Degeneración macular relacionada con la edad
La degeneración macular relacionada con la edad, o AMD, es la causa principal de ceguera en personas de 55 años y mayores en países desarrollados. La condición puede conllevar a una pérdida significativa de la visión central.
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Sobre la enfermedad
La degeneración macular relacionada con la edad, comúnmente llamada AMD, es una enfermedad retiniana degenerativa que causa una pérdida progresiva de la visión central. AMD es la causa más común de ceguera en individuos mayores de 55 años en los países desarrollados. Más de 10 millones de personas en Estados Unidos tienen AMD.
La retina está cargada de fotorreceptores, las células que nos permiten ver. Los fotorreceptores convierten la luz en impulsos eléctricos, que son transferidos al cerebro a través del nervio óptico y convertidos en las imágenes que vemos. La mácula es una pequeña región en el centro de la retina que es rica en conos, los fotorreceptores que permiten a una persona percibir detalles finos (por ejemplo, leer o reconocer rostros), colores, y objetos durante el día o en condiciones con buena iluminación. La pérdida de la visión central con AMD ocurre cuando los fotorreceptores conos en la mácula se degeneran.
Los factores de riesgo más importantes de la AMD son el envejecimiento y fumar. Una dieta insalubre y la exposición sin protección a la luz solar también pueden incrementar el riesgo de contraer AMD. La genética también es un factor de riesgo.
Las personas con AMD pueden advertir primero borrosidad en su visión central, especialmente durante tareas como leer o tejer. Además, las líneas rectas pueden verse distorsionadas o torcidas. A medida que la enfermedad progresa, pueden formarse puntos ciegos dentro del campo central de la visión. En la mayoría de los casos, si un ojo tiene AMD, el otro ojo tiene la condición o está en riesgo de desarrollarla. La pérdida del alcance de la visión central varía, y puede depender del tipo de AMD: seca o húmeda.
La mayoría de las personas con AMD comienzan con la variante seca. En muchos casos, las personas no experimentarán pérdida de visión con esta condición. En algunos casos, la AMD seca puede progresar y causar diferentes grados de pérdida de la visión central. La AMD seca avanzada a veces es denominada atrofia geográfica.
El sello distintivo de la AMD seca es la acumulación de minúsculas proteínas y depósitos de grasa conocidos como drusas, debajo de la retina. Muchas personas tienen drusas, lo que no afecta su visión. Sin embargo, ciertos tipos de drusas pueden interferir en la salud de la mácula, causando una degeneración progresiva de las células fotorreceptoras y pérdida de visión.
Alrededor de un 10 a 15% de las personas con AMD seca desarrollará la variante húmeda en uno o ambos ojos. Con la AMD húmeda, crecen vasos sanguíneos anormales por debajo de la mácula. Estos vasos derraman sangre y fluido dentro de la mácula y dañan a las células fotorreceptoras. La AMD húmeda a menudo progresa rápidamente y causa una pérdida sustancial de la visión central si no es tratada.
Los investigadores han descubierto que la genética puede tener un papel en el riesgo a contraer AMD. En 2005, tres grupos de investigadores, incluido un equipo armado por la Fundación, descubrieron que un gen llamado Complement Factor H (CFH) está vinculado con al menos un 50% de todos los casos de AMD. Desde ese descubrimiento, los investigadores han encontrado muchos otros genes vinculados a la AMD. CFH y muchos otros genes de la AMD están involucrados en el sistema inmune innato, el cual lucha contra la infección. Los científicos creen que la sobreactividad del sistema inmune innato incrementa el riesgo de AMD.
Mientras que la genética puede tener un papel en el riesgo de AMD, las personas con genética de bajo riesgo pueden obtener de igual manera la enfermedad. Asimismo, las personas con genética de alto riesgo podrían no contraer AMD.
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El Estudio de Enfermedades del Ojo Relacionadas con la Edad (AREDS), una investigación fundamental llevada a cabo por el National Eye Institute (NEI), determinó que un suplemento específico de antioxidantes puede retrasar el progreso de la AMD. La formulación del AREDS2 es un suplemento de antioxidantes de venta libre recomendado para personas que estén en riesgo de desarrollar formas más avanzadas de AMD seca o húmeda.
La formulación de AREDS2 contiene los siguientes nutrientes:
500 miligramos (mg) de vitamina C
400 unidades internacionales de vitamina E
80 mg de zinc como óxido de zinc
2 mg de cobre como óxido cúprico
10 mg de luteína y 2 mg de zeaxantina
Hay ahora disponibles muchas terapias para la forma húmeda de la AMD. La mayoría involucran inyecciones oculares regulares para detener el crecimiento de vasos sanguíneos chorreantes que roban la visión.
EYLEA™ (alflibercept): El tratamiento de AMD húmedo de Regeneron, Eylea, bloquea el desarrollo de vasos sanguíneos no sanos debajo de la retina. Regeneron indica que en pruebas clínicas, Eylea trató la AMD húmeda tan efectivamente como Lucentis, pero con menos inyecciones intraoculares. Típicamente, los pacientes son tratados mensualmente con Eylea por tres meses y cada otro mes a partir de ahí. Eylea fue aprobada por la FDA en 2011.
Lucentis™ (ranibizumab): Desarrollado por Genentech, Lucentis es efectivo para reducir el riesgo de pérdida de visión debido al crecimiento anormal de vasos sanguíneos asociados con la AMD húmeda bajo la retina. El tratamiento fue aprobado por la FDA y está disponible desde 2006. Un estudio de dos años mostró que el 95% de las personas con AMD húmeda que recibió inyecciones mensuales de Lucentis no experimentó una pérdida significativa en su agudeza visual como el punto de partida. Genentech también informó una mejora visual moderada en un 24,8% de los participantes tratados con una dosis de 0,3 mg de Lucentis y un 33,8% de los participantes tratados con una dosis de 0,5 mg.
Una droga para cáncer colorrectal llamada Avastin®, una droga similar a Lucentis, ha sido utilizada “off-label” por algunos oftalmólogos para tratar la AMD húmeda. El NEI completó un estudio clínico de gran escala en dos años que compara Avastin y Lucentis. Los resultados del estudio mostraron que las drogas eran similares en seguridad y eficacia.
Pruebas de investigación y clínicas
Vea una lista de ensayos clínicos actuales, muchos posibles gracias al apoyo de la Fundación.
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May 7, 2013
Retinal Regeneration is Major Focus of NEI's Audacious Goal
The goal, “to regenerate the neurons and neural connections in the eye and visual system,” is exactly what people with retinal diseases need to save and restore their vision.
Apr 30, 2013
Researcher Revolutionized Fight Against Blindness and Cancer
A profile on Dr. Robert Langer, a medical researcher who has received dozens of awards, accolades and honorary degrees, including, recently, FFB’s Visionary Award.
Apr 17, 2013
A New Therapeutic Trick for Old Dogs
Mar 8, 2013
Staying Alive: Saving Retinal Cells to Preserve Vision
Sometimes, saving vision simply comes down to keeping retinal cells alive, or at least slowing their degeneration.
Feb 18, 2013
History in the Making
More good news about treatments and technological advances for restoring vision for people with retinal diseases.
Jan 15, 2013
Why Face Recognition Can Be Difficult with Central Vision Loss
Diseases such as age-related macular degeneration, cone-rod dystrophy and Stargardt disease cause scotomas, or blind spots, which often have devastating effects on central vision. They cause gaps in a person’s visual field, making it difficult to see words in a book, images on a computer monitor or TV and the features of someone’s face.
Jul 27, 2012
Tempering the Immune System to Save Vision
Great progress is being made in identifying targets for therapies, including using the body’s own protective systems to keep the photoreceptors alive.
Jul 17, 2012
Tiny Implantable Telescope Can Restore Some Central Vision in AMD
Known as the implantable miniature telescope (IMT), the device is surgically placed in the eye, where it focuses images onto the area of the patient’s retina that is still functional.
Jun 19, 2012
Have I Got a Cure for You! Debunking an Alleged Treatment on the Internet
How do you know if a treatment is legit? There should be preclinical and clinical trial data published in a peer-reviewed journal on research for the treatment.
Feb 7, 2022
Racing for AMD
Sean was diagnosed with dry age-related macular degeneration (AMD) in his 40s. Now Sean is using his AMD as an opportunity to educate others about the entire spectrum of blinding diseases while fundraising for the Foundation Fighting Blindness.
Nov 22, 2021
Racing for a Reason
Sean Teare has completed a marathon and a triathlon as DIY fundraisers for the Foundation Fighting Blindness.
Dec 3, 2020
Janssen Acquires Rights to Novel Gene Therapy, Pioneering Treatment Solutions for Late-Stage Age-Related Macular Degeneration
Acquisition significantly expands Janssen’s eye disease portfolio and strengthens its gene therapy capabilities. Late-stage AMD affects millions of people with no effective treatments currently available .
Feb 5, 2020
Al Linde “Keeps on Rolling” with Macular Degeneration
Al Linde has learned to “just roll with it” throughout his life to overcome many challenges.