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Aldersrelatert makuladegenerasjon

Sist oppdatert: Sist revidert:
Sist revidert av:
Definisjon: 
Degenerasjon av pigmentepitelceller og fotoreseptorer i makulaområdet på retina. Aldersbetinget makulopati, genetiske faktorer, oksidativt stress og UV-lys disponerer for tilstanden
Forekomst: 
Prevalensen øker ved økende alder. Ca. 1% av befolkningen over 40 år har sent stadium/alvorlig MD
Symptomer: 
Smertefri og gradvis utvikling av synstap. Ofte med forvrengning av synsinntrykkene, lesevansker, skarpsynsvansker - i sen fase et sentralt skotom
Funn: 
Ved oftalmoskopi ses initialt små hvite flekker ved fovea (druser), senere pigmentforandringer, ev. blødninger og ødem
Diagnostikk:
Utredning hos spesialist omfatter angiografi med kontrast og OCT - (Optical Coherence Tomography)
Behandling:
Ingen behandling ved tørr type, anti-vekstfaktor injeksjoner ved våt type
  1. Mitchell P, Liew G, Gopinath B, Wong TY. Age-related macular degeneration. Lancet. 2018 Sep 29;392(10153):1147-1159. PMID: 30303083. PubMed  
  2. Bourne RR, Jonas JB, Flaxman, et al. Prevalence and causes of vision loss in high-income countries and in Eastern and Central Europe: 1990-2010. Br J Ophtalmol 2014. pmid:24665132 PubMed  
  3. Bunce C, Wormald R. Causes of blind certifiications in England and Wales: April 1999-March 2000. Eye 2008; 22: 905-11. PubMed  
  4. Buschini E, Piras A, Nuzzi R, Vercelli A. Age related macular degeneration and drusen: neuroinflammation in the retina. Prog Neurobiol 2011;95:14–25.
  5. Rein DB, Wittenborn JS, Burke-Conte Z, et al. Prevalence of Age-Related Macular Degeneration in the US in 2019. JAMA Ophtalmol 2022. pmid:36326752 PubMed  
  6. Berg K, Jørstad ØK. Aldersrelatert makuladegenerasjon (AMD). Nasjonal kvalitetshåndbok for oftalmologi. Vedtatt 2016. www.helsebiblioteket.no  
  7. Ennis A, Jomary C, Mullins R, et al. Association between the SERPING1 gene and age-related macular degeneration: a two-stage case-control study. Lancet 2008; 372: 1828-34. PubMed  
  8. Haddad A, Chen CA, Santangelo SL, Seddon JM. The genetics of age-related macular degeneration: a review of prgress to date. Surv Ophtalmol 2006; 51: 316-63. PubMed  
  9. Augood CA, Vingerling JR, deJong PTVM, et al. Prevalence of age-related maculopathy in older europeans - The European Eye Study (EUREYE). Arch Ophtalmol 2006; 124: 529-35. PMID: 16606879 PubMed  
  10. Tan JS, Wang JJ, Liew G, et al. Age-related macular degeneration and mortality from cardiovascular disease or stroke. Br J Ophthalmol 2008; 92:509-12. PMID: 18310310 PubMed  
  11. Lawrenson JG, Evans JR. Omega 3 fatty acids for preventing or slowing the progression of age-related macular degeneration. Cochrane Database of Systematic Reviews 2015, Issue 4. Art. No.: CD010015. DOI: 10.1002/14651858.CD010015.pub3 DOI  
  12. Lambert NG, ElShelmani H, Singh MK, et al. Risk factors and biomarkers of age-related macular degeneration. Prog Retin Eye Res. 2016;54:64-102. PMID: 27156982. PubMed  
  13. Fletcher AE, Bentham GC, Agnew M, et al. Sunlight exposure, antioxidants, and age-related macular degeneration. Arch Opthalmol 2008; 126: 1396-403. PubMed  
  14. Solomon SD, Lindsley K, Vedula SS, et al. Anti-vascular endothelial growth factor for neovascular age-related macular degeneration. Cochrane Database Syst Rev. 2014 ;8:CD005139. DOI: 10.1002/14651858.CD005139.pub3 DOI  
  15. Régnier S, Malcolm W, Allen F, et al. Efficacy of anti-VEGF and laser photocoagulation in the treatment of visual impairment due to diabetic macular edema: a systematic review and network meta-analysis. PLoS One. 2014 Jul 16;9:e102309. doi: 10.1371/journal.pone.0102309 DOI  
  16. Thulliez M. Angoulvant D, Pisella P, Bejan-Angoulvant T. Overview of Systematic Reviews and Meta-analyses on Systemic Adverse Events Associated With Intravitreal Anti-Vascular Endothelial Growth Factor Medication Use. JAMA Ophtalmol 2018. pmid:29566105 PubMed  
  17. Martin DF, Maguire MG, Ying G, for the CATT research group. Ranabizumab and bevacizumab for neo-vascular age-related macular degeneration. N Engl J Med 2011; : e-pub.
  18. FDA News Release. FDA approves Eylea for eye disorders in older people. FDA news release, nov. 2011.
  19. Yannuzzi NA, Freund KB. Brolucizumab: evidence to date in the treatment of neovascular age-related macular degeneration. Clin Ophthalmol. 2019; 13: 1323–1329. www.ncbi.nlm.nih.gov  
  20. Heier JS, Khanani AM, Ruiz CQ, et al. Efficacy, durability, and safety of intravitreal faricimab up to every 16 weeks for neovascular age-related macular degeneration (TENAYA and LUCERNE): two randomised, double-masked, phase 3, non-inferiority trials. Lancet 2022. PMID: 35085502 PubMed  
  21. Sjølie AK, Mortensen KK, Hansen MH. Antiangiogenesebehandling til alderselateret maculadegeneration. Ugeskr Læger 2005; 167: 3267. PubMed  
  22. Wormald R, Evans JR, Smeeth LL, Henshaw KS. Photodynamic therapy for neovascular age-related macular degeneration. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD002030. The Cochrane Library  
  23. Virgili G, Michelessi M, Parodi MB, Bacherini D, Evans JR. Laser treatment of drusen to prevent progression to advanced age-related macular degeneration. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD006537. The Cochrane Library  
  24. Gehlbach P, Li T, Hatef E. Statins for age-related macular degeneration. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD006927. The Cochrane Library  
  25. Christen WG, Glynn RJ, Chew EY, et al. Folic acid, pyridoxine, and cyancobalamin combination treatment and age-related macular degeneration in women. Arch Intern Med 2009; 169: 335-41. PubMed  
  26. Evans JR, Lawrenson JG. Antioxidant vitamin and mineral supplements for preventing age-related macular degeneration. Cochrane Database Syst Rev. 2017 Jul 30;7:CD000253. PMID: 28756617 PubMed  
  27. Bjerager J, Schneider N, Potapenko I. Diagnostic Accuracy of the Amsler Grid Test for Detecting Neovascular Age-Related Macular Degeneration A Systematic Review and Meta-analysis. JAMA Ophtalmol 2023. pmid:36795396 PubMed  
  28. Wong TY, Chakravarthy U, Klein R, et al. The natural history and prognosis of neovascular age-related macular degeneration; a systematic review of the literature and meta analysis. Ophtalmology 2008; 115: 116-26. PubMed  
  29. Macular Photocoagulation Study Group. Risk factors for choroidal neovascularisation in the second eye of patients with juxtafoveal or subfoveal choroidal neovascularisation secondary to age-related macular degeneration. Arch Ophtalmol 1997; 115: 741-7. PubMed  
  • Terje Johannessen, professor i allmennmedisin, Trondheim

Tidligere fagmedarbeidere

  • Johan H. Seland, professor emeritus, Universitetet i Bergen
  • Knut A. Holtedahl, professor i allmennmedisin, Institutt for samfunnsmedisinske fag, Universitetet i Tromsø