Rodriguez Daniel A, Song Alex, Bhatnagar Anshul, Weng Christina Y
Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.
Int Ophthalmol Clin. 2025 Jan 1;65(1):47-52. doi: 10.1097/IIO.0000000000000543. Epub 2024 Dec 23.
Age-related macular degeneration (AMD) is a chronic condition that causes gradual central vision loss, most commonly in patients 50 years or older. This disease is commonly classified as either dry (non-exudative) or wet (exudative). Most patients with AMD have the non-exudative form, characterized by the presence of drusen in the macula. These patients can be further subclassified based on drusen size into early, intermediate, or late stages. The pathogenesis of this disease is quite complex and has been linked to genetic variations, dysfunction of normal retinal homeostasis, chronic inflammation, and mitochondrial dysfunction. Current treatment options for patients with intermediate dry AMD are limited to lifestyle modifications and vitamin supplementation. Photobiomodulation therapy (PBT) has been proposed as an additional therapy for this disease. Early animal and human studies have shown that PBT can alter many of the pathways implicated in the pathogenesis of AMD including improving mitochondrial function, decreasing inflammation, and promoting wound healing. Clinical trials investigating the use of PBT in patients with non-exudative AMD have shown promising results. Many of these trials showed improvement in both clinical (visual acuity and contrast sensitivity) as well as anatomic (drusen volume and area geographic atrophy) variables. Most, however, are limited by sample size, differences in treatment algorithm, and populations tested. Ongoing clinical trials aim to expand on this work with longer follow-up, larger sample sizes, and studying a global population. Further work is needed to determine ideal treatment algorithms and patient populations that may benefit the most from this technology.
年龄相关性黄斑变性（AMD）是一种慢性疾病，会导致逐渐的中心视力丧失，最常见于50岁及以上的患者。这种疾病通常分为干性（非渗出性）或湿性（渗出性）。大多数AMD患者患有非渗出性形式，其特征是黄斑区存在玻璃膜疣。这些患者可根据玻璃膜疣大小进一步细分为早期、中期或晚期。这种疾病的发病机制相当复杂，与基因变异、正常视网膜内环境稳定功能障碍、慢性炎症和线粒体功能障碍有关。中度干性AMD患者目前的治疗选择仅限于生活方式调整和维生素补充。光生物调节疗法（PBT）已被提议作为这种疾病的一种额外治疗方法。早期的动物和人体研究表明，PBT可以改变许多与AMD发病机制相关的途径，包括改善线粒体功能、减轻炎症和促进伤口愈合。调查PBT在非渗出性AMD患者中应用的临床试验已显示出有希望的结果。许多这些试验在临床（视力和对比敏感度）以及解剖学（玻璃膜疣体积和地图样萎缩面积）变量方面都有改善。然而，大多数试验受到样本量、治疗方案差异和受试人群的限制。正在进行的临床试验旨在通过更长时间的随访、更大的样本量和研究全球人群来扩展这项工作。需要进一步开展工作来确定理想的治疗方案以及可能从这项技术中获益最大的患者群体。
