Photoreceptor degeneration and dysfunction in aging and age-related maculopathy

The relative rate of rod and cone degeneration is a fundamental characteristic of any disorder affecting photoreceptors, including aging and age-related maculopathy (ARM). The human macula consists of a small cone-dominated fovea surrounded by a rod-dominated parafovea. In aging and early ARM, rods degenerate before cones, a decline in scotopic (rod-mediated) sensitivity is more prominent than a decline in photopic (cone-mediated) sensitivity, and the time course of dark adaptation of rods slows dramatically. The topography of rod dysfunction and loss in early ARM matches the location of pathology in the retinal pigment epithelium (RPE)/Bruch's membrane complex visible in the ocular fundus. Rod dysfunction and loss in aging and ARM may be due to retinoid deficiency at the level of the photoreceptors cause by impaired retinoid translocation across the RPE/Bruch's membrane complex, a hypothesis deserving of further investigation.