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Potential AMD and sleep apnoea could alter treatment landscape

Discovering new risk factors for age-related macular degeneration (AMD) has led Centre for Eye Research Australia’s (CERA) macular research unit to investigate links between sleep apnoea and AMD.

Sleep apnoea is an often undiagnosed condition that is believed to affect as many as a quarter of Australians over 65 years of age.

“Sleep apnoea is a very common, often undetected problem in our community, and it’s common in the same group of people who develop age-related macular degeneration,” said Professor Robyn Guymer, CERA deputy director and head of the macular research unit.

“We don’t currently ask questions in our eye clinics about sleep apnoea, which seemed like a missed opportunity.”

Guymer said the two conditions may have a physiological link. In sleep apnoea, the throat muscles relax which obstructs airflow and reduces the amount of oxygen the body is able to absorb during the night. As oxygen plays a key role in the restorative process the retina goes through overnight, sleep apnoea could accelerate the progress of AMD.

“If we are able to find an association between having sleep apnoea and AMD then currently available treatments for sleep apnoea, such as continuous positive airway pressure (CPAP), may be a potential treatment,” Guymer said.

“This is opposed to having to develop a new drug, for example, which takes years to develop.”

Research by Guymer, with medical student Ms Wendy Fang and visiting researcher Dr Palaniraj Rama Raj, has already uncovered some early indications of a link based on the results of patient surveys.

Guymer’s team is now working on more objective ways to determine if there is an association between those who actually do drop their oxygen levels at night and AMD.

Researchers in the macular research unit are now providing patients with pulse oximeters to take home and wear over several nights to record actual oxygen levels in their blood.

“We record the number of times the oxygen levels drop below a normal level during sleep and how low it drops,” Guymer said.

Future work will also include looking to see if the association is with all AMD or particular subsets, such as the critical phenotype of reticular pseudodrusen (RPD).

“We’re trying to understand the core problem of RPD, a particular deposit that occurs in only about a quarter of people with AMD but is highly prevalent in the late form of disease when vision loss occurs,” Guymer said.

“If there were some more evidence to support an association, the next step might be to do formal sleep studies to consolidate the screening tests.”

Guymer’s research on sleep apnoea and AMD is supported by funding from of the National Medical Health and Research Council’s Synergy Grants Program.

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