What is the primary pathophysiological change in AMD?

The primary pathophysiological change in age-related macular degeneration (AMD) is the degeneration of retinal pigment epithelium (RPE). This layer of cells is crucial for supporting the photoreceptors in the retina, as it plays key roles in nutrient transport, waste disposal, and the visual cycle.

In AMD, the dysfunction and subsequent death of these RPE cells lead to the accumulation of drusen, which are deposits beneath the retina, and can result in the death of photoreceptors. This progressive damage culminates in vision loss primarily in the central visual field, which is characteristic of AMD. The degeneration of the RPE often precedes and facilitates other changes in the retina, such as the deterioration of the photoreceptors and the potential development of choroidal neovascularization (CNV), which can further compromise visual function.

While proliferation of retinal ganglion cells, deterioration of photoreceptors, and increased retinal detachment can be associated with various retinal diseases, they are not the hallmark changes seen specifically in AMD. The focus on the RPE's health highlights its pivotal role in maintaining overall retinal integrity and function, making this choice the most accurate representation of the condition's underlying pathology.