Medical therapy of AMD

Medical therapy is the first approach to AMD, especially in the early stages of the dry form. It is based on taking supplements containing substances with an antioxidant, anti-inflammatory and neuroprotective action capable of:
- prevent the occurrence of the disease
- slow down its progression towards advanced forms
- reduce tissue damage
- enhancing the action of anti-VEGF drugs.
Continuous exposure to oxygen free radicals (ROS) damages the EPR and promotes the appearance of the initial changes responsible for AMD, so the use of substances capable of counteracting oxidative stress-induced damage can improve retinal health in patients with maculopathy.
The main study on the subject, theAREDS I (2001), showed that the 5-year risk of progression to advanced AMD could be reduced by supplementation with antioxidants (17%), zinc (21%) or zinc combined with antioxidants (25%) in patients belonging to categories 3 and 4. Since then, the formulation used in the study has entered normal clinical practice and is still the 'standard of care' in the United States in patients belonging to the categories at risk of developing advanced AMD. From the outset, however, researchers have recommended caution in the use of beta-carotene in smoking patients because of the possible risk of an increased risk of lung cancer.
The next AREDS II examined the effect of high doses of carotenoids (Lutein/Zeaxanthin) and long-chain poly-unsaturated fatty acids (DHAdocosahexaenoic acid and EPA(eicosapentaenoic acid) on the progression of AMD. In particular, ?-3, called 'essential' fatty acids because they cannot be synthesised by the body, but only taken in with the diet, experimental data show them to have multiple protective actions on the retinal tissue by exerting an anti-inflammatory action, inhibiting neoangiogenesis, counteracting apoptosis and exerting a neuroprotective effect in case of ischaemic damage.
The Italian study CARMIS (Carotenoids in Age-related Maculopathy Italian Study) (2012) went on to show that the use of carotenoids (Lutein, Zeaxanthin and Astaxanthin) in combination with antioxidant treatment not only reduces the likelihood of progression to advanced forms of AMD, but is also able to improve visual function.
Other micronutrients that may be useful in preventing the progression of AMD include: Folic acid, Vitamin B6, Vitamin B12, Lycopene and Coenzyme Q10.