Abstract

THE NEW PERCEPTION THAT AGE-RELATED MACULAR DEGENERATION MAY BE A VASCULAR DISEASE OPENS UP THERAPEUTICAL/PREVENTIVE THERAPEUTCICAL VISTAS FULL OF PROMISE: Part II

Dr. Tamás Fischer , M. D

ABSTRACT

Regarding the treatment, preventiv therapy of AMD, the foregoing performed human studies in the AMD field reflect a "local/ophthalmic" and non-systhematic/holistic view: one should make an alteration in this usual/habitual orthodox approach/attitude(!): (I) Non-medicinal therapy: (1) Lifestyle modifications: smoking cessation; reduction of body weight; psysical activity; d i e t (appropriate dose of flavonoids, polyphenols, respectively, curcumin;omega-3 long-chain polyunsaturated fatty acids: docosahexaenoic acid, eicosapentaenoic acid; carotenoids (lutein and zeaxanthin); management of dietary glycemic index; caloric restriction; elimination of stressful lifestyle; elimination of chronic stress. We have to prefer non-pharmacological actions (against the disadvantageous lifestyle/habits).- (II) Medicinal prevention/preventive treatment of AMD: Medicines described below - RAAS-inhibiting angiotensin converting enzyme ihibitors and angiotensinreceptor blockers; direct renin inhibitors; statins; acetylsalicylic acid; trimetazidin; third generation beta blockers; PPARgamma agonist; folate; vitamin D; melatonin; AGE crosslink breakers alagebrium; ET receptor antagonist bosentan; coenzyme Q10; „causal” antioxidant vitamins”; N-acetyl-cysteine; resveratrol; L-arginine; 5-HT(1A) receptor agonists 8-Oh DPAT; tumor necrosis factor alfa blockers; specific inhibitor of AP of complement; adiponectin peptide I; EPA/AHA; doxycyclin - all have beneficial effects in ED. Restoration of ED can restabilize the condition of chronic vascular disease including age-related macular degeneration as well. (III) Completely to eliminate risk factors of CV/AMD disease.- The human vascular system is consubstantial, non-medicinal methods should be aplied, and the mentioned medicines should be given to patients: who have no macular degeneration, but have risk factors of AMDinducing ED, and are older than 50 years; patients who have been diagnosed with unilateral AMD, in order to prevent the damage of the contralateral eye; and finally patients with bilateral AMD, in order to avert deterioration and in the hope of a potential improvement.- (IV) Performance of randomised, prospective, clinical trials is necessary.

Keywords: age-related macular degeneration, endothelial dysfunction, oxidative stress, risk factors, primary and secondary prevention.