The Impact of Inflammation in the Development of Age-Related Macular Degeneration
Recent research has shed light on the critical role of inflammation and autoimmune mechanisms in the development and progression of Age-Related Macular Degeneration (AMD), the leading cause of visual impairment in people over 60.
Chronic low-grade inflammation, oxidative stress, and immune dysregulation contribute to AMD pathogenesis. In particular, molecular changes in the retinal environment and immune signalling pathways are of interest.
The accumulation of drusen, a deposit under the retina, contains inflammatory components, and local inflammation impairs retinal pigment epithelium (RPE) function, contributing to photoreceptor loss. Altered biochemical and structural changes promote oxidative stress and chronic inflammatory responses in the retinal environment.
Systemic inflammatory biomarkers, such as serum C-reactive protein (CRP), show dynamic changes during AMD progression. In early stages, CRP levels may be low, rising in intermediate stages, and potentially declining in advanced stages due to age-related systemic changes and medication effects. Higher CRP levels in intermediate AMD correlate with progression risk, reflecting systemic inflammation's role in disease advance.
Immune signalling and toll-like receptors (TLRs) are also of interest. Dysregulation of TLR pathways, crucial components of innate immunity, influences inflammation in AMD. Recent studies highlight their targeting as a potential therapeutic avenue to modulate harmful inflammatory signalling in age-related eye diseases.
While AMD is not classically an autoimmune disease, the immune dysregulation evident—including complement system activation and altered immune cell function—shares characteristics with autoimmune disorders. This suggests immune-mediated mechanisms contribute to retinal damage progression.
AMD shares pathogenic features with other inflammatory/degenerative conditions such as osteoporosis, underscoring the systemic nature of oxidative stress and inflammation in aging-related diseases.
Researchers are examining the role of inflammation and autoimmune disorders in AMD's development and progression. Factors such as a family history, smoking, and certain health conditions like diabetes and high blood pressure may increase the risk of developing AMD.
People can reduce their risk by quitting smoking, maintaining a healthy diet that emphasizes green leafy vegetables, brightly-colored fruits and vegetables, and fatty fish, and by treating and managing other health conditions, such as high blood pressure and cholesterol levels.
Regular exercise can also help reduce the risk of AMD. A comprehensive dilated eye exam can help identify signs of AMD, and the National Eye Institute recommends that Black people ages 40 or older, people with a family history of glaucoma, and individuals ages 60 or older get a comprehensive dilated eye exam.
In summary, inflammation and immune dysregulation—including elements reminiscent of autoimmune responses—play a central role in AMD's pathophysiology, affecting disease onset and progression. Ongoing research focuses on epigenetic regulation, immune receptor signalling (like TLRs), and systemic inflammatory biomarkers to improve early detection and guide personalized anti-inflammatory treatment strategies.
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