Autophagy: A new insight into pathogenesis and treatment possibilities in age-related macular degeneration

Age-related macular degeneration (AMD) is a significant problem in healthcare, because it is a leading cause of central vision loss in individuals over 50 years old in well-developed countries. Pathogenesis of AMD is multifactorial and still not completely understood. Proven risk factors include the following: natural senescence of retina, oxidative stress, complement activation, chronic subretinal inflammatory reaction, genetic and environmental factors. Data on links between autophagy and AMD development are being raised. Autophagy is a cellular process involving the degradation of long-lived proteins and damaged fragments and components of cells; it is responsible for the maintenance of dynamic intracellular homeostasis and it enables cell survival under stress conditions. Disturbances of autophagy mechanisms, i.e. its activation or inhibition, may lead to the development of many various pathologies. Thus, autophagy plays a dual role, as a mechanism responsible for protecting or killing cells. The paper describes autophagy mechanisms and their role in the natural process of retinal cells senescence and presents the autophagy impairment as a crucial cause of AMD development. We also describe the impact of intravitreal anti-VEGF therapy on retinal autophagy mechanisms and potential new therapeutic modalities for AMD based on autophagy modulation.