Age-Related Macular Degeneration

Innovative gene delivery systems for retinal disease therapy

The human retina, a complex and highly specialized structure, includes multiple cell types that work synergistically to generate and transmit visual signals. However, genetic predisposition or age-related degeneration can lead to retinal damage that severely impairs vision or causes blindness. Treatment options for retinal diseases are limited, and there is an urgent need for innovative therapeutic strategies. Cell and gene therapies are promising because of the efficacy of delivery systems that transport therapeutic genes to targeted retinal cells. Gene delivery systems hold great promise for treating retinal diseases by enabling the targeted delivery of therapeutic genes to affected cells or by converting endogenous cells into functional ones to facilitate nerve regeneration, potentially restoring vision. This review focuses on two principal categories of gene delivery vectors used in the treatment of retinal diseases: viral and non-viral systems. Viral vectors, including lentiviruses and adeno-associated viruses, exploit the innate ability of viruses to infiltrate cells, which is followed by the introduction of therapeutic genetic material into target cells for gene correction. Lentiviruses can accommodate exogenous genes up to 8 kb in length, but their mechanism of integration into the host genome presents insertion mutation risks. Conversely, adeno-associated viruses are safer, as they exist as episomes in the nucleus, yet their limited packaging capacity constrains their application to a narrower spectrum of diseases, which necessitates the exploration of alternative delivery methods. In parallel, progress has also occurred in the development of novel non-viral delivery systems, particularly those based on liposomal technology. Manipulation of the ratios of hydrophilic and hydrophobic molecules within liposomes and the development of new lipid formulations have led to the creation of advanced non-viral vectors. These innovative systems include solid lipid nanoparticles, polymer nanoparticles, dendrimers, polymeric micelles, and polymeric nanoparticles. Compared with their viral counterparts, non-viral delivery systems offer markedly enhanced loading capacities that enable the direct delivery of nucleic acids, mRNA, or protein molecules into cells. This bypasses the need for DNA transcription and processing, which significantly enhances therapeutic efficiency. Nevertheless, the immunogenic potential and accumulation toxicity associated with non-viral particulate systems necessitates continued optimization to reduce adverse effects in vivo . This review explores the various delivery systems for retinal therapies and retinal nerve regeneration, and details the characteristics, advantages, limitations, and clinical applications of each vector type. By systematically outlining these factors, our goal is to guide the selection of the optimal delivery tool for a specific retinal disease, which will enhance treatment efficacy and improve patient outcomes while paving the way for more effective and targeted therapeutic interventions.

Harnessing nanofibers for targeted delivery of phytoconstituents in age-related macular degeneration

Age-related macular degeneration is a degenerative eye condition that affects the macula and results in central vision loss. Phytoconstituents show great promise in the treatment of AMD. AMD therapy can benefit from the advantages of phytoconstituents loaded nanofibers. There are opportunities to improve the effectiveness of phytoconstituents in the treatment of age-related macular degeneration (AMD) through the use of nanofiber-based delivery methods. These novel platforms encapsulate and distribute plant-derived bioactives by making use of the special qualities of nanofibers. These qualities include their high surface area-to-volume ratio, variable porosity, and biocompatibility. Exploring the use of nanofiber-based delivery methods to provide phytoconstituents in AMD treatment is a great choice for enhancing patient adherence, safety, and efficacy in managing this condition. This article explores the potential of nanofiber-based delivery methods to revolutionize AMD treatment, providing an innovative and effective approach to treat this condition.

Macular neovascularization

Neovascularization of the macula, a common complication of many chorioretinal diseases such as neovascular age-related macular degeneration, polypoidal choroidal vasculopathy, and pathologic myopia, results from increased synthesis of vascular endothelial growth factor (VEGF) by the retinal pigment epithelium and/or Müller cells because of localized ischemia and inflammation. The Consensus on Neovascular AMD Nomenclature (CONAN) study group acknowledged that these vessels may originate from either the choriocapillaris or the retinal microvasculature, prompting them to propose the term 'macular neovascularization' (MNV) to include intraretinal, subretinal, and sub-pigment epithelial neovascularization localized to the macula. MNV frequently appears as a grey-green macular lesion with overlying intraretinal thickening and/or subretinal exudation, causing metamorphopsia, reduced central vision, relative central scotoma, decreased reading speed, and problems with color recognition. Multimodal imaging with optical coherence tomography (OCT), OCT angiography, dye-based angiographies, fundus autofluorescence, and multiwavelength photography help establish the diagnosis and aid in selecting an appropriate treatment. The standard of care for MNV is usually intravitreal anti-vascular endothelial growth factor injections, though thermal laser photocoagulation, verteporfin photodynamic therapy, and vitreoretinal surgery are occasionally used. We discuss the etiology and clinical features of MNV, the role of multimodal imaging in establishing the diagnosis, and the available therapeutic options.

Metformin inhibits subretinal fibrosis by activating Klotho by miR-126-5p

Subretinal fibrosis is a main cause of visual loss in patients with neovascular age-related macular degeneration (nAMD), for whom there has been a lack of effective medication. Metformin can improve inflammation and angiogenesis in eye diseases. This study aimed to investigate the mechanism by which metformin inhibits subretinal fibrosis. A subretinal fibrosis cell model was induced by treating human retinal pigment epithelial cells (ARPE-19) with TGF-β1, a subretinal fibrosis mouse model was induced by a laser, and both cells and mice were treated with metformin. Cell proliferation, migration, and invasion were detected by CCK-8, scratch, and Transwell assays. Western blotting and immunofluorescence were used to evaluate protein expression levels, and RT‒qPCR was used to detect gene expression levels. HE and Masson staining were used to observe the morphological changes in retinal and choroidal tissues. Metformin treatment inhibited the TGF-β1-induced proliferation, migration, invasion and epithelial‒mesenchymal transition (EMT) of ARPE-19 cells and effectively ameliorated laser-induced subretinal fibrosis in mice. Mechanistically, metformin inhibits the expression of miR-126-5p, promotes Klotho synthesis, slows the progression of subretinal fibrosis, and miR-126-5p targets and negatively regulates Klotho. Metformin activates Klotho by inhibiting miR-126-5p, thereby reversing TGF-β1-induced ARPE-19 cell EMT and improving laser-induced subretinal fibrosis in mice.

Cathepsins and age-related macular degeneration: A Mendelian randomization study unveiling causal relationships

Age-related macular degeneration (AMD) is a leading cause of vision impairment and blindness in older adults, profoundly affecting millions of individuals worldwide. Cathepsins are a crucial class of proteolytic enzymes that participates in multiple biological process. However, the role of cathepsins in AMD still remains unclear. This study aims to probe into the causal relationship between cathepsins and AMD using a 2-sample Mendelian randomization (MR). Instrumental variables associated with exposure (cathepsins) and the outcome (AMD) were sourced from published genome-wide association studies. To estimate the causal effects, methodologies such as inverse variance weighted, MR-Egger, and weighted median estimation (WM) were employed. Reverse MR and multivariate MR analyses were also performed. The elevated levels of cathepsin B significantly increased the risk of dry AMD, with an odds ratio (OR) of 1.068 (95% CI = 1.007-1.133) and a P-value of .029). Sensitivity analyses confirmed the robustness of these findings, with no evidence of heterogeneity or pleiotropy. Reverse MR analyses indicated that total AMD might elevate levels of cathepsin E (OR = 1.04, P = .029). Multivariate MR analysis showed significant associations between specific cathepsins and AMD subtypes, including cathepsin G and cathepsin O with significantly increasing risk. The study revealed a potential causal effect of cathepsin B on AMD, especially dry AMD. These findings provide potential therapeutic targets for AMD, and further research is needed to understand the underlying mechanisms.

Comparing visual outcomes of nAMD treatment during and after the COVID-19 restrictions period

MAIN OBJECTIVE

Compare treatment outcomes of newly diagnosed neovascular age-related macular degeneration (nAMD) during and after the COVID-19 restrictions.

METHODS

This retrospective study at the Retina Group of Washington analyzed nAMD patients treated with anti-VEGF therapy with ≥ 12 months of follow-up. Two groups were identified: 258 subjects diagnosed between March 2020-March 2022 (Group 1) and 376 subjects diagnosed after (Group 2). Primary outcomes were 12-month and final best-corrected visual acuity (BCVA), and number of injections in the first 12 months.

RESULTS

Initial mean BCVA was 20/71 and 20/68 in Group 1 and Group 2, with median BCVA of 20/60 and 20/50, respectively. At 12 months, mean BCVA improved to 20/65 and 20/54 in Group 1 and Group 2, respectively (p = 0.086). Final mean BCVA was 20/76 for Group 1 and 20/58 for Group 2 (p = 0.010). The mean change in LogMAR BCVA from the time of conversion to last follow-up was + 0.03 for Group 1 and -0.08 for Group 2 (p = 0.007). Group 1 had fewer injections in the first year of therapy (8.67 vs. 9.21, p = 0.004). 38.8% of Group 1 reached BCVA ≥20/40 at 12 months, versus 48.9% for Group 2 (p = 0.011).

CONCLUSION

Patients diagnosed during the COVID-19 restrictions period had worse visual outcomes than those diagnosed thereafter. Multiple factors, including, but not limited to reduced treatment frequency, likely contributed to worse visual outcomes.

The role of semaphorin 3A in the pathogenesis and progression of Alzheimer's disease and other aging-related diseases: A comprehensive review

Aging serves as a pivotal factor in the etiology of numerous diseases, such as Alzheimer's disease (AD), Parkinson's disease, diabetes, osteoarthritis, atherosclerosis and aging-related macular degeneration. Notably, these diseases often interact with AD through various pathways, facilitating the onset or progression of one another. Semaphorin 3 A (Sema3A), a protein that is essential for axonal guidance during neural development, has recently been identified as a novel regulator in the pathogenesis and progression of multiple aging-related diseases. This article provides a comprehensive review of the expression patterns and mechanisms of action of Sema3A in these diseases. Specifically, Sema3A influences the occurrence and development of aging-related diseases by participating in oxidative stress, inflammatory responses, apoptosis, and synaptic plasticity. Therefore, therapeutic strategies targeting Sema3A present promising avenues for delaying the progression of aging-related diseases and offer novel insights and strategies for their treatment.

Trends in the global disease burden of age-related macular degeneration from 1990 to 2021

AimTo investigate the global disease burden of age-related macular degeneration (AMD) from 1990 to 2021 using data from the Global Burden of Diseases 2021 database.MethodsWe recorded disability-adjusted life years (DALYs) and rates and estimated annual percentage changes (EAPCs) in AMD stratified by sex, age, sociodemographic index (SDI), geographic region, country, and risk factor.ResultsGlobally, the number of AMD-associated DALYs increased from 302,902 in 1990 to 578,020 in 2021, while the age-standardized rate (ASR) of DALYs decreased by 19.089% from 1990 to 2021, with an EAPC of -0.942 (95% CI, -1.010-0.873). During this period, males had fewer DALYs and lower ASRs than did females, and the ASR decreased with decreasing age. In 2021, the low-SDI region had the highest ASR (10.082 per 100,000 individuals) and the slowest ASR decrease (EAPC: -0.652, 95% CI, -0.708--0.595). East Asia had the most DALYs (154,300.168), and Western Sub-Saharan Africa had the highest ASR (14.735 per 100,000 individuals). From 1990 to 2021, all 21 regions experienced increased DALYs, while most regions, except for Central Sub-Saharan Africa and Southern Sub-Saharan Africa, experienced decreases in the ASR. China had the most DALYs (153,219.726) in 2021. The proportion of DALYs attributable to smoking in patients with AMD decreased globally and across all SDI regions from 1990 to 2021.ConclusionOver the past 32 years, AMD has remained a significant health concern, particularly affecting females, older individuals, and individuals living in lower-SDI regions, with a global decline in smoking-related AMD DALYs.

A Novel AMD Severity Scoring System Leveraging the AREDS Studies and Routine Clinical Electronic Medical Records

OBJECTIVE

To develop a novel severity scoring system for age-related macular degeneration (AMD) that can generate distinct scores for exudative and non-exudative AMD, and that can be applied to routine clinical features captured in electronic medical record (EMR) data, where complete data on features included in traditional scoring systems is rare.

DESIGN

Retrospective cohort study with external validation.

PARTICIPANTS

Data from participants in the Age-Related Eye Disease Study (AREDS), AREDS2, and the Eye Adult Changes in Thought study (Eye ACT).

METHODS

Severity score models were developed for non-exudative ("dry") AMD (AMD-D) and exudative ("wet") AMD (AMD-W) based on confirmatory factor analysis (CFA) of data from AREDS and AREDS2. Models were applied to an independent cohort of the Eye ACT study whose longitudinal ophthalmic clinical data were extracted from an EMR capturing routine care, using natural language processing-based text mining algorithms.

MAIN OUTCOME MEASURES

Trajectories of AMD-D and AMD-W scores in the Eye ACT cohort and relationship with age and the onset of the first anti-vascular endothelial growth factor (antiVEGF) treatment.

RESULTS

In the Eye ACT cohort, AMD-D and AMD-W scores showed a moderately positive correlation (Pearson 0.702, 95% CI: 0.699-0.704). In 4,412 eyes from 2,248 participants in Eye ACT, which never received antiVEGF, AMD-D scores increased slightly before the age of 80, followed by a steeper increase through age 90. In 220 eyes of 171 Eye ACT participants, which received antiVEGF, most showed a pattern of gradually increasing AMD-W scores in the weeks or months prior to the antiVEGF treatment.

CONCLUSIONS

The CFA-based scoring system enabled detailed assessments of both non-exudative and exudative AMD severity using features collected in a routine clinical setting with ubiquitous missing data, where standard AREDS scoring is not possible.

Optogenetic therapy for retinal degenerative diseases: A review

Optogenetics, a cutting-edge tool in novel gene manipulation and drug discovery, holds significant therapeutic potential for a variety of neurological disorders, including retinal diseases. Retinal diseases such as age-related macular degeneration (AMD) and retinitis pigmentosa (RP), significantly impair quality of life and cause severe visual impairment due to limited treatment options and a general lack of awareness. The increasing incidence of these degenerative conditions underscores the need for innovative solutions, such as optogenetics. Optogenetic therapy introduces genes coding for light-sensitive proteins, which are controlled by light signals to make neurons photosensitive. This precise targeting approach does not require specific gene intervention and can bypass dysfunctional photoreceptors, offering a treatment option for various degenerative and dystrophic eye diseases. Successful outcomes in patients with late-stage genetic retinal diseases and numerous clinical trials suggest that optogenetics could be an effective treatment for humans. This review provides an overview of the current landscape of optogenetic therapy, discusses its challenges, and summarizes the findings of ongoing clinical trials for neural and visual restoration.

Ocular manifestations in Ehlers-Danlos syndrome

BACKGROUND/OBJECTIVE

To provide a large-scale analysis on the demographics and ocular comorbidities in Ehlers-Danlos Syndrome (EDS) patients in the US.

SUBJECTS/METHODS

This is an exploratory cross-sectional study comparing medical records of EDS patients to the general population on demographic variables and ICD-10 ocular diagnoses. A research platform with de-identified EHR data of over 99 million patients across 60 healthcare organizations was utilized. Groups were stratified by 30-year age groups. Patients aged 0-61+ with an ICD-10 diagnosis of EDS (76,526), the general platform population aged 0-61+ (99,836,639), and patients with a concurrent ICD-10 ocular diagnosis were queried to determine the prevalence of EDS across demographic variables, ocular disease, and odds of ocular disease. Statistical analysis was conducted using Microsoft Excel and R studio, using p < 0.01 and 95% confidence intervals (CI).

RESULTS

An EDS diagnosis was most prevalent in white females aged 0-30 years old (259.6 per 100,000). The majority of ocular diagnoses were more prevalent in the 0-60-year-old EDS population compared to the general population including myopia (5227.0 per 100,000) and dry eye (4211.6 per 100,000). Overall, diagnoses of angioid streaks (POR 18.72, 95% CI 10.32, 33.94) and idiopathic intracranial hypertension (IIH) (POR 18.43, 95% CI 17.51, 19.39) showed the highest increased odds in patients with EDS while significantly decreased odds were shown for type 2 diabetic retinopathy, age-related macular degeneration, and retinal vein occlusion.

CONCLUSIONS

EDS was associated with increased odds of having a concurrent ocular pathology, suggesting that, upon diagnosis of EDS, referral to ophthalmology may be valuable.

Phlorizin Protects Against Oxidative Stress and Inflammation in Age-Related Macular Degeneration Model

BACKGROUND

Sweet Tea (Lithocarpus polystachyus Rehd.), a traditional ethnobotanical medicine, contains phlorizin, a dihydrochalcone compound with antioxidative and anti-inflammatory properties. Given the critical role of oxidative stress and inflammation in age-related macular degeneration (AMD), this study tested the hypothesis that phlorizin mitigates oxidative damage and inflammation in AMD models, thereby offering therapeutic potential.

MATERIALS AND METHODS

Adult retinal pigmented epithelial cells (ARPE-19) were pre-treated with phlorizin (0.01-0.1 μM) and subjected to oxidative stress induced by ultraviolet A (UVA) radiation or sodium iodate (NaIO3). Cell viability, reactive oxygen species (ROS) production, MAPK/NF-κB signaling, and the level of pro-inflammatory cytokines (IL-1β, IL-6, TNF-α) and pro-angiogenic factors (VEGF, MMP2, MMP9) expression were assessed using MTT assays, fluorescence imaging, Western blotting, and RT-qPCR. In vivo, a laser-induced choroidal neovascularization (CNV) mouse model was used to evaluate phlorizin's effects on CNV formation and vascular leakage via fundus photography and fluorescence angiography.

RESULT

Phlorizin significantly enhanced cell viability, reduced ROS production, inhibited MAPK/NF-κB activation, and downregulated inflammatory and angiogenic mediators. In vivo studies confirmed the reduced CNV formation and vascular leakage following the phlorizin treatment.

CONCLUSIONS

Phlorizin demonstrated significant protective effects against oxidative stress and inflammation, highlighting its therapeutic potential for treating AMD.

Nanoparticle-Based gene therapy strategies in retinal delivery

Vision loss and blindness are significant issues in both developed and developing countries. There are a wide variety of aetiologies that can cause vision loss, which are outlined in this review. Although treatment has significantly improved over time for some conditions, nearly half of all people with vision impairment are left untreated. Gene delivery is an emerging field that may assist with the treatment of some of these difficult to manage forms of vision loss. Here we review how a component of nanotechnology-based, non-viral gene delivery systems are being applied to help resolve vision impairment. This review focuses on the use of lipid and polymer nanoparticles, and quantum dots as gene delivery vectors to the eye. Finally, we also highlight some emerging technologies that may be useful in this discipline.

Association of systemic inflammatory biomarkers with ocular disease: a large population-based cross-sectional study

BACKGROUND

The aim of this study was to explore the association of systemic inflammatory biomarkers (systemic immune-inflammation (SII) index and systemic inflammatory response index (SIRI)) with the prevalence of ocular disease in the general population of the United States (U.S.).

METHODS

We conducted a cross-sectional study of subjects in the National Health and Nutrition Examination Survey 2005-2008 years. For the analysis of the association of SII index, and SIRI with the prevalence of ocular disease (glaucoma, cataract, age-related macular degeneration (ARMD), and diabetic retinopathy), the restricted cubic spline (RCS) plot, multivariable logistic regression models, and subgroup analysis were performed.

RESULTS

There was a total of 5377 individuals. As shown by the RCS plot, SII index and SIRI were linked with ARMD risk in a U-shaped pattern. Additionally, the SII index and SIRI were linearly positive with glaucoma and cataract. Finally, the risk of diabetic retinopathy was associated with the L-shaped and N-shaped curves of the SII index and SIRI, respectively.

CONCLUSIONS

Two new systemic inflammatory biomarkers, SII index and SIRI, are closely related to the risk of eye disease. There are different associations between SII index and different ocular diseases. This should raise more concerns and lead to better prevention strategies for systemic inflammation.

Bringing ophthalmology into the scientific world: Novel nanoparticle-based strategies for ocular drug delivery

The distinctive benefits and drawbacks of various drug delivery strategies to supply corneal tissue improvement for sense organs have been the attention of studies worldwide in recent decades. Static and dynamic barriers of ocular tissue prevent foreign chemicals from entering and inhibit the active absorption of therapeutic medicines. The distribution of different medications to ocular tissue is one of the most appealing and demanding tasks for investigators in pharmacology, biomaterials, and ophthalmology, and it is critical for cornea wound healing due to the controlled release rate and increased drug bioavailability. It should be mentioned that the transport of various types of medications into the different sections of the eye, particularly the cornea, is exceedingly challenging because of its distinctive structure and various barriers throughout the eye. Nanoparticles are being studied to improve medicine delivery strategies for ocular disease. Repetitive corneal drug delivery using biodegradable nanocarriers allows a medicine to remain in different parts of the cornea for extended periods of time and thus improve administration route effectiveness. In this review, we discussed eye anatomy, ocular delivery barriers, as well as the emphasis on the biodegradable nanomaterials ranging from organic nanostructures, such as nanomicelles, polymers, liposomes, niosomes, nanowafers, nanoemulsions, nanosuspensions, nanocrystals, cubosomes, olaminosomes, hybridized NPs, dendrimers, bilosomes, solid lipid NPs, nanostructured lipid carriers, and nanofiber to organic nanomaterials like silver, gold, and mesoporous silica nanoparticles. In addition, we describe the nanotechnology-based ophthalmic medications that are presently on the market or in clinical studies. Finally, drawing on current trends and therapeutic approaches, we discuss the challenges that innovative optical drug delivery systems confront and propose future research routes. We hope that this review will serve as a source of motivation and inspiration for developing innovative ophthalmic formulations.

Long-term effects of the COVID-19 lockdown on the structural and functional outcomes of neovascular AMD patients in Suzhou, China

BACKGROUND

Timely anti-vascular endothelial growth factor (VEGF) therapy is essential for visual function in neovascular age-related macular degeneration (nAMD). The coronavirus pandemic has led to unprecedented delays in anti-VEGF intravitreal therapy because of the need to reduce hospital attendance.

OBJECTIVES

To assess the long-term impact of COVID-19 pandemic-related delays in intravitreal anti-VEGF therapy on nAMD patients.

METHODS

This was a retrospective study of 98 patients (102 eyes) with nAMD whose anti-VEGF treatments were interrupted for >  8 weeks due to the COVID-19 pandemic. Best-corrected visual acuity (BCVA), central retinal thickness (CRT) and anatomical characteristics on spectral domain optical coherence tomography (SD-OCT) were measured at baseline, at the last follow-up visit before treatment interruption (V0), at the first visit after the COVID-19 lockdown had ended (V1), at the six-month follow-up (V-6 months) and at the final visit at the 1-year follow-up (V-final). The control group included nAMD patients who had completed at least three anti-VEGF treatments and received consecutive follow-up with timely anti-VEGF treatments for one year.

RESULTS

After one year of regular follow-up and standardized treatment, the treatment-interrupted group (TIG) had significantly worse visual acuity than the treatment-continuous group (TCG) (0.71 ± 0.38 vs. 0.52 ± 0.32, p < 0.001); however, there was no significant difference between the groups in the mean CRT (273.95 ± 112.96 µm vs. 261.43 ± 90.66 µm, p > 0.05). Furthermore, subgroup analysis revealed that, compared with those before treatment interruption, the BCVA of the TIG patients slightly improved, but the mean CRT and related activity indices returned to baseline values according to OCT imaging (all p > 0.05). Multiple linear regression analysis revealed that longer treatment interruption was associated with greater deterioration in visual acuity (p = 0.009).

CONCLUSION

Treatment interruption for more than 8 weeks had a sustained negative impact on visual acuity in treated eyes one year later. For nAMD patients, continuous treatment, regardless of the underlying regimen, remains critical.

Real-world insights of patient voices with age-related macular degeneration in the Republic of Korea and Taiwan: an AI-based Digital Listening study by Semantic-Natural Language Processing

BACKGROUND

In this era of active online communication, patients increasingly share their healthcare experiences, concerns, and needs across digital platforms. Leveraging these vast repositories of real-world information, Digital Listening enables the systematic collection and analysis of patient voices through advanced technologies. Semantic-NLP artificial intelligence, with its ability to process and extract meaningful insights from large volumes of unstructured online data, represents a novel approach for understanding patient perspectives. This study aimed to demonstrate the utility of Semantic-NLP technology in presenting the needs and concerns of patients with age-related macular degeneration (AMD) in Korea and Taiwan.

METHODS

Data were collected and analysed over three months from January 2023 using an ontology-based information extraction system (Semantic Hub). The system identified patient "stories" and extracted themes from online posts from January 2013 to March 2023, focusing on Korea and Taiwan by filtering the geographic location of users, the language used, and the local online platforms. Extracted texts were structured into knowledge graphs and analysed descriptively.

RESULTS

The patient voice was identified in 133,857 messages (9,620 patients) from the Naver online platform in Korea and included internet chat forums focused on macular degeneration. The most important factors for AMD treatments were effectiveness (1,632/3,401 mentions; 48%), price and access to insurance (33%), tolerability (10%) and doctor and clinic recommendations (9%). Treatment burden associated with intravitreal injection of vascular endothelial growth factor inhibitors related to tolerability (254/942 mentions; 27%), financial burden (20%), hospital selection (18%) and emotional burden (14%). In Taiwan, 444 messages were identified from Facebook, YouTube and Instagram. The success of treatment was judged by improvements in visual acuity (20/121 mentions; 16.5%), effect on oedema (10.7%), less distortion (9.1%) and inhibition of angiogenesis (5.8%). Tolerability concerns were rarely mentioned (26/440 mentions; 5.9%).

CONCLUSIONS

Digital Listening using Semantic-NLP can provide real-world insights from large amounts of internet data quickly and with low human labour cost. This allows healthcare companies to respond to the unmet needs of patients for effective and safe treatment and improved patient quality of life throughout the product lifecycle.

The Relationship Between Aortic Stenosis and the Possibility of Subsequent Macular Diseases: A Nationwide Database Study

Objectives: This study aimed to investigate the possible relationship between aortic stenosis (AS) occupancy and the incidence of subsequent macular diseases. Methods: A retrospective cohort study was conducted using the TriNetX database, and participants with AS were enrolled and matched to non-AS participants. A total of 421,860 and 421,860 participants were evenly divided into the AS and non-AS groups, respectively. The major outcomes of the present study include the development of age-related macular degeneration (AMD), retinal vascular occlusion (RVO), epiretinal membrane (ERM), and central serous chorioretinopathy (CSC). Cox proportional hazard regression was utilized for statistical analysis. Results: There were 4426 and 3013 AMD events; 7315 and 4753 RVO events; 2780 and 1910 ERM events; and 113 and 64 CSC events in the AS and non-AS groups, respectively. According to the results of Cox proportional hazard regression analysis, the AS group demonstrated significantly higher incidences of all macular diseases, including AMD, RVO, ERM, and CSC, compared to the non-AS group (all p < 0.05). The cumulative probabilities of all macular diseases were significantly higher in the AS group than in the non-AS group (all p < 0.05). In the sensitivity analysis, the developmental risks of AMD were significantly higher in the AS group than in the non-AS group with all traits. Conclusions: This study determined that AS occupancy is related to a higher risk of developing macular diseases, which positively correlated to the disease time of AS.

Comparison of choroidal thickness and vascularity in patients with subretinal drusenoid deposits and large drusen using swept-source optical coherence tomography

PURPOSE

The aim of this study is to assess the choroidal features in patients diagnosed with non-advanced age-related macular degeneration (AMD) using Swept-source Optical Coherence Tomography (SS-OCT) and compare the findings of those with subretinal drusenoid deposits (SDD) and those with large drusen.

METHODS

Individuals aged 50 years and above, presenting with either SDD or large drusen alongside non-advanced AMD, underwent a thorough ophthalmic assessment. OCT scans were acquired using SS-OCT. Choroidal thickness (CT) maps within the early treatment diabetic retinopathy study (ETDRS) subfields were obtained. Choroidal vascularity index (CVI) was obtained from a foveal horizontal OCT scan, and it was determined as the ratio of luminal area to the total choroidal area. The data obtained were compared between the groups.

RESULTS

Forty-three eyes of 27 patients with SDD and 40 eyes of 21 patients with large drusen were included in the study. The mean age was 72.0 ± 8.6 years in the SDD group and 71.3 ± 5.6 years in the large drusen group with no significant difference (p = 0.717). In the choroidal thickness maps CT and CT in all ETDRS subfields were significantly lower in SDD group compared to the large drusen group. CVI values were not significantly different between SDD (0.628 ± 0.18) and large drusen groups (0.629 ± 0.20) (p = 0.812).

CONCLUSION

Non-advanced AMD patients with SDD exhibited reduced choroidal thickness compared to those with large drusen. Choroidal vascularity index did not significantly differ, suggesting that choroidal thickness may play a more substantial role than vascularity changes in the pathogenesis of SDD.

Sodium Iodate-Induced Ferroptosis in Photoreceptor-Derived 661W Cells Through the Depletion of GSH

Oxidative stress-induced photoreceptor cell death is closely associated with the etiology of age-related macular degeneration (AMD), and sodium iodate (SI) has been widely used as an oxidant stimulus in AMD models to induce retinal pigment epithelium (RPE) and photoreceptor cell death. However, the mechanism underlying SI-induced photoreceptor cell death remains controversial and unclear. In this study, we elucidate that ferroptosis is a critical form of cell death induced by SI in photoreceptor-derived 661W cells. SI disrupts system Xc-, leading to glutathione (GSH) depletion and triggering lipid peroxidation, thereby promoting ferroptosis in photoreceptor-derived 661W cells. Additionally, SI enhances intracellular Fe2+ levels, which further facilitates reactive oxygen species (ROS) accumulation, making the 661W cells more susceptible to ferroptosis. Exogenous GSH, as well as specific inhibitors of ferroptosis such as Fer-1 and antioxidants like NAC, significantly attenuate SI-induced ferroptosis in photoreceptor-derived 661W cells. These findings provide new insights into the mechanisms of ferroptosis as a key pathway in SI-induced photoreceptor-derived 661W cell death.

Rac1 overexpression promotes Treg-derived cytokines to mediate choroidal neovascularization in wet age-related macular degeneration

Age-related macular degeneration (AMD), particularly the wet form characterized by choroidal neovascularization, is a leading cause of vision loss. Dysregulation of regulatory T cells (Tregs), key modulators of inflammatory responses, may contribute to wet AMD pathogenesis. This study explored the involvement of Tregs and the Rac1 signaling pathway in modulating Treg-derived cytokine expression and their role in choroidal neovascularization during wet AMD progression. Peripheral blood samples from healthy controls, dry AMD patients, and wet AMD patients were collected. An in vitro transmembrane co-culture system of Tregs and human choroidal endothelial cells (HCECs) was employed to investigate the impact of Tregs (with or without Rac1 silencing) on the angiogenic phenotype of HCECs. A mouse model of AMD was established to evaluate the effects of a Rac1 inhibitor and IL-10/TGF-β neutralization on Tregs and choroidal neovascularization. An increased Treg percentage in the CD4+ T lymphocyte population was found in the peripheral blood samples of wet AMD patients. Tregs from wet AMD patients showed an increased expression of Rac1 and an elevated production of IL-10 and TGF-β1. Rac1 silencing suppressed Treg stability and differentiation, and impaired the pro-angiogenic effect of Tregs on HCECs. In the animal model of AMD, the administration of a Rac1 inhibitor or neutralizing antibodies against IL-10/TGF-β1 reduced Treg abundance and attenuated choroidal neovascularization. Rac1 upregulation in Tregs promoted IL-10 and TGF-β1 production to mediate choroidal neovascularization in wet AMD. Targeting Rac1 and Treg-derived IL-10/TGF-β1 production in Tregs may serve as a strategy to ameliorate AMD progression.

Clinical perspective on pluripotent stem cells derived cell therapies for the treatment of neurodegenerative diseases

Self-renewal capacity and potential to differentiate into almost any cell type of the human body makes pluripotent stem cells a valuable starting material for manufacturing of clinical grade cell therapies. Neurodegenerative diseases are characterized by gradual loss of structure or function of neurons, often leading to neuronal death. This results in gradual decline of cognitive, motor, and physiological functions due to the degeneration of the central nervous systems. Over the past two decades, comprehensive preclinical efficacy (proof-of-concept) and safety studies have led to the initiation of First-in-Human phase I-II clinical trials for a range of neurodegenerative diseases. In this review, we explore the fundamentals and challenges of neural-cell therapies derived from pluripotent stem cells for treating neurodegenerative diseases. Additionally, we highlight key preclinical investigations that paved the way for regulatory approvals of these trials. Furthermore, we provide an overview on progress and status of clinical trials done so far in treating neurodegenerative diseases such as spinal cord injury (SCI), Parkinson's disease (PD), and amyotrophic lateral sclerosis (ALS), as well as advances in retina diseases such as Stargardt disease (a.k.a fundus flavimaculatus), retinitis pigmentosa (RP) and age-related macular degeneration (AMD). These trials will pave the way for the development of new cell-based therapies targeting additional neurological conditions, including Alzheimer's disease and epilepsy.

Targeting macrophage to myofibroblast transition by circ_0001103 for subretinal fibrosis treatment

PURPOSE

Subretinal fibrosis is an important cause of visual loss in age-related macular degeneration, but its mechanism remains unclear. This study aims to investigate the role of macrophage-to-myofibroblast transition (MMT) in the formation of subretinal fibrosis and assess whether circ_0001103 can regulate the formation of subretinal fibrosis by regulating MMT.

METHODS

Subretinal fibrosis was induced in C57BL/6J mice by laser induction. The expression profiles of circRNAs in a choroidal neovascularization (CNV) and subretinal fibrosis mice model were accessed via microarray analysis. MMT was induced by TGF-β1 (2.5 ng/ml, 48 h). Immunohistochemistry was used to assess macrophages (F4/80), MMT (α-SMA) and fibrovascular lesions (collagenI and Isolectin B4) in vivo. The interaction between circ_0001103, miR-7240-5p, and SLC9A was assessed using a dual-luciferase reporter assay, FISH, RNA immunoprecipitation assay, qRT-PCR and western blot. Finally, immunofluorescence, paraffin section and choroidal flatmounts were used to observe the changes of MMT, subretinal fibrosis and CNV after the intervention of circ_0001103 by intravitreal injection on day 7 after laser induction in mice.

RESULTS

The results revealed that 58 circRNAs were significantly altered in the RPE-choroid-sclera complexes of CNV mice (p < 0.05, fold change > 2.0). Additionally, circ_0001103 increased in MMT and subretinal fibrosis mice. Circ_0001103 can sponge miR-7240-5p targeting SLC9A to modulate MMT in vitro. Inhibition of circ_0001103 can suppress MMT, subretinal fibrosis and CNV leakage.

CONCLUSION

circ_0001103 sponge adsorption miR-7240-5p regulates SLC9A1-mediated MMT and subretinal fibrosis. Inhibition of circ_0001103 can suppress subretinal fibrosis and CNV leakage by inhibiting MMT.

Trends in Research Payments for Age-related Macular Degeneration From 2015 to 2021

OBJECTIVE

This study aimed to evaluate characteristics of industry and public research payments for age-related macular degeneration studies.

MATERIALS AND METHODS

Studies involving "age-related macular degeneration" or "AMD" from 2015 to 2021 were extracted from the Open Payments Database and the National Eye Institute RePORTER tool and compared to each other.

RESULTS

From 2015 to 2021, 620 ophthalmologists received $178,394,734.09 in industry research payments with a 76.9% increase from 2015 to 2020 and a subsequent 40.7% decrease in 2021. There were 84 female industry funding recipients (13.7%) compared to 528 (86.3%) male recipients (P < 0.001). For public funding, 119 ophthalmologists received $157,319,575.00 with a 31.0% increase from 2015 to 2021. Among 119 principal investigators, 37 (31.1%) were women and 82 (68.9%) were men (P = 0.05).

CONCLUSION

Industry-funded and publicly funded age-related macular degeneration-related research payments overall increased from 2015 to 2021. Funding distribution by sex trended towards male recipients. [Ophthalmic Surg Lasers Imaging Retina 2025;56:95-100.].

Association between Age-Related Macular Degeneration with Visual Disability and Risk of Dementia: A Nationwide Cohort Study

OBJECTIVES

To investigate the prospective association between the risk of dementia and age-related macular degeneration (AMD) in patients with related visual disability (VD).

DESIGN

A nationwide population-based cohort study used authorized data provided by the Korean National Health Insurance Service.

SETTING AND PARTICIPANTS

A total of 1,788,457 individuals aged >50 years who participated in the Korean National Health Screening Program were enrolled.

METHODS

From January 2009 to December 2019, participants were tracked for a diagnosis of dementia using registered diagnostic codes from claims data. Participants with VD were defined as those registered in a national disability registration established by the Korean government. The prospective association of AMD and related VD with new-onset dementia was investigated using a multivariate-adjusted Cox proportional hazard model adjusted for age, sex, body mass index, income level, systemic comorbidities, psychiatric diseases, and behavioral factors.

RESULTS

During the average follow-up period of 9.7 ± 2.16 years, 4260 of 21,384 participants in the AMD cohort and 137,166 of 1,662,319 participants in the control cohort were newly diagnosed with dementia, respectively. Participants diagnosed with AMD showed a higher risk of new-onset dementia than those in the control group in the fully adjusted model [hazard ratio (HR) 1.11, 95% CI 1.07-1.14]. The risk of dementia was higher in participants diagnosed with AMD and associated VD (HR 1.28, 95% CI 1.15-1.43) compared to those without VD (HR 1.09, 95% CI 1.06-1.13).

CONCLUSIONS AND IMPLICATIONS

A diagnosis of AMD was associated with an increased risk of all-cause dementia and its major subtypes. Close monitoring of cognitive function in patients with AMD, especially those with VD, may help in early detection of all-cause dementia, which could reduce the socioeconomic burden and improve the quality of life of patients.

Investigating the Link between Psychological Well-Being and Early-Stage Age-Related Macular Degeneration: A Mendelian Randomization Analysis

PURPOSE

While some studies have started to focus on the link between psychological well-being and age-related macular degeneration (AMD), the relationship remains uncertain. Our research aims to provide new insights into this association, laying a foundation for future interventions and addressing existing knowledge gaps.

METHODS

We utilized the "TwoSampleMR" package in R for a bidirectional Mendelian randomization analysis of psychological well-being (subjective well-being, depression, neuroticism, and Sensitivity to Environmental Stress and Adversity) and early-stage AMD. Causal effects were estimated using the inverse-variance weighted method, and additional methods included weighted median and MR-Egger regression. Sensitivity analyses included Cochran's Q test, MR-Egger intercept analysis, MR-PRESSO, and leave-one-out analysis.

RESULTS

The study found that the population with genetic predisposition to neuroticism had a 39.7% lower risk of early-stage AMD (OR = 0.603, 95% CI = 0.385-0.945, p = 0.027). Conversely, the population with genetic predisposition to subjective well-being had a 3.2% increased risk of early-stage AMD (OR = 1.032, 95% CI = 1.003-1.063, p = 0.029). No significant causal relationships were found from depression or Sensitivity to Environmental Stress and Adversity to early-stage AMD, nor from early-stage AMD to psychological well-being.

CONCLUSION

This study provides preliminary evidence that the relationship between psychological well-being and early-stage AMD may be complex and multifaceted. It suggests that moderate neuroticism levels might reduce early-stage AMD risk through health behaviors, pathophysiological mechanisms, and other factors, while high subjective well-being levels might increase this risk similarly. However, these findings are insufficient for preventive strategies due to a lack of substantial evidence and still require extensive experimental research for further validation.

Associations between co-exposure to multiple heavy metals and age-related macular degeneration: A cross-sectional study

BACKGROUND & AIMS

Accumulating evidence suggests that exposure to single heavy metal can facilitate the progression of age-related macular degeneration (AMD). However, the effects of exposure to mixtures of heavy metals on AMD remain largely unexplored. This study aims to investigate both the joint and individual impacts of arsenic (As), mercury (Hg), cadmium (Cd), and lead (Pb) on AMD within a co-exposure framework.

METHODS

Data from subjects participating the US National Health and Nutrition Examination Survey (NHANES, 2005-2008) were analyzed. Concentrations of As, Hg, Cd, and Pb were determined in urine by inductively coupled plasma dynamic reaction cell mass spectrometry (ICP-DRC-MS) for As and Hg, and inductively coupled plasma mass spectrometry (ICP-MS) for Cd and Pb. The weighted quantile sum (WQS) and Bayesian kernel machine regression (BKMR) models were employed to assess the effects of heavy metal mixtures on AMD risk.

RESULTS

Both WQS and BKMR analyses consistently revealed a significant overall association between heavy metal mixtures and the risk of all types of AMD. The combined effect was more evident among patients with early AMD compared to those with late AMD. Cd and Hg were the main contributors driving these combined effects within the context of metal mixtures. Elevated urinary levels of Cd were positively correlated with an increased risk for all types as well as early AMD. Higher exposure to Hg corresponded with an elevated risk for early AMD. Furthermore, BKMR analysis indicated that the influence of Cd on early AMD exhibited a non-linear pattern.

CONCLUSIONS

Our findings suggest that co-exposure to As, Hg, Cd, and Pb is associated with an elevated risk for developing AMD, particularly in its early stages. Furthermore, excessive exposure to Cd and Hg has been identified as key contributing factors in this process.

Exploring ocular disorders in Parkinson's disease: A comprehensive review and future perspectives

Parkinson's disease (PD) is a multifaceted neurodegenerative disorder characterized by predominantly motor symptoms. However, recent research has broadened our understanding of PD by revealing its impact on non-motor functions, including ocular manifestations. This review explored the intricate relationship between PD and ocular health, shedding light on the mechanisms underlying common ocular diseases such as dry eye disease, cataract, glaucoma, age-related macular degeneration, and diabetic retinopathy. It also underscores the importance of recognizing ocular manifestations as potential early markers of PD, as well as their impact on patients' daily activities, necessitating prompt identification and intervention to prevent complications and enhance the overall quality of life. Furthermore, future research should prioritize unraveling the potential association between PD and other prevalent ocular diseases, such as myopia, to formulate effective treatment strategies.

Association of dietary inflammatory index with ocular diseases: a population-based cross-sectional study

BACKGROUND

Our research was designed to investigate the relationship between dietary inflammatory index (DII) and risk of ocular diseases, including glaucoma, cataract, age-related macular degeneration (ARMD), and diabetic retinopathy.

METHODS

We used the National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2008 to conduct this study. The correlation between DII and risk of ocular diseases was examined using weighted multivariable logistic regression analysis, restricted cubic spline (RCS) plots, and subgroup analysis.

RESULTS

In total, 2885 participants from the NHANES database were included. The DII scores were divided into four group: Q1 (- 4.438-0.386), Q2 (0.387-1.848), Q3 (1.849-3.073), and Q4 (3.074-4.970). RCS shown that there was a U-shaped correlation between DII and prevalence of glaucoma, cataract, ARMD, and diabetic retinopathy. After adjusting for underlying confounding variables, compared to Q1 group, the odd ratios (ORs) with 95 percent confidence intervals (CIs) for glaucoma, cataract, ARMD, and diabetic retinopathy across the quartiles were [0.97 (0.54, 1.75), 1.20 (0.68, 2.11), and 1.29 (0.73, 2.30)], [0.87 (0.56, 1.35), 1.12 (0.73, 1.73), and 1.16 (0.75, 1.80)], [0.85 (0.53, 1.36), 0.66 (0.40, 1.09), and 0.97 (0.61, 1.56)] and [0.86 (0.63, 1.18), 0.89 (0.65, 1.22), and 1.04 (0.75, 1.45)] for DII, respectively.

CONCLUSIONS

Reducing the intake of pro-inflammatory foods may be an effective measure to prevent the onset of ocular disease, including glaucoma, cataract, ARMD, and diabetic retinopathy. However, eating only anti-inflammatory foods is not the best choice.

Utilization of Nanoparticles for Treating Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is a predominant cause of vision loss, posing significant challenges in its management despite advancements such as anti-vascular endothelial growth factor (anti-VEGF) therapy. Nanomedicine, with its novel properties and capabilities, offers promising potential to transform the treatment paradigm for AMD. This review reports the significant advancements in the use of diverse nanoparticles (NPs) for AMD in vitro, in vivo, and ex vivo, including liposomes, lipid nanoparticles, nanoceria, nanofibers, magnetic nanoparticles, quantum dots, dendrimers, and polymer nanoparticles delivered in forms such as gels, eye drops, intravitreally, or intravenously. Drug delivery was the most common use of NPs for AMD, followed by photodynamic therapy dose enhancement, antioxidant function for nanoceria, biomimetic activity, and immune modulation. Innovative approaches arising included nanotechnology-based photodynamic therapy and light-responsive nanoparticles for controlled drug release, as well as gene therapy transfer. Nanomedicine offers a transformative approach to the treatment and management of AMD, with diverse applications. The integration of nanotechnology in AMD management not only provides innovative solutions to overcome current therapeutic limitations but also shows potential in enhancing outcomes and patient quality of life.

A review on eye diseases induced by blue light: pathology, model, active ingredients and mechanisms

Blue light induced eye damage (BLED) belongs to modern diseases. It is an ophthalmic disease caused by prolonged exposure to electronic devices or screens containing a large amount of high-energy short waves (blue light). Specific symptoms include dryness and discomfort in the eyes, blurred vision, headache, insomnia, and in severe cases, it may also cause various eye diseases such as cataracts and glaucoma. At present, the development of health products and drugs for eye blue light injury faces many difficulties. Therefore, further exploration and research are needed on the pathogenesis, pathophysiology, and pharmacological mechanisms of blue light injury. Natural medicine ingredients and preparations have unique advantages in targeting eye blue light injury fatigue products due to their multi-component synergistic effects, overall regulation, and mild and safe characteristics. Starting from the disease-related mechanisms and pathophysiological characteristics of eye blue light injury, this article elucidates the pharmacological mechanisms of various drugs for treating eye blue light injury. At the same time, it reviews the research on in vitro cultured cell and animal model conditions for blue light injury eyes, in order to provide reference for subsequent blue light injury modeling experiments. And explore future research directions to provide new ideas and methods for the prevention and treatment of BLED.

The amplitude of low frequency fluctuation and spontaneous brain activity alterations in age-related macular degeneration

Background

Wet age-related macular degeneration (wAMD) is a vision-threatening eye disease worldwide. The amplitude of low-frequency fluctuation (ALFF) method was used to observe changes in spontaneous brain activity, which may help to investigate the underlying pathological mechanism of AMD.

Methods

Eighteen patients with wAMD and 18 age- and gender-matched healthy controls (HCs) were recruited. The ALFF method was used on each subject and mean ALFF values were compared between groups. The receiver operating characteristic (ROC) curve was used to compare the two groups.

Results

ALFF values in the temporal lobe and limbic lobe/parahippocampal gyrus were significantly higher than controls, while values in the postcentral gyrus were significantly lower. The under the curve of the ROC (AUC) of the three regions shows high accuracy of the diagnosis.

Conclusion

The abnormal spontaneous brain activity of patients with AMD suggests scope for the use of ALFF in the diagnosis or prognosis in AMD.

Co-isolation of human donor eye cells and development of oncogene-mutated melanocytes to study uveal melanoma

BACKGROUND

Uveal melanoma (UM) is the most common intraocular tumor in adults, arises either de novo from normal choroidal melanocytes (NCMs) or from pre-existing nevi that stem from NCMs and are thought to harbor UM-initiating mutations, most commonly in GNAQ or GNA11. However, there are no commercially available NCM cell lines, nor is there a detailed protocol for developing an oncogene-mutated CM line (MutCM) to study UM development. This study aimed to establish and characterize premalignant CM models from human donor eyes to recapitulate the cell populations at the origin of UM.

RESULTS

Given the precious value of human donor eyes for studying multiple ocular cell types, we validated a co-isolation protocol of both human NCMs and retinal pigment epithelial (RPE) cells from a single eye. To this end, NCMs and RPE cells were sequentially isolated from 20 donors, with success rates of 95% and 75%, respectively. MutCMs were generated from 10 donors using GNAQQ209L-carried lentivirus with high mutant copies (up to 98.8% of total GNAQ copies being mutant). NCM growth and behavior were characterized under different culture conditions (i.e., supplementation with serum and 12-O-tetradecanoylphorbol-13-acetate) to determine optimized protocols. Particularly, Matrigel™ coating induced spheroid growth under certain coating thickness and cell seeding density but did not improve NCM metabolic activity. Current methodologies in NCM isolation, culture, and research applications were summarized. Proteomic profiling of 4 NCMs, 1 MutCM, and 3 UMs allowed to discover significant differences in UMs including a downregulation of proteins linked to melanocyte differentiation and an upregulation of proteins involved in RNA metabolism. RNA sequencing revealed enriched pathways related to cancer, notably PI3K-Akt and MAPK signaling pathways, in MutCMs and UM cells compared to NCMs, providing insights into molecular changes in GNAQQ209L-mutated pre-cancer cell models and UM cells.

CONCLUSIONS

We successfully isolated and established NCM, RPE, and MutCM cell lines. We describe efficient methods for the isolation and growth of NCMs and report their phenotypic, proteomic, and transcriptomic characteristics, which will facilitate the investigation of UM development and progression. The co-isolated RPE cells could benefit research on other ocular pathologies, such as age-related macular degeneration.

A bibliometric and visualization analysis of electrochemical biosensors for early diagnosis of eye diseases

Electrochemical biosensors can provide an economical, accurate and rapid method for early screening of disease biomarkers in clinical medicine due to their high sensitivity, selectivity, portability, low cost and easy manufacturing, and multiplexing capability. Tear, a fluid naturally secreted by the human body, is not only easily accessible but also contains a great deal of biological information. However, no bibliometric studies focus on applying electrochemical sensors in tear/eye diseases. Therefore, we utilized VOSviewer and CiteSpace, to perform a detailed bibliometric analysis of 114 papers in the field of research on the application of tear in electrochemical biosensors screened from Web of Science with the combination of Scimago Graphica and Microsoft Excel for visualization to show the current research hotspots and future trends. The results show that the research in this field started in 2008 and experienced an emerging period in recent years. Researchers from China and the United States mainly contributed to the thriving research areas, with 41 and 29 articles published, respectively. Joseph Wang from the University of California San Diego is the most influential author in the field, and Biosensors & Bioelectronics is the journal with the most published research and the most cited journal. The highest appearance keywords were "biosensor" and "tear glucose," while the most recent booming keywords "diagnosis" and "in-vivo" were. In conclusion, this study elucidates current trends, hotspots, and emerging frontiers, and provides future biomarkers of ocular and systemic diseases by electrochemical sensors in tear with new ideas and opinions.

Applications and latest research progress of liposomes in the treatment of ocular diseases

The special structure of eyes and the existence of various physiological barriers make ocular drug delivery one of the most difficult problems in the pharmaceutical field. Considering the problems of patient compliance, local administration remains the preferred method of drug administration in the anterior part of eyes. However, local administration suffers from poor bioavailability, need for frequent administration, and systemic toxicity. Administration in the posterior part of the eye is more difficult, and intravitreal injection is often used. But intravitreal injection faces the problems of poor patient compliance and likely side effects after multiple injections. The development of nanocarrier technology provides an effective way to solve these problems. Among them, liposomes, as the most widely used carrier in clinical application, have the characteristics of amphiphilic nanostructure, easy surface modification, extended release time, good biocompatibility, etc. The liposomes are expected to overcome obstacles and effectively deliver drugs to the target site to improve ocular drug bioavailability. This review summarized the various controllable properties of liposomes for ocular delivery as well as the application and research progress of liposomes in various ocular diseases. In addition, we summarized the physiological barriers and routes of administration contained in eyes, as well as the prospects of liposomes in the treatment of ocular diseases.

Physiology and pathophysiology of the retinal neuroglia

Neuroglia of the retina are represented by Müller glia, parenchymal astrocytes, microglia and oligodendrocytes mainly associated with the optic nerve. Müller glia are the most numerous glia, endowed with multiple homeostatic functions and indispensable for the retinal morphofunctional organization. Müller cells integrate retinal neurons into individual functional units (known as retinal columns) and act as a living light guide, transmitting photons to photoreceptors. In pathology, retinal neuroglia undergo complex changes, which include upregulation of neuroprotection, reactive gliosis, and functional asthenia. The balance between all these changes defines the progression and outcome of retinal disorders.

Incidence and risk factors of fellow-eyes wet conversion in unilateral neovascular age-related macular degeneration over 15-year follow-up

PURPOSE

Incidence and risk factors of fellow eye wet conversion in unilateral neovascular age-related macular degeneration (nAMD) over 15-years follow-up.

METHODS

This retrospective study reviewed 593 unilateral nAMD patients with a minimum of five years up to 15 years of follow-up. The demographic data, visual acuity, fellow eye nAMD conversion rate, and the number of anti-vascular endothelial growth factor (anti-VEGF) injections in the primary eye were evaluated. Also, the nAMD-converted fellow eyes were divided into two groups based on the time of conversion (less and more than two years from the first injection in the primary eye). Based on the data types, the T-test, Chi-square, and Mann-Whitney U test were used to analyze.

RESULTS

The total cases were 593 patients, and 248 eyes (41.82%) converted to nAMD in the mean interval of 34.92 ± 30.62 months. The males exhibited a predisposition to wet conversion at 2.54 years earlier than their female counterparts (P = 0.025). In all the converted fellow eyes, the mean age was 2.3 years higher at presentation in the group who converted within two years of follow-up in compared to eyes that converted after two years (79.82 ± 8.64 vs 77.51 ± 8.5 years, P = 0.035). Additionally, eyes converting within two years had a mean baseline LogMAR visual acuity of 0.44 ± 0.47, compared to 0.32 ± 0.41 for conversions after two years (P = 0.014).

CONCLUSION

This study reported that males showed a predisposition to fellow eye nAMD conversion at an earlier age. Additionally, there was a trend of faster fellow eye nAMD conversion in individuals with higher age and lower baseline visual acuity.

KEY MESSAGES

What is known • Certain risk factors may make the fellow eye of neovascular age-related macular degeneration (nAMD) more likely to progress to wet conversion. • Identifying these risk factors for fellow eye wet conversion can help prevent it, potentially preserving the patient's vision quality for a longer duration. • The studies on the incidence of wet conversion in the fellow eye have yielded controversial results. What is new • During the 15-year follow-up period, nearly half (47.58%) of the fellow eyes that underwent wet conversion did so within the initial two years following the wet conversion of the first eye. • Males showed a predisposition to fellow eye nAMD conversion at an earlier age. • There was a trend of faster fellow eye nAMD conversion in individuals with higher age and lower baseline visual acuity.

Pistachio Consumption Increases Macular Pigment Optical Density in Healthy Adults: A Randomized Controlled Trial

BACKGROUND

Pistachios are a bioavailable source of the xanthophyll lutein. Along with zeaxanthin, these plant pigments are major components of macular pigment (MP) in the human retina. MP can be non-invasively measured and is referred to as MP optical density (MPOD). MPOD is modifiable with dietary interventions that include lutein and zeaxanthin (L/Z). Higher MPOD protects the eye from light damage and is positively associated with eye health.

OBJECTIVES

This dietary intervention study aimed to evaluate the effect of pistachio consumption on MPOD.

METHODS

This single-blinded, randomized controlled trial compared a 12-week pistachio intervention (2 oz/d) with usual diet (UD) on MPOD and serum L/Z in middle-aged to older healthy adults (n = 36) in a 1:1 randomization scheme. Participants were selected for habitually low L/Z intake and low baseline MPOD. MPOD was measured using heterochromatic flicker photometry at 4 retinal eccentricities during baseline, week 6, and week 12 study visits. Serum L/Z was analyzed using high-performance liquid chromatography. Primary statistical analysis was conducted on an intent-to-treat basis using repeated-measure analysis of variance.

RESULTS

Compared with UD, MPOD of the participants in the pistachio intervention group (PIS) had significantly increased (P < 0.001) at all eccentricities over the initial 6-wk period. This increase was maintained at week 12. MPOD in the UD participants did not change during the 12-week period. Serum lutein concentration followed a similar pattern to MPOD; serum cis-lutein and zeaxanthin did not change in either group over the 12-wk intervention.

CONCLUSIONS

The results of our study demonstrate that a dietary intervention with pistachios is efficacious in increasing MPOD in healthy adults selected for habitually low intake of L/Z and low baseline MPOD. This suggests that pistachio consumption could be an effective dietary strategy for preserving eye health. Future studies need to evaluate the generalizability of our findings to other populations. This trial was registered at clinicaltrials.gov as NCT05283941.

Therapeutic Management and New Upcoming Approaches for Age Related Macular Degeneration

Age-related Macular Degeneration (AMD) is a severe eye illness that is going to lead in the race for incurable blindness globally among the elderly population. AMD is the third common reason responsible for affecting the quality of life globally. The macula and the retinal layers are adversely affected during AMD and are responsible for the loss of vision eventually. Numerous genetic variables, lipid metabolism, ageing and oxidative damage are the causative factors in the genesis of AMD. Lack of antioxidants, smoking and excessive alcohol intake contribute to increasing the risk of AMD. Management of dry AMD involves the use of nutritional supplements like zinc and antioxidants, along with conventional treatment, however, the use of nutritional supplements can only give minor benefits on the progression of dry AMD. Later stages of AMD need to be managed by cell-based interventions where the damaged or lost cells are replaced with fresh donor cells. A plethora of treatment methods are used in the management of AMD, such as nutrition, antibody-based treatments, stem cell management and nanotherapeutics. The available expensive treatments come with a number of adverse effects and future developments require the involvement of risk factor modification approaches, personalized therapy, targeting the disease specific pathways, exploring better anti-vascular endothelial growth factor (VEGF) inhibitors and many other regenerative approaches, that will broaden techniques to diagnose, control and treat AMD. This review provides an overview of the progression of AMD and the causative factors, with considerable emphasises on the current and potential prospects.

Innovative technologies for the treatment of dry age-related macular degeneration (AMD) - modern therapeutic perspectives and their future

Purpose

This review explores modern therapeutic options for the dry form of age-related macular degeneration (AMD), a condition representing one of the most significant challenges in ophthalmology due to its progressive nature and lack of effective treatment. The study discusses innovative approaches, evaluates available methods, and examines the potential of emerging technologies to improve patients' quality of life.

Methods

A comprehensive review of current literature was conducted, being focused on therapies for dry AMD, including classical methods such as AREDS/AREDS2 supplementation, molecularly targeted drugs, gene therapy, cell transplants, tissue engineering, nanotechnology, and light-based therapies. Emerging tools leveraging artificial intelligence for personalized treatment and predictive modeling were also evaluated.

Results

AREDS/AREDS2 therapies effectively slow disease progression but cannot reverse retinal damage. Advances include molecularly targeted therapies (Pegcetacoplan, Avacincaptad Pegol) that reduce inflammation, gene therapy (HMR59) protecting RPE cells, and mitochondria-targeted drugs (SS-31) mitigating oxidative stress. Using scaffolds, nanoparticles, tissue engineering, and nanotechnology enhances RPE regeneration and drug delivery. Light-based therapies (LLLT, adaptive phototherapy) improve mitochondrial function, while AI aids in predicting disease progression and personalizing treatment.

Conclusions

Modern therapeutic approaches for dry AMD provide promising avenues to slow disease progression and protect vision. However, further clinical trials are needed to optimize these strategies, assess long-term outcomes, and expand patient access to effective treatments. These advancements have the potential to significantly improve the quality of life for individuals affected by dry AMD.

Geographic atrophy and factors associated with disease progression among Medicare Advantage enrollees

BACKGROUND

Geographic atrophy (GA) is a form of advanced age-related macular degeneration (AMD) that can cause irreversible vision impairment and is responsible for approximately 20% of legal blindness in the United States. There is limited real-world evidence assessing health outcomes and health care resource use (HCRU) among individuals with GA.

OBJECTIVE

To examine the progression from GA without subfoveal involvement (SFI) to GA with SFI, progression to irreversible blindness, and HCRU among older individuals with GA enrolled in Medicare Advantage Prescription Drug (MAPD) plans.

METHODS

This retrospective study used claims data for MAPD-plan enrollees aged at least 65 years with an AMD diagnosis between 2018 and 2021. To assess progression of GA, development of blindness, and HCRU, propensity score matched cohorts of individuals with GA and without GA were identified and compared. For GA progression analysis, at least 12 months of follow-up was required, and patients were followed until the end of either follow-up or study period.

RESULTS

Total 9,511 individuals with GA were matched 1:1 to individuals without GA. Among individuals with GA, initial diagnosis was primarily by an ophthalmologist (58.6%) followed by an optometrist (30.9%). The most common diagnostic imaging procedure at index was optical coherence tomography (53.0%). Mean follow-up time was 2.3 years. At index, 4,781 (50.3%) individuals had GA without SFI and 4,697 (49.4%) had GA with SFI. Among individuals with GA without SFI at index, 479 (10.2%) progressed to GA with SFI during the 12-month follow-up. Among individuals with GA without SFI at index, 173 (3.6%) developed irreversible blindness, compared to 312 (6.6%) of those with SFI, and 51 (0.5%) individuals without GA. Kaplan-Meier analysis indicated fastest progression to irreversible blindness among individuals with GA with SFI, followed by those without SFI (log-rank test P < 0.001). Both diagnosis of GA without SFI (hazard ratio [HR] [CI] = 6.77 [4.98-9.35], P < 0.001) and diagnosis of GA with SFI (HR [CI] = 12.59 [9.43-17.16], P < 0.001) were strongly associated with increased risk of developing irreversible blindness. Significant predictors of progression to GA with SFI were wet AMD at baseline (HR [CI] = 5.70 [4.63-6.99], P < 0.001), Elixhauser comorbidity score of 4-5 (HR [CI] = 1.46 [1.12-1.91], P = 0.006), and more than 5 (HR [CI] = 1.40 [1.02-1.89], P = 0.035).

CONCLUSIONS

GA with or without SFI was associated with progression to irreversible blindness in an MAPD-plan population. Patients with GA with SFI progressed to irreversible blindness faster than patients with GA without SFI. With the recent approval of GA treatments, future research is needed to assess the impacts on disease progression, including blindness.

RPE Basal Lamina Biology and Pathophysiology Related to Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is a progressive eye disease that primarily affects the central part of the retina and is a leading cause of vision impairment worldwide (Wong WL, Su X, Li X, Lancet Glob Health 2:e106-116, 2014). Sub-retinal pigment epithelium (RPE) deposits represent a broadly defined term encompassing compositionally and anatomically distinct protein and lipid aggregates (i.e., drusen, basal linear deposits [BLinDs], and basal laminar deposits [BLamDs]). These deposits play a pivotal role in the pathogenesis of AMD and act as both key indicators and contributors to disease progression (van der Schaft TL, de Bruijn WC, Mooy CM, de Jong PT, Graefes Arch Clin Exp Ophthalmol 231:470-475, 1993; Sarks SH, Arnold JJ, Killingsworth MC, Sarks JP, Br J Ophthalmol 83:358-368, 1999; Sura AA, Chen L, Messinger JD, Invest Ophthalmol Vis Sci 61:19, 2020). Thus, understanding factors that influence sub-RPE deposit formation is crucial, especially in the context of retinal health and disease (Loeffler KU, Lee WR, Br J Ophthalmol 82:1104-1105, 1998; Sarks SH, Arnold JJ, Killingsworth MC, Sarks JP, Br J Ophthalmol 83:358-368, 1999). In this mini review, we have gathered and discussed valuable insights to provide a comprehensive overview focusing on BLamDs and their relevance to retinal disease.

Annual prevalence of geographic atrophy and wet age-related macular degeneration among Medicare Advantage enrollees in a US health plan

BACKGROUND

Geographic atrophy (GA) is an advanced form of dry age-related macular degeneration (AMD) that can lead to visual impairment. Published studies estimate approximately 1 million people in the United States have GA in at least 1 eye. There is a lack of real-world evidence from the US payer perspective on the prevalence of AMD and GA among Medicare Advantage prescription drug (MAPD) plan enrollees.

OBJECTIVE

To estimate the annual prevalence of GA, wet AMD, and co-occurring GA and wet AMD among MAPD plan enrollees from 2018 through 2021.

METHODS

This retrospective, cross-sectional study estimated the prevalence of GA and AMD based on Medicare Advantage enrollee claims data. Individuals aged 65 years and older who had continuous enrollment throughout each calendar year constituted the denominator for each annual prevalence calculation. Enrollees with at least 1 medical claim with a diagnosis code for GA or wet AMD during each year were identified to estimate annual prevalence for that respective calendar year.

RESULTS

The total number of patients in the denominator was 2,175,803 (2018); 2,445,163 (2019); 2,680,322 (2020); and 2,905,366 (2021). The annual prevalence of GA was 0.56% (2018), 0.55% (2019), 0.48% (2020), and 0.51% (2021). The annual prevalence of wet AMD was 1.2% (2018), 1.3% (2019), 1.2% (2020), and 1.3% (2021). The prevalence of GA was highest among individuals classified as White race (annual range 0.61% to 0.71%) and among patients with GA aged 75 years and older (range 0.95% to 1.11%). The proportion of patients with GA with co-occurring wet AMD was 25.6% to 28.0%. The annual prevalence of advanced AMD (GA or wet AMD) was 1.6% to 1.7%.

CONCLUSIONS

In the Medicare populations, the prevalence of GA was greatest among patients aged 75 years and older and individuals classified as White race. A substantial proportion of individuals with GA had evidence of co-occurring wet AMD. MAPD plans should evaluate how their membership may be impacted by the recently approved medications for the treatment of GA.

The Potential Causal Association of Apolipoprotein A and B and Age-Related Macular Degeneration: A Mendelian Randomisation Study

BACKGROUND/OBJECTIVES

Research has suggested a potential relationship between apolipoproteins A (ApoA) and B (ApoB) and age-related macular degeneration (AMD). This study explored the potential causal relationship between ApoA/ApoB levels and AMD/AMD subtypes using two-sample Mendelian randomisation (MR).

METHODS

We selected 308 single nucleotide polymorphisms (SNPs) for ApoA and 198 SNPs for ApoB from the UK Biobank data. Summary statistics for AMD were collected from the genome-wide association study of the FinnGen project. We performed two-sample MR to assess the causal effects of ApoA/ApoB on AMD and its subtypes. Potential confounders, including body mass index, C-reactive protein level, and smoking status, were assessed using a multivariable MR analysis.

RESULTS

ApoA showed a significant causal association with AMD (odds ratio [OR] = 1.14, 95% confidence interval [CI] = 1.05-1.25, p = 0.003) and was linked to both dry (p = 0.004) and wet (p = 0.025) AMD. ApoB showed a decreasing trend in dry AMD risk (p = 0.074), though not significant, and was not associated with overall or wet AMD. The multivariable MR analysis showed no significant association of ApoA with any AMD subtype (p > 0.05). ApoB decreased dry AMD risk (OR = 0.89, 95% CI = 0.80-0.99, p = 0.039), with trends for overall and wet AMD that were not significant (p = 0.070 and p = 0.091, respectively).

CONCLUSIONS

These findings suggest that ApoB is associated with lower AMD risk, particularly for dry AMD. Further research is needed to clarify lipid biomarker's role as AMD risk factors.

Potential Use of Plasma Rich in Growth Factors in Age-Related Macular Degeneration: Evidence from a Mouse Model

Background and Objectives: Age-related macular degeneration (AMD) is the leading cause of low vision and legal blindness in adults in developed countries. Wet AMD can be successfully treated using vascular endothelial growth factor (VEGF) inhibitors; however, dry AMD currently has no effective treatment. The purpose of this study is to analyze the efficacy of intraocular injection of plasma rich in growth factors (PRGF) in an AMD mouse model induced by intraperitoneal administration of sodium iodate. Materials and Methods: Intravitreal application of PRGF (experimental group) and saline (control group) was performed immediately after intraperitoneal injection of sodium iodate. Retinographies were performed at 2 and 7 days after treatment administration. The eyes were retrieved for histological and immunohistological analysis. Statistical analysis was performed to compare the outcomes between the study groups. Results: In comparison to saline solution, PRGF significantly decreased the depigmentation of the RPE, showing a more reddened retina. PRGF intravitreal treatment significantly reduced the glial fibrillary acidic protein (GFAP) stained processes, suggesting a significant reduction in the risk of scar formation. Moreover, the myofibroblast invasion into the RPE cell layer was significantly reduced in the PRGF-treated group of mice. There was a tendency for better preservation of the photoreceptors in the PRGF group. Conclusions: Within the limitations of this study, intravitreal injection of PRGF provided significant protection against the degeneration of the photoreceptors and the RPE induced by the systemic administration of NaIO3.

Different Therapeutic Approaches for Dry and Wet AMD

Age-related macular degeneration (AMD) is the most common cause of irreversible loss of central vision in elderly subjects, affecting men and women equally. It is a degenerative pathology that causes progressive damage to the macula, the central and most vital part of the retina. There are two forms of AMD depending on how the macula is damaged, dry AMD and wet or neovascular AMD. Dry AMD is the most common form; waste materials accumulate under the retina as old cells die, not being replaced. Wet AMD is less common, but can lead to vision loss much more quickly. Wet AMD is characterized by new abnormal blood vessels developing under the macula, where they do not normally grow. This frequently occurs in patients who already have dry AMD, as new blood vessels are developed to try to solve the problem. It is not known what causes AMD to develop; however, certain risk factors (i.e., age, smoking, genetic factors) can increase the risk of developing AMD. There are currently no treatments for dry AMD. There is evidence that not smoking, exercising regularly, eating nutritious food, and taking certain supplements can reduce the risk of acquiring AMD or slow its development. The main treatment for wet AMD is inhibitors of VEGF (vascular endothelial growth factor), a protein that stimulates the growth of new blood vessels. VEGF inhibitors can stop the growth of new blood vessels, preventing further damage to the macula and vision loss. In most patients, VEGF inhibitors can improve vision if macular degeneration is diagnosed early and treated accordingly. However, VEGF inhibitors cannot repair damage that has already occurred. Current AMD research is trying to find treatments for dry AMD and other options for wet AMD. This review provides a summary of the current evidence regarding the different treatments aimed at both forms of AMD with particular and greater attention to the dry form.

Advances in the study of tissue-engineered retinal pigment epithelial cell sheets

Regarded as the most promising treatment modality for retinal degenerative diseases, retinal pigment epithelium cell replacement therapy holds significant potential. Common retinal degenerative diseases, including Age-related Macular Degeneration, are frequently characterized by damage to the unit comprising photoreceptors, retinal pigment epithelium, and Bruch's membrane. The selection of appropriate tissue engineering materials, in conjunction with retinal pigment epithelial cells, for graft preparation, can offer an effective treatment for retinal degenerative diseases. This article presents an overview of the research conducted on retinal pigment epithelial cell tissue engineering, outlining the challenges and future prospects.

Traversing the epigenetic landscape: DNA methylation from retina to brain in development and disease

DNA methylation plays a crucial role in development, aging, degeneration of various tissues and dedifferentiated cells. This review explores the multifaceted impact of DNA methylation on the retina and brain during development and pathological processes. First, we investigate the role of DNA methylation in retinal development, and then focus on retinal diseases, detailing the changes in DNA methylation patterns in diseases such as diabetic retinopathy (DR), age-related macular degeneration (AMD), and glaucoma. Since the retina is considered an extension of the brain, its unique structure allows it to exhibit similar immune response mechanisms to the brain. We further extend our exploration from the retina to the brain, examining the role of DNA methylation in brain development and its associated diseases, such as Alzheimer's disease (AD) and Huntington's disease (HD) to better understand the mechanistic links between retinal and brain diseases, and explore the possibility of communication between the visual system and the central nervous system (CNS) from an epigenetic perspective. Additionally, we discuss neurodevelopmental brain diseases, including schizophrenia (SZ), autism spectrum disorder (ASD), and intellectual disability (ID), focus on how DNA methylation affects neuronal development, synaptic plasticity, and cognitive function, providing insights into the molecular mechanisms underlying neurodevelopmental disorders.

Reactive Oxygen Species Responsive Supramolecular Prodrug Eyedrops for the Treatment of Choroidal Neovascularization

Choroidal neovascularization (CNV) represents a hallmark of neovascular fundus diseases, including age-related macular degeneration and diabetic retinopathy. Traditional eyedrops have encountered formidable challenges in treating CNV, primarily due to their extremely poor intraocular bioavailability and potential adverse off-target effects. Herein, an ocular-permeable supramolecular prodrug eyedrop (Di-DAS/P-PCD) has been developed for the on-demand delivery of antiangiogenic agents in the oxidative microenvironment of CNV. The eyedrop nanoformulation is composed of cell-penetrating peptide-modified PEGylated cyclodextrin (P-PCD) and reactive oxygen species (ROS)-sensitive antiangiogenic dasatinib prodrug Di-DAS. In a laser-induced CNV mouse model, daily instillation of Di-DAS/P-PCD has achieved remarkable penetration into the choroid and significantly suppressed CNV growth while exhibiting a good biocompatibility profile. Our results highlight the potential of the supramolecular prodrug eyedrops as a versatile approach for the targeted treatment of CNV and other neovascular eye disorders.

Protective effect of zinc against A2E-induced toxicity in ARPE-19 cells: Possible involvement of lysosomal acidification

A key pathogenic mechanism of dry age-related macular degeneration (AMD) is lysosomal dysfunction in retinal pigment epithelium (RPE) cells, which results in the accumulation of lipofuscins such as A2E (N-retinylidene-N-retinylethanolamine) that further compromises lysosomal function. This vicious cycle leads to cell death and poor visual acuity. Here, we established an in vitro model of AMD by treating a human RPE cell line (ARPE-19) with A2E and examined whether raising zinc levels confers protective effects against lysosomal dysfunction and cytotoxicity. MTT assay showed that A2E induced apoptosis in ARPE-19 cells. pHrodo™ Red fluorescence staining showed that lysosomal pH increased in A2E-treated ARPE-19 cells. Treatment with a zinc ionophore (clioquinol) reduced A2E accumulation, restored lysosomal pH to the acidic range, and reduced A2E-induced cell death, all of which were reversed by the addition of a zinc chelator (TPEN). Consistent with the in vitro results, subretinal injections of A2E in mouse eyes resulted in the death of RPE cells as well as lysosomal dysfunction, all of which were reversed by co-treatment with clioquinol. Our results suggest that restoring the levels of intracellular zinc, especially in lysosomes, would be helpful in mitigating A2E-induced cytotoxic changes including lysosomal dysfunction in RPE cells in the pathogenesis of AMD.