straight-line grid for at-home self-monitoring center vision.
· Exam with Dilated Eyes
It involves widening the pupils to check for AMD symptoms in the optic nerve and retina.
· OCT, or optical coherence tomography
It provides precise cross-sectional pictures of the retina, which aid in the detection of anomalies.
VEGF-Injecting Agents
Injections of medications such as aflibercept and ranibizumab are used to stop the proliferation of aberrant blood vessels in the eye in cases of wet AMD.
· Laser Therapy: Abnormal blood vessels may be destroyed with laser therapy in certain situations.
· Photodynamic therapy: This modality of treating aberrant blood vessels in the eye combines light activation with a light-sensitive medication.
· Low Vision Rehabilitation: People can make the most of their residual vision with the use of visual aids, adaptive technology, and rehabilitation services.
Preventive Measures and Lifestyle Adjustments
Although certain AMD risk factors are uncontrollable, the following lifestyle modifications can help avoid AMD:
· Give Up Smoking: Giving up smoking will greatly lower your chance of developing AMD and slow its growth.
· Frequent Exercise: Keeping an active lifestyle is linked to a decreased risk of AMD.
· Frequent Eye Exams: Frequent ocular examinations can help diagnose and treat AMD early on.
Omega-3 Fatty Acids
Recent years have seen a significant increase in interest in omega-3 fatty acids because of their potential health advantages, especially in the areas of inflammation management and cardiovascular health.
Types of Fatty Acids Omega-3
Eicosapentaenoic Acid (EPA)
· Long-chain omega-3 fatty acids like EPA are mostly present in fatty seafood like salmon and tuna.
· Research indicates that EPA is essential in lowering the risk of myocardial infarctions.
Docosahexaenoic Acid (DHA)
DHA is another important long-chain omega-3 fatty acid that is found in abundance in fish oil.
· Its involvement in anti-inflammatory reactions and benefit to cardiovascular health is supported by research.
Food-Based Sources
· Saturated Fish: Flavored with both EPA and DHA, omega-3 fatty acids may be found in abundance in salmon, tuna, mackerel, and sardines. It is advised to consume regularly for ideal heart health.
· Plant-Based Resources: Alpha-linolenic acid (ALA), a precursor to EPA and DHA, may be found in abundance in flaxseeds, chia seeds, and walnuts, among other plant-based foods. They add to total omega-3 consumption, even though they are not as powerful as marine sources.
· Supplements with Fish Oil: To make sure that these vital fatty acids are consumed in sufficient amounts, omega-3 supplements made from fish oil are frequently employed.
The recommended dosage varies according to health objectives. When it comes to lowering the risk of sudden cardiac death and overall mortality in those with established heart problems, omega-3 fatty acids are vital constituents. These fats, particularly docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are found in large quantities in fish oil and fatty seafood like tuna and salmon. Walnuts, canola oil, and flaxseed are other food sources.
In addition to their ability to prevent cardiac arrhythmias, omega-3 fatty acids have anti-inflammatory and anti-thrombotic qualities. On the other hand, omega-6 fatty acids, which are present in meat, seeds, and vegetable oils, tend to increase inflammation and blood clotting. In addition, diseases including rheumatoid arthritis, hypertension, and hyperlipidemia are treated with omega-3 fatty acids [1].
When using omega-3 fatty acids, there are no noteworthy drug interactions. The American Heart Association suggests eating fish regularly; for those without regular disease, this means consuming two servings or more each week; for people with heart problems, this means consuming fish every day. A daily dose of around 1 gram of EPA and DHA is recommended for cardioprotection.
Studies show that omega-3 fatty acids, especially EPA and DHA, alter the make-up of immune-related cells. Western diets typically produce cells that have high levels of the pro-inflammatory fatty acid arachidonic acid. On the other hand, EPA, and DHA from marine omega-3 fatty acids, such as those in fish oil, can take the role of arachidonic acid to produce a more anti-inflammatory environment.
Omega-3 fatty acids from diet contain several immune-modulating and anti-inflammatory properties that are important to diseases including stroke, myocardial infarction, atherosclerosis, and sudden death. Research demonstrates their beneficial effects on blood pressure, inflammation, platelet function, cholesterol, and triglycerides. The advantages of omega-3 fatty acids in lowering the risk of coronary heart disease and sudden cardiac death are further supported by epidemiological and clinical research.
The FDA has authorized fish oil, which is enriched in omega-3 fatty acids, to lower triglyceride levels and raise high-density lipoprotein. It has also demonstrated clinically significant antiarrhythmic qualities, most notably in lowering the risk of sudden death in myocardial infarction survivors. This emphasizes how crucial fish oil is to European post-infarction treatment plans.
Particularly in Western nations, current dietary intakes of extremely long-chain omega-3 fatty acids (EPA and DHA) are frequently deficient. Fish oil supplements and fatty fish are good sources. When integrated into the body, these fatty acids affect several physiological functions, the composition of cell membranes, the production of lipid mediators, and the expression of genes, all of which support good health and disease prevention. Increased consumption has been advised since the advantages go beyond heart health to ailments including rheumatoid arthritis [2].
Role of Omega-3 Fatty Acids in Age-Related Macular Degeneration
Based on the information supplied, the mechanism and function of omega-3 fatty acids (FA) in age-related macular degeneration (AMD) may be summed up as follows:
Antioxidant Activity as a Protective Mechanism
· The antioxidant action of long-chain n-3 (omega-3) fatty acids, which are mostly present in fish and fish oil, protects retinal cells.
· The antioxidant effect is probably due to the modification of the composition of the cell membrane, namely the substitution of arachidonic acid, which lowers the probability of lipid peroxidation.
The Beneficial Impact of DHA on Retinal Cells
· The preventive effects of docosahexaenoic acid (DHA), a kind of omega-3 fatty acid, have been investigated in the retinas of cultured Wistar rats.
· DHA supplementation to the cell culture reduced photoreceptor apoptosis and maintained mitochondrial membrane integrity in retinas subjected to the oxidative chemical paraquat.
· In retinal cultures treated with DHA, there was an increase in the expression of the anti-apoptotic Bcl-2 protein.
Possibility of Oxidative Danger with DHA Antagonists
· There were higher DHA levels in the photoreceptors of SD rats given linolenic acid, a DHA precursor.
· Due to DHA's oxidation susceptibility, these animals' retinal and retinal pigment epithelium (RPE) cells sustained more substantial damage after being exposed to light.
Preclinical and Clinical Trials of Omega-3 Fatty Acids
Preclinical Trials of Milk Thistle: Preclinical studies have explored the protective role of docosahexaenoic acid (DHA) found in fish oil on retinal cells. DHA exhibited a protective role against oxidative damage, reducing photoreceptor apoptosis and maintaining the integrity of the mitochondrial membrane in an experiment involving the retinas of cultured Wistar rats. However, because DHA is prone to oxidation, increasing DHA levels caused more substantial damage to retinal and RPE cells when exposed to light in rats given linolenic acid, a precursor to DHA [3].
The effects of omega-3 fatty acids, obtained from Eyetas® (3.7g of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA); EPA: DHA=5:1), on patients with dry age-related macular degeneration (AMD) or Stargardt disease (SD) were investigated in a multicenter, prospective, randomized, double-blind, placebo-controlled clinical trial. The research comprised 21 patients, with a mean age of 60.0 ± 2.3 years (9 females and 12 men).
Throughout the 24-week experiment, participants were given the active substance or a placebo (sunflower oil; 7 patients) orally every day. The Early Treatment Diabetic Retinopathy Study (ETDRS) letters were used to quantify best-corrected visual acuity (BCVA), with a minimum BCVA of 21 to 55 letters during the screening visit serving as the primary inclusion criterion.
The mean BCVA of the active group significantly improved throughout the study, going from 40.93 ± 9.18 at screening to 46.93 ± 9.18 after 24 weeks (p=0.003). There was no discernible rise in the placebo group. There was a statistically significant difference (p=0.002) between the active and placebo groups when comparing the mean letters obtained at 24 weeks. Trends were similar at 12 weeks.
Furthermore, the arachidonic acid (AA)/EPA ratio, as determined by gas chromatography, significantly decreased in the active group from screening (5.84 ± 1.05) to 12 weeks (1.50 ± 0.23, p=0.002) and 24 weeks (1.47 ± 0.16, p=0.002). AA/EPA did not significantly vary in the placebo group.
Subjective evaluations using a questionnaire on mood and perceived eyesight revealed similar results at 12 weeks, while the active group scored higher after 24 weeks (9.38 ± 3.35 vs. 7.28 ± 2.36 in the placebo).
The clinical experiment concludes that individuals with dry AMD and SD may benefit from oral omega-3 fatty acid supplementation (3.7g; EPA: DHA=5:1), which may improve both objective and subjective vision [4].
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