scholarly journals Impact of living with a bilateral central vision loss due to geographic atrophy—qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047861
Author(s):  
Gopinath Madheswaran ◽  
S Ve Ramesh ◽  
Shahina Pardhan ◽  
Raju Sapkota ◽  
Rajiv Raman
Keyword(s):  
Qualitative Study ◽  
Thematic Analysis ◽  
Vision Loss ◽  
Negative Impact ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Central Vision ◽  
Central Vision Loss ◽  
Age Related ◽  
The Impact

ObjectiveGeographic atrophy (GA), a type of dry age-related macular degeneration, affects vision as central vision loss (CVL). The challenges faced due to bilateral CVL in activities of daily living and strategies taken to overcome those challenges are not very well understood in the Indian population. This qualitative study aims to understand the impact on everyday life activities and related adaptive and coping strategies in people with long-standing bilateral CVL due to GA in India.Design, participants, setting and methodsA qualitative study using a semistructured face-to-face interview was conducted on 10 people with bilateral CVL after obtaining written informed consent. The interviews were audio-recorded, and were transcribed verbatim. Thematic analysis was carried out to understand the challenges faced and adaptive methods due to the impact of CVL.ResultsTen participants (50% male) with a median age (IQR) of 72 (70, 74) years were interviewed. All the participants had best-corrected visual acuity of ≤6/60 in the better eye and reported an absolute central scotoma with the home Amsler chart. Qualitative thematic analysis identified four main themes: challenges in everyday living (difficulty in face identification, reading), challenges with lifestyle and socialisation (driving, cooking, reading for a longer duration, watching TV, socially inactive), psychological implications (depression, poor self-esteem, fear due to poor vision) and strategies to overcome the challenges (voice identification, technology support).ConclusionGA has a severe negative impact on the quality of life in people with CVL. Inability to recognise faces was the main reason for dependency on others and being socially disconnected. The findings will help clinicians in providing improved rehabilitative care.

scholarly journals Simulated central vision loss impairs implicit location probability learning

2020 ◽  
Author(s):  
Douglas A Addleman ◽  
Gordon E Legge ◽  
Yuhong Jiang
Keyword(s):  
Vision Loss ◽  
Target Location ◽  
Probability Learning ◽  
Age Related Macular Degeneration ◽  
Oculomotor Control ◽  
Central Scotoma ◽  
Central Vision ◽  
Central Vision Loss ◽  
Age Related ◽  
High Acuity

Central vision loss (CVL) occurs in advanced forms of age-related macular degeneration (AMD). It impairs high-acuity vision and results in difficulties with oculomotor control. Goal-driven guidance of attention is less effective in people with CVL, but do central scotomas also affect implicit, experience-driven attention? We investigated how simulated central scotomas affect young adults’ ability to prioritize locations that frequently contain a visual search target (location probability learning). Experiment 1 successfully induced probability learning in a no scotoma phase, regardless of whether participants became aware of the target’s location probability. Subsequently, central scotomas were introduced using a gaze-contingent eye tracking paradigm. The previously learned spatial bias persisted for a short time in this phase, an effect that was statistically comparable for no-scotoma and scotoma testing. Experiment 2 investigated whether participants could acquire location probability learning when trained with a simulated central scotoma. Unlike Experiment 1, training with a central scotoma yielded location probability learning only in participants who were aware of the target’s location probability. This effect transferred to search with no scotoma in aware but not unaware participants. Together, the results show that simulated central vision loss interferes with the acquisition of implicitly learned location probability learning, supporting a role of central vision in implicit spatial attentional biases.

scholarly journals Autophagy: A new insight into pathogenesis and treatment possibilities in age-related macular degeneration

2020 ◽  
Vol 74 ◽  
pp. 213-223
Author(s):  
Agnieszka Kubicka-Trząska ◽  
Izabella Karska-Basta ◽  
Katarzyna Żuber-Łaskawiec
Keyword(s):  
Macular Degeneration ◽  
Vision Loss ◽  
Developed Countries ◽  
Age Related Macular Degeneration ◽  
Therapeutic Modalities ◽  
Central Vision Loss ◽  
Age Related ◽  
Genetic And Environmental Factors ◽  
The Impact ◽  
Insight Into

Age-related macular degeneration (AMD) is a significant problem in healthcare, because it is a leading cause of central vision loss in individuals over 50 years old in well-developed countries. Pathogenesis of AMD is multifactorial and still not completely understood. Proven risk factors include the following: natural senescence of retina, oxidative stress, complement activation, chronic subretinal inflammatory reaction, genetic and environmental factors. Data on links between autophagy and AMD development are being raised. Autophagy is a cellular process involving the degradation of long-lived proteins and damaged fragments and components of cells; it is responsible for the maintenance of dynamic intracellular homeostasis and it enables cell survival under stress conditions. Disturbances of autophagy mechanisms, i.e. its activation or inhibition, may lead to the development of many various pathologies. Thus, autophagy plays a dual role, as a mechanism responsible for protecting or killing cells. The paper describes autophagy mechanisms and their role in the natural process of retinal cells senescence and presents the autophagy impairment as a crucial cause of AMD development. We also describe the impact of intravitreal anti-VEGF therapy on retinal autophagy mechanisms and potential new therapeutic modalities for AMD based on autophagy modulation.

scholarly journals Superoxide Dismutase-1 Induced Oxidative Stress Mediated Apoptosis in Murine Retinal Pigment Epithelial Cells

2019 ◽  
Vol 8 (4S2) ◽  
pp. 463-466
Keyword(s):  
Oxidative Stress ◽  
Cell Death ◽  
Vision Loss ◽  
Retinal Pigment ◽  
Retinal Pigment Epithelial Cells ◽  
Age Related Macular Degeneration ◽  
Superoxide Dismutase 1 ◽  
Central Vision Loss ◽  
Age Related ◽  
Pigment Epithelial Cells

Age related macular degeneration (AMD) is a complicated ocular disease which occurs in elderly people and leads to central vision loss. The AMD generated because of overproduction of oxidative stress which leads to RPE cell death. The present study investigates whether SOD1 induced MRPE cell death based on that overexpression of SOD1 in MRPE cells which induced cell death. The SOD1 gradually increased ROS production and fragmentation of nuclei. To explore the ER stress persuaded UPR via GRP78, and CHOP, protein expression level analyses were carried out by western blotting. Together, our results represent that SOD1 could possibly produce the oxidant induced MRPE cell death.

The Effects of Indocyanine Green Dye-Enhanced Photocoagulation on the Blood Flow in the Choriocapillaris and the Choroidal Neovascularization (CNV)

2000 ◽  
Author(s):  
C. von Kerczek ◽  
L. Zhu ◽  
A. Ernest ◽  
C. Eggleton ◽  
L. D. T. Topoleski ◽  
...  
Keyword(s):  
Laser Treatment ◽  
Choroidal Neovascularization ◽  
Vision Loss ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
The United States ◽  
Age Related Macular Degeneration ◽  
Central Vision ◽  
Age Related ◽  
Direct Laser

Abstract Age-related macular degeneration (AMD) is the most common cause of vision loss in patients aged 65 years and older in the United States. In the majority of cases, the loss of central vision is secondary to exudative changes and fibrovascular scarring following choroidal neovascularization (CNV). Prompt laser treatment is recommended [Asrani et al., 1996; Macular Photocoagulation Study Group, 1993; Schneider et al, 1998]. However, direct laser treatment to the entire subfoveal lesion is almost invariably associated with immediate loss of central vision. Loss of central vision may be due to direct damage to foveal photoreceptors and retinal pigment epithelium or from damage to the nerve fiber layer serving foveal function [Han et al., 1988].

scholarly journals MicroRNA-processing Enzymes Are Essential for Survival and Function of Mature Retinal Pigmented Epithelial Cells in Mice

2017 ◽  
Vol 292 (8) ◽  
pp. 3366-3378 ◽  
Author(s):  
Thomas R. Sundermeier ◽  
Sanae Sakami ◽  
Bhubanananda Sahu ◽  
Scott J. Howell ◽  
Songqi Gao ◽  
...  
Keyword(s):  
Cell Death ◽  
Vision Loss ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Mirna Biogenesis ◽  
Mirna Processing ◽  
Processing Enzymes ◽  
Age Related ◽  
Death And Loss ◽  
And Function

Age-related macular degeneration (AMD) is a major cause of irreversible vision loss. The neovascular or “wet” form of AMD can be treated to varying degrees with anti-angiogenic drugs, but geographic atrophy (GA) is an advanced stage of the more prevalent “dry” form of AMD for which there is no effective treatment. Development of GA has been linked to loss of the microRNA (miRNA)-processing enzyme DICER1 in the mature retinal pigmented epithelium (RPE). This loss results in the accumulation of toxic transcripts of Alu transposable elements, which activate the NLRP3 inflammasome and additional downstream pathways that compromise the integrity and function of the RPE. However, it remains unclear whether the loss of miRNA processing and subsequent gene regulation in the RPE due to DICER1 deficiency also contributes to RPE cell death. To clarify the role of miRNAs in RPE cells, we used two different mature RPE cell-specific Cre recombinase drivers to inactivate either Dicer1 or DiGeorge syndrome critical region 8 (Dgcr8), thus removing RPE miRNA regulatory activity in mice by disrupting two independent and essential steps of miRNA biogenesis. In contrast with prior studies, we found that the loss of each factor independently led to strikingly similar defects in the survival and function of the RPE and retina. These results suggest that the loss of miRNAs also contributes to RPE cell death and loss of visual function and could affect the pathology of dry AMD.

Challenges faced by older adults with vision loss: a qualitative study with implications for rehabilitation

2011 ◽  
Vol 26 (8) ◽  
pp. 748-757 ◽  
Author(s):  
Verena R Cimarolli ◽  
Kathrin Boerner ◽  
Mark Brennan-Ing ◽  
Joann P Reinhardt ◽  
Amy Horowitz
Keyword(s):  
Older Adults ◽  
Qualitative Study ◽  
Vision Loss ◽  
Age Related Macular Degeneration ◽  
Functional Domain ◽  
Social Challenges ◽  
Age Related ◽  
Vision Rehabilitation ◽  
Almost All ◽  
Over Time

Objective: To provide an in-depth assessment of challenges faced by older adults with recent vision loss and to determine changes in the nature of these challenges over time for the purpose of informing the design of vision rehabilitation services. Design: Longitudinal, qualitative study with three time points. Setting: Vision rehabilitation agency. Subjects: Three hundred and sixty-four older adults aged 65 with significant vision impairment due to age-related macular degeneration. Interventions: In-person interviews conducted at baseline, one year and two years and coded using a qualitative analytical approach. Main measures: Open-ended questions assessing challenges faced due to vision loss in functional, social and psychological life domains. Results: Almost all participants reported a wide variety of challenges across all three domains with the most variety in the functional domain. Over a two-year period, functional challenges (e.g. using transportation) increased, social challenges (e.g. recognizing people) remained stable, and psychological challenges (e.g. negative affect) decreased overall. Conclusions: Although functional challenges are predominant, social and psychological challenges are quite common and need to be addressed in vision rehabilitation. Rehabilitation planning should also consider that vision-related challenges can change over time.

scholarly journals Age-Related Macular Degeneration Revisited: From Pathology and Cellular Stress to Potential Therapies

2021 ◽  
Vol 8 ◽  
Author(s):  
Majda Hadziahmetovic ◽  
Goldis Malek
Keyword(s):  
Macular Degeneration ◽  
Vision Loss ◽  
Clinical Care ◽  
Retinal Pigment ◽  
Retinal Pigment Epithelial Cells ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
The Impact

Age-related macular degeneration (AMD) is a neurodegenerative disease of the aging retina, in which patients experience severe vision loss. Therapies available to patients are limited and are only effective in a sub-population of patients. Future comprehensive clinical care depends on identifying new therapeutic targets and adopting a multi-therapeutic approach. With this goal in mind, this review examines the fundamental concepts underlying the development and progression of AMD and re-evaluates the pathogenic pathways associated with the disease, focusing on the impact of injury at the cellular level, with the understanding that critical assessment of the literature may help pave the way to identifying disease-relevant targets. During this process, we elaborate on responses of AMD vulnerable cells, including photoreceptors, retinal pigment epithelial cells, microglia, and choroidal endothelial cells, based on in vitro and in vivo studies, to select stressful agents, and discuss current therapeutic developments in the field, targeting different aspects of AMD pathobiology.

scholarly journals Percentage of Foveal versus Total Macular Geographic Atrophy as a Predictor of Visual Acuity in Age-related Macular Degeneration

2019 ◽  
Author(s):  
Saghar Bagheri ◽  
Ines Lains ◽  
Rebecca Silverman ◽  
Ivana Kim ◽  
Dean Eliott ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Fundus Autofluorescence ◽  
Cross Sectional Study ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Cross Sectional ◽  
Age Related ◽  
The Impact ◽  
Foveal Sparing

AbstractObjectivesTo investigate the relationship between visual acuity (VA), total area of geographic atrophy (GA) and percentage of foveal GA.MethodsMulticenter, retrospective cross-sectional study of patients with GA due to age-related macular degeneration. Demographics, VA, fundus autofluorescence (FAF) and optical coherence tomography (OCT) images were collected. Using FAF images aided by OCT, foveal sparing status, GA pattern, total GA size, and percentage of GA covering the foveal area - area within a 1.5 mm diameter circle centered on the fovea centralis - were assessed. Univariable and multiple linear regression analyses were performed.Results54 eyes (mean age 78.7 ±7.7 (SD), 60.0% female) were studied. Mean VA was 0.8 ± 0.6 logMAR, mean total GA 8.8 ± 6.7 mm2 and mean percentage of foveal GA was 71.5 ± 30.9%. Of all assessed eyes, 48.2% (n = 26) presented with multifocal GA, and 18.5% (n = 10) had foveal sparing. Multiple regression analysis revealed that, controlling for age and GA pattern, the percentage of foveal GA presented a statistically significant association with VA (ß = 0.41, P = 0.004). No significant associations were observed with mean total GA size, while controlling for the same variables (ß = 0.010, P = 0.440).ConclusionPercentage of foveal GA was significantly associated with VA impairment, while the same was not verified for total GA area. These findings suggest that percentage of foveal GA may represent a more useful tool for assessing the impact of GA on VA. Further validation is needed in larger cohorts.

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