Dear Colleagues,

Age-related macular degeneration (AMD) is one of the main causes of the irreversible loss of central vision in the population over 50 years of age in developed countries. This disease is a huge social problem which came to be called an epidemic of blindness in the 21st century. It is a chronic disease with complex and multifactorial pathogenesis, and the incidence increases with age. AMD affects the central area of retina known as the macula, and it is classified as early stage to late stage (advanced AMD). Advanced AMD is classified into the atrophic form (dry AMD) and the exudative or neovascular form (wet AMD). More severe vision loss is typically associated with the wet form. It is believed that both genetic and environmental factors influence the development of AMD. The known risk factors include age, female sex, white race, family history of AMD, bright blue color of iris, cardiovascular diseases, arterial hypertension, cigarette smoking, intensive exposure to visible light and UV radiation, and dietary antioxidant deficiency.

Multiple genetic factors, lipid metabolism, oxidative stress and aging play a role in the etiology of AMD.

The population with AMD is increasing, with ethnic and regional differences. From 1990 to 2010, the incidence of blindness and visual impairment caused by AMD was increased. With population aging worldwide, it is estimated that the number of AMD patients will be increased to 288 million in 2040. Since Asia accounts for more than half of the world’s population, the number of cases is expected to reach 113 million by 2040. Because the highest prevalence of AMD is in Europe, the number of future cases in this region is predicted to be second after Asia. The prevalence rate of AMD in Europe was 12.33%, in Asia it was 7.38%, and in Africa it was 7.53%

Based on the recognition of OCT scans, a deep-learning algorithm was developed that distinguishes wet AMD from normal macula with high accuracy. Currently, anti-VEGF (anti-vascular endothelial growth factor) therapy is highly effective in treating wet AMD, and is widely used in Europe and around the world as the standard treatment for the condition. However, with the increase in the number of people over 50 years of age in highly developed countries, the need for improved diagnostic and therapeutic methods continues to grow. Brolucizumab, which is a recently introduced anti-VEGF drug, is increasingly being used to treat this condition. This creates new opportunities associated with treatment regimens such as pro re nata (PRN) and treat and extend (T&E). Due to its low-molecular-weight structure and higher molar concentration than previously commercially available drugs, it penetrates deep into the retinal layers. Several next-generation drugs such as faricimab, conbercept, abicipar pegol, RPE cell therapy derived from induced pluripotent stem cells (iPSCs) and Port Delivery System (PDS) with ranibizumab are currently in clinical trials and promise to improve AMD treatment in the near future.

The aim of this Special Issue is to present the innovative experiences of authors, interesting cases, modern imaging techniques, and treatments of age-related macular degeneration including gene therapies.

Prof. Dr. Katarzyna Michalska-Małecka
Prof. Dr. Robert Rejdak
Guest Editors

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• age-related macular degeneration
• anti-VEGF
• gene therapy
• OCT
• OCT-A
• choroidal neovascularization
• pathogenesis AMD
• drusen
• therapeutic strategies
• vascular endothelial growth factor