The Impact of Artificial Lighting on the Visual Capacity of Patients With Age-Related Macular Degeneration.

Introduction Aging is associated with an increased prevalence of neurodegenerative disorders and leads to irreversible changes in both humans and animal models. The retina, a layer of neural tissue that lines the interior of the eyeball, is exposed to various harmful and stressful environmental factors, including age-related changes, which affect its function. Age-related macular degeneration (AMD) is the leading cause of visual decline and blindness worldwide in individuals aged 65 years and older. The number of patients suffering from AMD is expected to increase significantly in the coming decades. AMD primarily affects the macular region of the retina, which is responsible for central vision. It has a significant impact on patients' lives due to the loss of sharp and color vision, interfering with daily activities such as recognizing faces and reading.

To date, there is no proven treatment that slows or prevents the progression of advanced AMD. Laser photocoagulation and photodynamic therapy reduce the risk of moderate or severe vision loss in some individuals with the neovascular form of the disease. Other medical and surgical interventions are under investigation, but none have been shown to be effective. Identifying the exact pathophysiological mechanisms of AMD remains challenging. However, clinico-pathological observations and epidemiological studies have provided valuable insights into potential pathways involved in AMD development. AMD is generally classified into two forms: non-exudative (dry or atrophic) and exudative (wet).

Exudative AMD is characterized by the development of choroidal neovascularization (CNV), i.e., fibrovascular tissue that grows from the choriocapillaris, penetrates through breaks in Bruch's membrane into the sub-retinal pigment epithelium (RPE) space, and then under the neurosensory retina. Dry AMD involves dysfunction in the RPE-Bruch's membrane-choriocapillaris complex, resulting in lesions such as drusen (small, yellow-white deposits located mainly in the macular area), focal pigment clumping, and RPE atrophy. The most severe atrophic lesion observed in AMD is geographic atrophy, characterized by a well-demarcated round or oval area of depigmentation or clear absence of RPE cells.

The wet form of AMD represents less than 10% of cases but can lead to severe complications if untreated. The latest approach in CNV treatment includes intravitreal injections of anti-angiogenic agents. Vascular Endothelial Growth Factor (VEGF) plays a key role in angiogenesis and in the development of all forms of wet AMD, regardless of angiographic appearance, and increases vascular permeability. Anti-VEGF drugs aim to inhibit VEGF activity, thereby suppressing neovascular growth and reducing vascular leakage. However, this therapy merely delays disease progression. Thus, there is a need for novel preventive and therapeutic strategies targeting AMD.

One factor influencing AMD patients' ability to perform daily activities is lighting conditions. According to current literature, the ideal lighting conditions for AMD patients have not yet been thoroughly studied. Recently, our research team published a pioneering mathematical model to determine optimal lighting intensity in phakic and pseudophakic patients. Identifying optimal lighting for AMD patients could greatly enhance their quality of life.