EditorialThe role of the atherosclerotic process in the pathogenesis of age-related macular degeneration☆
Section snippets
Studies of the aging bruch membrane and drusen
It has been known for some time that the spectrum of cholesterol esters and other lipids in the aging sclera4 resembles that found in the aging systemic arterial wall. Conversely, despite the absence of identifiable components of rods or cones in either drusen or Bruch membrane, it has been generally assumed that the lipids in drusen and basal deposits of Bruch membrane are the result of the failure of the retinal pigment epithelium to process the cellular debris associated with outer segment
Discussion
The vascular model proposes the progressive deposition of lipid, basic to aging and atherosclerosis, as the underlying cause of age-related macular degeneration. For the past several decades, atherosclerosis has been dismissed as a probable cause of age-related macular degeneration, because the process typically affects large and medium-sized systemic arteries, and the eye is neither an artery nor does it contain arteries large enough (greater than 1,000 μm) to develop atheromata. However, the
Summary
This editorial updates a hypothesis that attempts to explain the pathogenesis of age-related macular degeneration. It is based on mounting evidence that age-related macular degeneration shares both risk factors and pathogenetic mechanisms with atherosclerosis, resulting in the deposition of lipid in the sclera and in Bruch membrane. There is evidence that the scleral lipid ultimately results in a decrease in choroidal blood flow as well as an elevation of choriocapillary pressure, and the
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2022, Science of the Total EnvironmentCitation Excerpt :Long-term cigarette smoke has been shown to alter kinetics of blood clot formation and fibrin structure, both of which contribute to thrombosis (Srirangarajan et al., 2021). There are significant changes in choroidal vasculature in AMD model, similar to atherosclerosis which causes a decrease in choroidal blood flow (Friedman, 2000). Furthermore, nicotine alters the microcirculation and causes vasoconstriction by activating α-adrenergic receptors, which also increases post capillary resistance.
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2022, HeliyonCitation Excerpt :In 1997, Friedman proposed the hemodynamic (or vascular) model of AMD to theorize the role of ASVD in the pathogenesis of AMD [52, 53, 54, 55]. The model states that AMD is a vascular disorder, the hemodynamic sequela of atherosclerotic changes affecting the eye [52, 53, 54, 55]. AMD begins with age-related lipid infiltration of the sclera and BrM, which increases the stiffness of these tissues [52, 53, 54, 55].
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This work was supported in part by The Solman Friedman Research Fund, Boston, Massachusetts; The Harold Alfond Research Fund, Boston, Massachusetts; and The Ben Wunsch Research Fund, Boston, Massachusetts.