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    Visual cycle metabolites: Cause of AMD?

    Oxidative stress from accumulation of visual cycle adducts may play role

    Reviewed by Janet R. Sparrow, MD

    New York—Evidence to date suggests that age-related macular degeneration (AMD) is a multifactorial disease.

    However, new findings suggest that oxidative stress stemming from a growing accumulation of visual cycle adducts may play an important role in the pathogenesis of AMD, said Janet R. Sparrow, MD.

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    “There are a number of genes that have been implicated in AMD and there are likely multiple modifiable environmental factors at work,” said Dr. Sparrow, Anthony Donn Professor of Ophthalmic Science, Columbia University, New York.

    But the disease process probably also involves photo reactive fluorescent compounds that are produced inadvertently by the visual cycle and are deposited secondarily into the retinal pigment epithelium (RPE). Other changes in photoreceptor cells and in the choroid occur secondary to the dysfunction in RPE cells, she noted.

    At least 34 different genetic loci have been associated with AMD, Dr. Sparrow noted.

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    Nongenetic risk factors include age, smoking, nutrition, and sunlight. And while patients may not be able to reduce genetic risk factors for AMD or increasing age, they can take such positive steps as smoking cessation, appropriate nutrition that is high in antioxidative compounds, and sun protection, such as sunglasses.

    The protective effects of smoking cessation, increased intake of antioxidants, and sunglasses all play roles in reducing oxidative stress in the visual system, particularly in RPEs.

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    All cells are subject to oxidative stress, she said, but the visual system appears to be particularly vulnerable.

    Visual cycle adducts

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