What is macular degeneration?

Macular degeneration, also known as age-related macular degeneration (AMD), is a progressive eye condition that affects the macula, the central part of the retina responsible for sharp, central vision. The macula is essential for tasks such as reading, driving, and recognizing faces.


There are two main types of macular degeneration:


  • Dry AMD (Non-neovascular AMD): Dry AMD is the more common form of macular degeneration, accounting for about 85-90% of cases. It occurs when the cells in the macula gradually break down and the tissue of the macula thins and deteriorates over time. Drusen, which are small yellow deposits that form under the retina, are often observed in dry AMD. Dry AMD typically progresses slowly and may cause gradual central vision loss.


  • Wet AMD (Neovascular AMD): Wet AMD is less common but more severe than dry AMD. It occurs when abnormal blood vessels grow beneath the retina and leak fluid or blood into the macula. This leakage can lead to rapid and severe central vision loss. Wet AMD can develop suddenly and progress rapidly, causing significant vision impairment if left untreated.


What is the relationship between macular degeneration and oxidative stress?

The relationship between macular degeneration (MD) and oxidative stress is a significant area of research, and evidence suggests that oxidative stress plays a crucial role in the development and progression of this condition. Oxidative stress refers to an imbalance between the production of reactive oxygen species (ROS) and the body’s antioxidant defenses, leading to damage to cellular components such as lipids, proteins, and DNA. Here’s how oxidative stress is thought to contribute to macular degeneration:


  • Retinal Damage: The retina, and specifically the macula, is highly susceptible to oxidative damage due to its exposure to light and high metabolic activity. The retina contains a high concentration of polyunsaturated fatty acids, which are vulnerable to oxidation by ROS. Oxidative damage to retinal cells, including photoreceptors and retinal pigment epithelial (RPE) cells, can disrupt normal cellular function and contribute to the development of macular degeneration.


  • Drusen Formation: Drusen are small yellow deposits that accumulate under the retina in individuals with macular degeneration, particularly in the dry form of the disease. Drusen contain lipids, proteins, and cellular debris, and their formation is thought to be driven by oxidative stress and inflammation. ROS-induced damage to RPE cells and impaired clearance of cellular debris may contribute to the formation of drusen, which can further exacerbate oxidative stress and inflammation in the retina.


  • Inflammatory Response: Oxidative stress can trigger an inflammatory response in the retina, characterized by the release of pro-inflammatory cytokines, chemokines, and adhesion molecules. Chronic inflammation in the retina can further promote oxidative damage and contribute to the progression of macular degeneration. Inflammatory cells, such as macrophages and microglia, can produce ROS as part of their antimicrobial defense mechanisms, leading to tissue damage and exacerbating oxidative stress.


  • Choroidal Neovascularization: In wet macular degeneration, abnormal blood vessels grow beneath the retina and leak fluid or blood into the macula, leading to rapid and severe vision loss. Oxidative stress has been implicated in the pathogenesis of choroidal neovascularization, with ROS playing a role in promoting angiogenesis (blood vessel growth) and vascular permeability. ROS-induced endothelial dysfunction and activation of angiogenic signaling pathways may contribute to the development of abnormal blood vessels in the retina.


  • Antioxidant Defenses: Antioxidant defenses in the retina, including enzymatic antioxidants such as superoxide dismutase (SOD), catalase, and glutathione peroxidase, as well as non-enzymatic antioxidants such as vitamin C, vitamin E, and carotenoids, play a crucial role in protecting against oxidative damage. However, with aging and disease, antioxidant defenses may become overwhelmed by ROS production, leading to oxidative stress and cellular damage in the retina.


Overall, oxidative stress is believed to be a key factor in the pathogenesis of macular degeneration, contributing to retinal damage, drusen formation, inflammation, and choroidal neovascularization.