AGE- MACULAR DEGENERATION AND GLAUCOMA. EPIDEMIOLOGICAL AND CLINIC-PATHOGENETIC ASPECTS

Nowadays age-related macular degeneration (AMD) and glaucoma are the main causes of the irreversible loss of sight in the developed countries. The analysis of 5000 of out-patient records of senior patients (over 50 years) has revealed glaucoma in 30.3 %, AMD in 37.94 %, and their combination in 20.3 % cases. In AMD, the structure signs of the dry form of the disease are diagnosed in 74 % of the cases, the geographical atrophy in 12 % and the wet atrophy - in 14 %. Primary open-angle glaucoma reduces risk of the wet AMD development while the tendency of early formation of the geographical atrophy of the retina increases and the share of the patients with the wet form goes down to 7 %. The article is intended to scrutinize the main pathogenetic mechanisms of the development of the diseases. Distinctions in the quantitative and qualitative components of biomarkers of the oxidative stress, endothelial dysfunction and inflammation are analysed as predictors of the start and development of comorbid pathology. This allows to identify the risk groups and therapy prospects. The vascular theory of pathogenesis related to the reduction of the perfusion of the head of the optic nerve, retina and chorioidea defines the diagnostic importance of the layer thickness parameters of the peripapillar nervous fibers and ganglion cell in differential diagnostics of this pathology. Application of anti-VEGF to patients with AMD and glaucoma is harmless and does not significantly influence the level of intraocular pressure and intraocular blood circulation. However, it requires careful monitoring of dynamics of the visual-functional and structural changes of the retina and optic nerve, as well as timely therapy correction. A combined course of the diseases with neurodegenerative nature of lesion leads to decrease of not only visual, but also cognitive functions, significantly influences of the senior age group patients’ quality of life and their adaptation in society.

age-related macular degeneration, open-angle glaucoma, geographic atrophy

1. Нероев В.В. Инвалидность по зрению в Российской Федерации // Российский офтальмологический конгресс «Белые Ночи»: тез. докл., СПб., 28-30 мая 2017 г. Санкт-Петербург, 2017. http://glaucoma.eye-portal.ru/neroev-vv-disability-in-sight-in-russian-federation.

2. Новик А.А., Ионова Т.И. Руководство по исследованию качества жизни в медицине. 2-е изд. М.: ОЛМА Медиа групп, 2007. 320 с.

3. Статистика: Продолжительность жизни в России. https://ruxpert.ru/ Статистика: Продолжительность_жизни_в_России.

4. Coleman D.J., Silverman R.H., Rondeau M.J., Lloyd H.O., Khanifar A.A., Chan R.V. Age-related macular degeneration: choroidal ischaemia? // Br. J. Ophthalmol. 2013. 97. (8). 1020-1029.

5. Coscas G., de Benedetto U., Coscas F., Li Calzi C.I., Vismara S., Roudot-Thoraval F., Bandello F., Souied E. Hyperreflective dots: a new spectral-domain optical coherence tomography entity for follow-up and prognosis in exudative age-related macular degeneration // Ophthalmologica. 2013. 229. (1). 32-37.

6. Cuellar-Partida G., Craig J., Burdon K.P., Wang J.J., Vote B.J., Souzeau E., McAllister I.L., Isaacs T., Lake S., Mackey D.A., Constable I.J., Mitchell P., Hewitt A.W., MacGregor S. Assessment of polygenic effects links primary open-angle glaucoma and age-related macular degeneration // Sci. Rep. 2016. 6. 26885.

7. Feigl B. Age-related maculopathy - Linking aetiology and pathophysiological changes to the ischaemia hypothesis // Prog. Retin. Eye Res. 2009. 28. (1). 63-86.

8. Garner A., Sarks A., Sarks J.P. Degenerative and related disorders of the retina and choroids // Pathobiology of ocular disease, 2nd ed. / Ed. M. Dekker. N.Y., 1994. 631-674.

9. Griffith J., Goldberg J. Prevalence of comorbid retinal disease in patients with glaucoma at an academic medical center // Clin. Ophthalmol. 2015. 9. 1275-1283.

10. Harrabi H., Kergoat M.J., Rousseau J., Boisjoly H., Schmaltz H., Moghadaszadeh S., Roy-Gagnon M.H., Freeman E.E. Age-related eye disease and cognitive function // Invest. Ophthalmol. Vis. Sci. 2015. 56. (2). 1217-1221.

11. Harwerth R., Wheat J., Rangaswamy N. Age-related losses of retinal ganglion cells and axons // Invest. Ophthalmol. Vis. Sci. 2008. 49. (10). 37-44.

12. Hochberg C., Maul E., Chan E.S., Van Landingham S., Ferrucci L., Friedman D.S., Ramulu P.Y. Association of vision loss in glaucoma and age-related macular degeneration with IADL disability // Invest. Ophthalmol. Vis. Sci. 2012. 53. (6). 32-38.

13. Hu C., Ho J., Lin H., Kao L. Association between open-angle glaucoma and neovascular age-related macular degeneration: a case-control study // Eye. 2017. 31. (6). 872-877.

14. Kashiwagi K., Iizuka Y., Tanaka Y., Araie M., Suzuki Y., Tsukahara S. Molecular and cellular reactions of retinal ganglion cells and retinal glial cells under centrifugal force loading // Invest. Ophthalmol. Vis. Sci. 2004. 45. (10). 3778-3786.

15. Krueger D., Milton R., Maunder L. The Framingham eye study: Introduction to the monograph //Surv. Ophthalmol. 1980. 24. (6). 614-620.

16. Masuzzo A., Dinet V., Cavanagh C., Mascarelli F., Krantic S. Amyloidosis in retinal neurodegenerative diseases // Front. Neurol. 2016. 7. 127.

17. Medeiros N.E., Curcio C.A. Preservation of ganglion cell layer neurons in age-related macular degeneration // Invest. Ophthalmol. Vis. Sci. 2001. 42. (3). 795-803.

18. Morgan J. Optic nerve head structure in glaucoma: Astrocytes as mediators of axonal damage //Eye. 2000. 14. (3b). 437-444.

19. Prins D., Hanekamp S., Cornelissen F. Structural brain MRI studies in eye diseases: are they clinically relevant? A review of current findings // Acta Ophthalmol. 2015. 94. (2). 113-121.

20. Prokofyeva E., Zrenner E. Epidemiology of major eye diseases leading to blindness in Europe: A literature review // Ophthalmic Res. 2012. 47. (4). 171-188.

21. Remsch H., Spraul C., Lang G., Lang G. Changes of retinal capillary blood flow in age-related maculopathy // Graefe’s Arch. Clin. Exp. Ophthalmol. 2000. 238. (12). 960-964.

22. Rimayanti U., Kiuchi Y., Yamane K. et al. Inner retinal layer comparisons of eyes with exudative age-related macular degeneration and eyes with age-related macular degeneration and glaucoma // Graefe’s Arch. Clin. Exp. Ophthalmol. 2013. 252. (4). 563-570.

23. Tan O., Chopra V., Lu A.T., Schuman J.S., Ishikawa H., Wollstein G., Varma R., Huang D. Detection of macular ganglion cell loss in glaucoma by Fourier-domain optical coherence tomography // Ophthalmology. 2009. 116. (12). 2305-2314.

24. Taylor H. The global issue of vision loss and what we can do about it // Asia Pac. J. Ophthalmo.l (Phila.). 2016. 5. (2). 95-96.

25. Umfress A., Brantley M. Eye care disparities and health-related consequences in elderly patients with age-related eye disease // Semin. Ophthalmol. 2016. 31. (4). 432-438.

26. Velpandian T., Nath M., Halder N. Circulating biomarkers in glaucoma, age-related macular degeneration, and diabetic retinopathy // Indian J. Ophthalmol. 2017. 65. (3). 191-198.

27. Wong W., Su X., Li X., Cheung C.M., Klein R., Cheng C.Y., Wong T.Y. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis // Lancet Glob. Health. 2014. 2. (2). e106-e 116.

28. Zheng Y., Wu X., Lin X., Lin H. The prevalence of depression and depressive symptoms among eye disease patients: A systematic review and metaanalysis // Sci. Rep. 2017. 7. 453-464.

29. Zucchiatti I., Parodi M., Pierro L., Cicinelli M.V., Gagliardi M., Castellino N., Bandello F. Macular ganglion cell complex and retinal nerve fiber layer comparison in different stages of age-related macular degeneration // Am. J. Ophthalmol. 2015. 160. (3). 602-607