pp 1–33 | Cite as

Microvascular contributions to age-related macular degeneration (AMD): from mechanisms of choriocapillaris aging to novel interventions

  • Agnes Lipecz
  • Lauren Miller
  • Illes Kovacs
  • Cecília Czakó
  • Tamas Csipo
  • Judit Baffi
  • Anna Csiszar
  • Stefano Tarantini
  • Zoltan Ungvari
  • Andriy Yabluchanskiy
  • Shannon ConleyEmail author


Aging of the microcirculatory network plays a central role in the pathogenesis of a wide range of age-related diseases, from heart failure to Alzheimer’s disease. In the eye, changes in the choroid and choroidal microcirculation (choriocapillaris) also occur with age, and these changes can play a critical role in the pathogenesis of age-related macular degeneration (AMD). In order to develop novel treatments for amelioration of choriocapillaris aging and prevention of AMD, it is essential to understand the cellular and functional changes that occur in the choroid and choriocapillaris during aging. In this review, recent advances in in vivo analysis of choroidal structure and function in AMD patients and patients at risk for AMD are discussed. The pathophysiological roles of fundamental cellular and molecular mechanisms of aging including oxidative stress, mitochondrial dysfunction, and impaired resistance to molecular stressors in the choriocapillaris are also considered in terms of their contribution to the pathogenesis of AMD. The pathogenic roles of cardiovascular risk factors that exacerbate microvascular aging processes, such as smoking, hypertension, and obesity as they relate to AMD and choroid and choriocapillaris changes in patients with these cardiovascular risk factors, are also discussed. Finally, future directions and opportunities to develop novel interventions to prevent/delay AMD by targeting fundamental cellular and molecular aging processes are presented.


Retina SD-OCT OCTA Choroidal thickness Cardiovascular risk factors Smoking Hypertension 


Funding information

This work was supported by the National Institutes of Health (NIGMS 1 P20 GM12552801A1, SMC, AY), the Oklahoma Center for the Advancement of Science and Technology (HRP HR18-118, SMC), the Government of Hungary (EFOP-3.6.3-VEKOP-16-2017-00009 to CC), and the Presbyterian Health Foundation (SMC, LM).


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Copyright information

© American Aging Association 2019

Authors and Affiliations

  • Agnes Lipecz
    • 1
    • 2
    • 3
    • 4
    • 5
  • Lauren Miller
    • 2
    • 6
  • Illes Kovacs
    • 2
    • 5
    • 7
  • Cecília Czakó
    • 5
  • Tamas Csipo
    • 1
    • 2
    • 4
    • 8
  • Judit Baffi
    • 2
  • Anna Csiszar
    • 1
    • 2
    • 4
    • 9
  • Stefano Tarantini
    • 1
    • 2
    • 4
    • 9
  • Zoltan Ungvari
    • 1
    • 2
    • 4
    • 9
    • 10
  • Andriy Yabluchanskiy
    • 1
    • 2
  • Shannon Conley
    • 2
    • 6
    Email author
  1. 1.Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular BiologyUniversity of Oklahoma Health Sciences CenterOklahoma CityUSA
  2. 2.Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular BiologyUniversity of Oklahoma Health Sciences CenterOklahoma CityUSA
  3. 3.Department of OphthalmologyJosa Andras HospitalNyiregyhazaHungary
  4. 4.International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public HealthSemmelweis UniversityBudapestHungary
  5. 5.Department of OphthalmologySemmelweis UniversityBudapestHungary
  6. 6.Department of Cell BiologyUniversity of Oklahoma Health Sciences CenterOklahoma CityUSA
  7. 7.Department of OphthalmologyWeill Cornell Medical CollegeNew York CityUSA
  8. 8.International Training Program in Geroscience, Division of Clinical Physiology, Department of Cardiology, Faculty of MedicineUniversity of DebrecenDebrecenHungary
  9. 9.International Training Program in Geroscience, Theoretical Medicine Doctoral SchoolUniversity of SzegedSzegedHungary
  10. 10.Department of Health Promotion Sciences, College of Public HealthUniversity of Oklahoma Health Sciences CenterOklahoma CityUSA

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