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Abstract

In the genesis and later development of age-related macular degeneration (AMD), endothelial dysfunction (ED) has a crucial role. Various medicines (ACE inhibitors, AR blockers, statins, acetylsalicylic acid, trimetazidine, and third generation beta blockers) exert a beneficial effect on endothelial dysfunction or its consequential functional, structural and metabolic disorders. The beneficial effect of a favourable influence on and successful treatment of ED in patients with chronic vascular and cardiovascular diseases has become evidence now. In ED induced by oxidative stress (OS) ACE inhibitors, AR blockers and statins regenerate the lost balance between vasoconstrictors and vasodilators, growth factors and their inhibitors, pro-inflammatory and anti-inflammatory agents, as well as pro-thrombotic and fibrinolytic factors. They inhibit the development of OS and the evolution of its harmful effects. In addition, the AT1-receptor blocker telmisartan, with its peroxisome proliferator-activated receptor-gamma (PPARγ) agonist effect, also inhibits the development of choroidal neovascularisation (CNV); it exerts a clinically favourable influence on CNV and improves it. Aspirin, with its pleiotropic antiplatelet activity, effectively contributes to the restoration of the balance of endothelium, and trimetazidine helps in normalising, restoring the pathological metabolic status of organ tissues with impaired function. The third generation beta blocker carvedilol, nebivolol, as well as the PPARγ agonist pioglitazone and rosiglitazone exert their protective vascular effects exactly by means of their mitochondrial antioxidant effects. As the human vascular system is uniform, consubstantial; thus medicines beneficial in ED exert a favourable effect also on the vessels of the eye, in the retina. Based on the above, it seems logical to presume that, as a part of our primary and secondary preventive activity, such medicines should be given to (1) patients who have no macular degeneration, but have risk factors of AMD [and cardiovascular (CV) disease] inducing ED, and are older than 50 years; (2) patients who have been diagnosed with unilateral AMD, in order to prevent the damage of the contralateral eye due to macular degeneration; and finally (3) patients who have been diagnosed with bilateral AMD, in order to avert deterioration and in the hope of a potential improvement. In addition, we should strive to completely eliminate the risk factors of macular degeneration (and CV disease) which induce OS and consequential ED.

“A novel interpretation of relations between phenomena, particularly if it is a source for intellectual value, is worth as much as a discovery”

Confucius

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