Oxidative stress is a common contributor to many different neurodegenerative diseases, including retinal disorders such as age-related macular degeneration (AMD).
1 2 The retina is particularly susceptible to oxidative stress because of its high levels of photosensitizers and pigments, its high consumption of oxygen, and its exposure to visible light.
1 2 3 Multiple factors have been linked to the pathogenesis of AMD. These include inflammation,
4 choroidal neovascularization,
5 genetic factors including complement factor H polymorphisms,
6 and the accumulation of lipofuscin,
7 particularly a
bis-retinoid,
N-retinylidene-
N-retinylethanolamine (A2E), and its photoisomers, the major blue light–absorbing fluorophores of lipofuscin in the RPE believed to be associated with AMD pathogenesis.
7 Several epidemiologic studies suggest that long-term history of exposure to light may have some impact on the incidence of AMD.
8 Exposure to intense light causes photoreceptor death. Light-induced photoreceptor death is mediated by rhodopsin,
9 and the extent of its bleaching and its regeneration and visual transduction proteins determine the degree of damage.
10 11 Blue light– and white light–induced damage of retinal cells have been widely used as in vivo models.
12 13 Although the abnormality of the retinal pigment epithelium is thought to constitute the primary lesion in AMD,
14 it is the dysfunction and death of photoreceptors that accounts for vision loss. Studies performed on nonexudative AMD tissue show that the RPE becomes dysfunctional in persons susceptible to AMD. Secondarily, rod loss continues and cones begin to degenerate. Eventually, only a few cones remain in late-stage AMD.
15