Retinal disease can have devastating consequences. Indeed, age-related macular degeneration (AMD) is the leading cause of legal blindness among adults in the United States. Early diagnosis and prompt treatment can help prevent or delay visual progression, and research suggests some promising new approaches. This Resource Center is a collection of the latest medical news and clinical information on AMD and the range of diseases that affect the retina.

Age-related macular degeneration (AMD) is the leading cause of blindness in the industrialized world.[1-3] Although there are many studies evaluating therapy to treat the sequela of AMD, there are no natural history studies. The current study is a meta-analysis of all studies that included an observation group. This meta-analysis included 53 studies, 28 of which were randomized clinical trials, over a 25-year period (1980-2005). Mean baseline vision was approximately 20/87. Vision decreased on average 1 line at 3 months, 2.7 lines at 12 months, and 4 lines at 2 years. Vision of 20/200 or worse increased from 19.7% of patients to 75.7% without intervention at 3 years. Neovascularization of a fellow eye occurred in 12.2% patients within 2 year and in 26.8% by 4 years. As expected, the natural history of AMD proved quite devastating without detection. Within 1 year of presentation, vision loss was significant. The findings underscore the importance of early detection and intervention.

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To determine the prevalence and visual significance of cystoid macular edema (CME) in eyes with subfoveal neovascular age-related macular degeneration using optical coherence tomography (OCT).

Cystoid macular edema is a common finding in patients with choroidal neovascularization associated with age-related macular degeneration. The presence of CME and foveal thickening is associated with worse visual acuity in these patients. Cystoid macular edema is more common with choroidal neovascularization containing classic component. The OCT is a useful test to detect the presence of CME in these patients since CME may be difficult to identify on fluorescein angiogram.

Age-related macular degeneration (AMD), a disorder of the retinal pigment epithelium, is the leading cause of blindness for people aged 65 and older. Due to an aging population, the number of AMD cases is expected to triple in the next 25 to 40 years. There is, as yet no cure for this disease. The Age-Related Eye Disease Study (AREDS) was the first large clinical trial to investigate the effect of high-dose ocular supplementation on progression of AMD. Among patients with advanced AMD in one eye or with intermediate AMD, high levels of both antioxidants and zinc reduced the risk of progression to advanced AMD and risk of at least 15 letters of vision loss from baseline in 5 years by 25% and 19%, respectively.

Since 1874, when it was first described in the medical literature as "symmetrical central choroido-retinal disease occurring in senile persons,"1 age-related macular degeneration has also been referred to as senile, or diskiform, macular degeneration, among many other terms. About 25 years ago, the term "age-related maculopathy" was coined and its end stage was acknowledged as age-related macular degeneration. In this review, I use the commonly accepted age-related macular degeneration, although I have reservations about its appropriateness.

Although age-related macular degeneration (AMD) continued to dominate discussions at Retina Subspecialty Day preceding the 2007 Annual Meeting of the American Academy of Ophthalmology, there was much of interest in the retinal world outside of AMD. Among the non-AMD retina highlights were a discussion of the new developments in genetic retinal disease, advances in imaging, strategies for reducing infection risk, and treatment and patterns of neovascularization in disorders other than AMD.

Age-related macular degeneration (AMD) predicts stroke and cardiovascular events in the long-term in persons aged 49 to 75 years, according to the results of a prospective study reported in the February 29 Online First issue of the British Journal of Ophthalmology.

"Age-related macular degeneration (AMD) and vascular disease share similar risk factors," write J.S.L. Tan, from the University of Sydney in Sydney, Australia, and colleagues. "Recent data suggest AMD may independently predict stroke or coronary heart disease. We prospectively assessed the relationship between AMD and risk of stroke- or cardiovascular-related death in an Australian population."

Age-related macular degeneration is a visually devastating disease and the leading cause of blindness in people aged 60 years and older. Previous treatments for AMD attempted to halt the progression of visual loss but offered little chance for improvement in visual acuity. Recent advances in treatment, including anti-vascular endothelial growth factor drugs, have delayed vision loss and even improved vision for patients with AMD. To best treat patients with AMD, ophthalmologists should be aware of how to evaluate and choose the best treatment options, including recently developed therapies. This CME activity uses a case-based format to show how to incorporate these agents into your clinical practice.

The revised Age-Related Macular Degeneration Preferred Practice Pattern has incorporated new recommendations for care for AMD. Based on clinical trial results, new recommendations are made for treatment of neovascular AMD, including recommendations for nutritional supplements; recommendations for treatment with thermal laser photocoagulation surgery, PDT with verteporfin, pegaptanib sodium, ranibizumab, and bevacizumab intravitreal injection; and follow-up recommendations for patients with all AMD stages.

Although AMD is not curable, in some cases severe vision loss can be prevented because certain forms of the disease respond favorably to laser treatment, especially with early diagnosis and prompt intervention. Certain preventive measures, including appropriate long-term surveillance, patient education, lifestyle changes, and careful evaluation, can reduce ocular morbidity. Only a small percentage of patients with AMD will benefit from laser photocoagulation treatment; identifying candidates for treatment is critical in attempting to prevent severe vision loss.

NICE recommends photodynamic therapy (PDT) for people with wet ARMD who have a confirmed diagnosis of classic subfoveal CNV, with no sign of occult CNV.

The American Academy of Ophthalmology strongly encourages the Centers for Medicare and Medicaid Services to fund and support a NEI-designed multi-center randomized controlled study of bevacizumab (Avastin™) compared to ranibizumab (Lucentis™) in the treatment of neovascular age-related macular degeneration (AMD). Bevacizumab is the full-length monoclonal antibody that binds vascular endothelial growth factor (VEGF) and ranibizumab was fragmented from this full-length antibody. Currently, ranibizumab is FDA approved for the treatment of neovascular AMD and bevacizumab is FDA approved for the treatment of metastatic colorectal cancer. Although prospective randomized trials regarding bevacizumab have not yet been conducted, its availability, beneficial impact on patients’ vision and lower costs have resulted in its being widely employed "off-label." A well-designed clinical trial would answer questions about the comparative effectiveness of these two similar treatments, and guide treatment decisions in the public’s best interests.