Dégénérescence maculaire liée à l'âge. État des lieux 2015

Age-related macular degeneration (AMD) remains the leading cause of visual loss and legal blindness after 55 years in developed countries. Nevertheless, it has underwent a major revolution since the beginning of the 21st Century. The most significant change has been the widespread use of anti-VEGF therapy in exsudative AMD, allowing an improvement of visual acuity in previously untreated eyes. 2 anti-VEGF molecules are currently reimbursed by French social security for exsudative AMD: ranibizumab since July 2007 and aflibercept since November 2013. However, the best results of anti-VEGF therapy can only be achieved by adhering to strict and personalized therapeutic regimen. New imaging technology has allowed retina specialists to see deeper (choroïd analysis with OCT-enhanced depth imaging and swept source) while improving the resolution and the contribution of each modality (multimodal imagery with the association of colour fundus photograph, fundus autofluorescence, fluorescein and indocyanine green angiography, OCT spectral domain and swept source…). The genes most associated with AMD are now well identified and hopefully will help improve our knowledge about the pathogenesis of the disease and offer new therapeutic avenues, perhaps even before visual loss occurs. Prevention of AMD is currently based on avoiding identified risk factors such as smoking and obesity and on dietary supplements including vitamins C and E, lutein, zeaxanthin, zinc and most often omega-3 fatty acids.