ORIGINAL ARTICLE Is age-related macular degeneration a local manifestation of systemic disorder? Changes in nailfold capillaries at age-related macular degeneration Mehmet Fatih Küçük 1 & Ayşe Ayan 2 & Devrim Toslak 3 & Elçin Süren 3 & Lütfiye Yaprak 3 & Ersan Çetinkaya 3 & Muhammet Kazım Erol 3 & Deniz Turgut Çoban 3 Received: 5 August 2019 /Accepted: 21 September 2019 # Royal Academy of Medicine in Ireland 2019 Abstract Aims Determining whether nailfold capillary involvement is present in patients with Age-related macular degeneration (AMD) and whether there are different nailfold capillaroscopy findings between wet and dry types. Methods From January 2016 to December 2017, with an initial diagnosis of AMD, 53 consecutive adult patients (AMD group) and 91 age- and sex-matched healthy individuals were studied prospectively. There was no history of any other ocular disease and other disease affecting nailfold capillaries. All subjects underwent a complete ophthalmic examination. The classified and advanced stages of wet and dry types were not included. All nailfold capillaroscopy examinations were performed by the same rheumatologist. Results It was found that the frequency of major capillaroscopic findings such as capillary ectasia, micro-hemorrhage, tortuosity, neo-formation, bizarre capillary, and bushy capillaries increased in the AMD group according to the normal group, but no significant relationship was found for capillary aneurysm. In dry or wet type of AMD in terms of ectasia, micro-hemorrhage, tortuosity, neo-formation, bizarre structure, bushy structure, or aneurism of nailfold capillaries, no significant correlation was found. Conclusions Nailfold capillaroscopy can detect microvascular changes in the nailfold capillary, in early and late stages of AMD. There were morphological changes in the nailfold capillaries of AMD patients, suggesting that there are systemic superficial microvascular changes that may be due to the systemic nature of the disease. Keywords Age-related macular degeneration . Nailfold capillaroscopy . Pathophysiology Introduction Age-related macular degeneration (AMD) is a chronic degen- erative disorder with gradual central vision loss. AMD is the leading cause of irreversible blindness in Western countries [1, 2]. The earliest clinical stage of AMD is characterized by drusens and changes in macular pigmentations [3]. At early stages, vision may be slightly affected or completely normal, whereas, at advanced stages of the disease, the vast majority of patients have impaired vision [4]. Landmark studies showed that multiple genetic and environmental risk factors play a significant role in the pathogenesis of AMD, but exact etiolo- gy is still unknown [5]. Nevertheless, genetic studies have indicated inflammatory mechanisms [6–8], whereas physio- logical studies suggested that ischemia and hypoxia [9–11] play a role. One of the first studies conducted by Verhoeff and Grossman in 1937 says that AMD pathogenesis is asso- ciated with deterioration of choroidal blood flow and drusen development [12]. Clinical studies have shown evidence of choroidal watershed filling defect during fluorescein and in- docyanine green angiography [ 13, 14], and impaired * Mehmet Fatih Küçük mehmet.kucuk@alanya.edu.tr 1 Department of Ophthalmology, Faculty of Medicine, Alanya Alaaddin Keykubat University, Temel Tıp Bilimleri Binası Kestel Kampüsü Alanya, 07070 Antalya, Turkey 2 Department of Rheumatology, Health Sciences University Antalya Training and Research Hospital, Antalya, Turkey 3 Department of Ophthalmology, Health Sciences University Antalya Training and Research Hospital, Antalya, Turkey Irish Journal of Medical Science (1971 -) https://doi.org/10.1007/s11845-019-02109-1