Form Of Age-related Macular Degeneration Research Articles

Vitelliform changes in the central retina occurring in adults

Introduction. Vitelliform lesions of the central retinal area in adult patients represent a heterogeneous group of diseases. This article describes different variants of vitelliform changes in adults, based on the published literature data.
 Materials and methods. We have analyzed and described different variants of vitelliform changes in adults, based on literature data, examples from own clinical practice using multimodal approach are included.
 Discussion. Vitelliform lesions of the central retinal area are can debut at various ages, occurring in mono- or multifocal way, have various stages of degradation of vitelliform material, masquerading as other lesions of the macular area and of the posterior pole. Many of these diseases appear due to mutations in determined genes, though, a fairly large proportion of cases is considered to be sporadic. Nowadays, characteristic signs of different diseases with the vitelliform material are described. But differential diagnosis with other similar diseases (some age-related macular degeneration forms and those of central serous chorioretinopathy) is fairly difficult and requires a multimodal ophthalmologic approach, and in some cases genetic studies.
 Conclusions. Vitelliform lesions of the central retinal area, occurring in adult patients are a group of diseases that are difficult to diagnose and masquerade themselves as other diseases of the central retina, which requires certain doctors knowledge and ability to carry out a multimodal imaging and prescribe the appropriate treatment if needed.

Real clinical practice of antiangiogenic therapy in patients with age-related macular degeneration. Retrospective analysis of functional results

To assess the functional results of antiangiogenic therapy in patients with exudative form of age-related macular degeneration (AMD) in real clinical practice. The study included 90 people (90 eyes) with active choroidal neovascularization (CNV) on the background of AMD. All patients were divided into 6 groups depending on the year of treatment - from 2013 to 2018, all patients were divided into 6 groups and overall the retrospective study sited at Research Institute of Eye Diseases (Moscow) lasted 8 years. All patients underwent standard ophthalmological examination including visometry, biomicroscopy and ophthalmoscopy under drug-induced mydriasis, as well as optical coherence tomography, fundus angiography and OCT-angiography. According to the results of the analysis of OCT data obtained from 2013 to 2017, among all patients with exudative AMD, patients with types I and II of CNV and single patients with RAP prevailed, which explains the high visual acuity - about 0.5 - in all groups after the start of the treatment (table 1 and 2). In 2018, 33.3% of patients were diagnosed with RAP (the same number of eyes as with types I and II of CNV), which can be explained by the introduction of OCT-angiography into wide clinical practice. The lack of increase in visual acuity is most likely associated with a small amount of intravitreal injections (IVI) - 4.8 IVI in the first year and 3.3 IVI in the second injection year. In patients who received more than three IVI in the first year of observation, visual acuity increased from 0.49±0.03 to 0.6±0.03 (p=0.04), in the case of less than three IVI in the first year, visual acuity was not changed, amounting to 0.42±0.1 before and 0.44±0.1 (p=0.655) after the treatment. Patients of all groups exhibited proportional stabilization of visual acuity, a decrease in the thickness of the retina and total macular volume. The lack of improvements of visual acuity is most likely associated with a small amount of IVI.

Practical application of ophthalmic nutraceuticals in patients with dry form of age-related macular degeneration

To conduct a placebo-controlled clinical monitoring of visual functions in patients with dry AMD while taking a drug Complex that corresponds to the AREDS 2 formula. The study included 90 people in 3 equivalent parallel groups, two of which were represented by patients with AMD who took the Complex for 3-6 months or Placebo for 3 months. The third group included healthy subjects of the same age. In addition to standard eye examination, participants underwent evaluation of the macular pigment optical density (MPOD), spatial-frequency contrast sensitivity (CS), photostress test, and reading parameters on the Salzburg Reading Desk device. The changes of blood plasma antioxidant activity (AOA) were also evaluated in the main group. By day 90 of the study, patients of the main group showed statistically significant (p<0.001) growth of MPOD from 0.24±0.13 to 0.32±0.1, reduction of photostress recovery time from 68.2±17.8 to 57.3±17.5 seconds, improvement of high-spatial-frequency CS - from 25.0±8.2 to 30.6±6.8 dB, increase of near visual acuity logMAR from 0.22±0.04 to 0.19±0.03 and reading speed, and decrease of reading mistakes. Statistically significant (p<0.05) reduction of in AOA was seen during the observation period from 1.52±0.16 to 1.68±0.16. Patients of the main group who received the Complex for 180 days demonstrated additional improvements of visual functions. The drug Complex corresponding to the AREDS 2 formula contributes to a significant increase in MPOD, improvements of visual functions and overall antioxidant status of patients, which confirms the feasibility of its use in patients with dry AMD.

Circulating adropin and vascular endothelial growth factor receptor-2 levels in age-related macular degeneration and T2DM patients-A cross-sectional study.

Background:Macular drusen formation and angiogenesis are the two chief processes associated with age-related macular degeneration. Adropin and vascular endothelial growth factor receptor-2 (VEGFR-2) may be involved in these pathologies. By altering lipid metabolism, adropin may contribute in the early stages of age-related macular degeneration (AMD). VEGFR-2 may participate in the later form of AMD, by promoting angiogenesis. This study compared the circulatory levels of adropin and VEGFR-2 in AMD and patients without AMD and assessed their association with disease severity, to understand their possible role in AMD.Objectives:This study aimed to assess and compare the serum levels of adropin and VEGFR-2 in patients with AMD and type 2 diabetes patients without AMD, and, to investigate the correlation between these two parameters with disease severity.Methods:Our study involves two groups of 39 each. Group A (age-related macular degeneration) and Group B (diabetes patients without age-related macular degeneration). Routine parameters fasting blood sugar (FBS), lipid profile, and liver function tests (LFT) were estimated by using autoanalyzer. Serum adropin and VEGFR-2 were assessed by ELISA.Results:Among the basic parameters, systolic blood pressure and fasting blood glucose alone were significantly different across the groups. We did not find significant alterations in adropin and VEGFR-2 levels between the study groups. Our lipid profile parameters (triglycerides and total cholesterol) have significant positive association. VEGFR-2 showed a positive correlation with the severity of AMD. Adropin did not exhibit any correlation with disease severity and with VEGFR-2.Conclusion:We could not find any observable alterations of statistical significance, in adropin and VEGFR-2 levels. VEGFR-2's correlation with disease severity could be important. Adropin might have subtler roles in AMD, though not evident from our study, and requires a deeper observation at the molecular level to elucidate its function.

Abnormalities in the thickness of the retinal ganglion cell/inner plexiform layer in age-related macular degeneration

Introduction/Objective. The study aims to analyze the thickness of both the ganglion cell layer and the inner plexiform layer (GCL + IPL) among patients suffering from dry and wet form of age-related macular degeneration (AMD). Methods. One hundred ninety-five patients with AMD participated in the study, along with 94 healthy individuals (mean age 75.2 ? 7.8 years; range 55?86). They were divided into three groups: the first group, or group I, included 100 patients suffering from wet AMD; the second group, or group II, included 95 patients afflicted with dry AMD; the final 94 patients made up the control group, group III, of healthy individuals without systemic or ocular diseases. Measurements such as the average macular thickness, the average and minimum GCL + IPL thickness, and the GCL + IPL thickness in all six sectors were obtained by Cirrus spectral-domain optical coherence tomography (SD-OCT, Carl Zeiss Meditec, Inc., Dublin, CA, USA). SPSS version 20.0 was used to analyze the data, while the level of statistical significance was set at p &lt; 0.05. Results. In the case of patients with wet AMD, the average value for GCL + IPL thickness was 43.13 ?m, for patients with dry AMD the value was 66.73 ?m, and the average thickness measured for the control group was 86.23 ?m. There was a statistically significant difference between the average GCL + IPL and minimum GCL + IPL thicknesses between the groups (p &lt; 0.001). Lower values were noted for patients with wet AMD (p &lt; 0.001) than those with dry AMD. In the latter, the average GCL + IPL and the minimum GCL + IPL thicknesses were lower than those of the healthy participants, at a level of statistical significance (p &lt; 0.001). Conclusion. Participants with AMD exhibited thinner GCL + IPL than the healthy participants, as did the participants with wet AMD when compared to the participants with dry AMD.

Altered Long Non-coding RNAs Involved in Immunological Regulation and Associated with Choroidal Neovascularization in Mice.

Choroidal neovascularization (CNV) is a severe complication of the wet form of age-related macular degeneration (AMD). Long non-coding RNAs (lncRNAs) have been implicated in the pathogenesis of different ocular neovascular diseases. To identify the function and therapeutic potential of lncRNAs in CNV, we assessed lncRNAs and mRNA expression profile in a mouse model of laser-induced CNV by microarray analysis. The results of altered lncRNAs were validated by qRT-PCR. Bioinformatics analyses, including Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, were performed to clarify the potential biological functions and signaling pathways with which altered genes are most closely related. Moreover, to identify the interaction of lncRNAs and mRNAs, we constructed a coding-non-coding gene co-expression (CNC) network. By microarray analysis, we identified 716 altered lncRNAs and 821 altered mRNAs in CNV mice compared to controls. A CNC network profile based on 7 validated altered lncRNAs (uc009ewo.1, AK148935, uc029sdr.1, ENSMUST00000132340, AK030988, uc007mds.1, ENSMUST00000180519) as well as 282 interacted and altered mRNAs, and were connected by 713 edges. GO and KEGG analyses suggested that altered mRNAs, as well as those lncRNA-interacted mRNAs were enriched in immune system process and chemokine signaling pathway. Thus, lncRNAs are significantly altered in this mouse model of CNV and are involved in immunological regulation, suggesting that lncRNAs may play a critical role in the pathogenesis of CNV. Thus, dysregulated lncRNAs and their target genes might be promising therapeutic targets to suppress CNV in AMD.

DICER1 in the Pathogenesis of Age-related Macular Degeneration (AMD) - Alu RNA Accumulation versus miRNA Dysregulation.

DICER1 deficiency in the retinal pigment epithelium (RPE) was associated with the accumulation of Alu transcripts and implicated in geographic atrophy (GA), a form of age-related macular degeneration (AMD), an eye disease leading to blindness in millions of people. Although the exact mechanism of this association is not fully known, the activation of the NLRP3 inflammasome, maturation of caspase-1 and disruption in mitochondrial homeostasis in RPE cells were shown as critical for it. DICER1 deficiency results in dysregulation of miRNAs and changes in the expression of many genes important for RPE homeostasis, which may also contribute to AMD. DICER1 deficiency can change the functions of the miR-183/96/182 cluster that regulates photoreceptors and their synaptic transmission. Aging, the main AMD risk factor, is associated with decreased expression of DICER1 and changes in its diurnal pattern that are not synchronized with circadian regulation in the retina. The initial insult inducing DICER1 deficiency in AMD may be oxidative stress, another major risk factor of AMD, but further studies on the role of deficient DICER1 in AMD pathogenesis and its therapeutic potential are needed.

Evaluation of Flowmetry Indicators in Patients with a Wet AMD Form during Antiangiogenic Therapy

Purpose: to assess the effect of aflibercept (Eylea; “Regeneron”, USA) intravitreal injections on ocular blood flow and intraocular pressure parameters in patients with neovascular form of age-related macular degeneration (wet AMD). Currently, neovascular agerelated macular degeneration (wet AMD) is one of the leading causes of irreversible vision loss and blindness among populations over the age of 50 . Material and methods. The study included 35 patients (35 eyes), 10 men and 25 women. Mean patients’ age was 72 ± 6 years. The inclusion criteria were the established diagnosis of a neovascular form of age-related macular degeneration and the level of ophthalmotonus not more than the accepted upper limit of the average norm — IOP 21 mm hg prior to drug administration of the drug. All patients underwent flowmetry with ocular blood flow (OBF) volume determination and intraocular pressure (IOP) measurement. The patients received a singular intravitreal aflibercet injection (2 ml). OBF and IOP were measured at baseline before the injection and the on day 4 and 1 month after the injection. Results. There was no statisticaly significant difference between the IOP level before and after the injection. We revealed a tendency towards OBF decrease in 1 month after the injection, but overall values and the decrease both 4 days and 1 month after the intravitreal injection did not prove to be statistically significant. The absence of statistically significant changes of intraocular pressure level and volumetric ocular blood flow additionally confirms information about the safety of intravitreal administration of aflibercept to patients with a wet form of age-related macular degeneration.

Oxidative stress-induced angiogenesis is mediated by miR-205-5p.

miR‐205‐5p is known to be involved in VEGF‐related angiogenesis and seems to regulate associated cell signalling pathways, such as cell migration, proliferation and apoptosis. Therefore, several studies have focused on the potential role of miR‐205‐5p as an anti‐angiogenic factor. Vascular proliferation is observed in diabetic retinopathy and the ‘wet’ form of age‐related macular degeneration. Today, the most common treatments against these eye‐related diseases are anti‐VEGF therapies. In addition, both AMD and DR are typically associated with oxidative stress; hence, the use of antioxidant agents is accepted as a co‐adjuvant therapy for these patients. According to previous data, ARPE‐19 cells release pro‐angiogenic factors when exposed to oxidative insult, leading to angiogenesis. Matching these data, results reported here, indicate that miR‐205‐5p is modulated by oxidative stress and regulates VEGFA‐angiogenesis. Hence, miR‐205‐5p is proposed as a candidate against eye‐related proliferative diseases.

Implantation of the First IMT Macular Lens in Age-Related Macular Degeneration (Literature Review)

This review presents the characteristics and results of clinical studies of patients with age-related macular degeneration implanted with the developed for this purpose first macular IOL – intraocular macular telescope (IMT). This lens was designed specifically for patients with the most severe or terminal form of age-related macular degeneration and is designed for monocular implantation to provide central vision while maintaining peripheral vision of the paired eye, which is important for maintaining the balance and orientation of patients. This device allows patients to see both in dynamic and static situations in the near, intermediate and far ranges. The disadvantages of this lens are a decrease in the visual field and depth of focus (which excludes its bilateral implantation), the need for a large (10–12 mm) incision for implantation, which can cause an increase in corneal astigmatism and the risk of complications, in particular, the pupillary block with an increase in intraocular pressure. There are also difficulties in the study of the fundus after its implantation to assess the small changes in the macula or to identify possible postoperative complications after cataract surgery (macular oedema, etc.). Also after the implantation of this lens, there is need for special programs of visual rehabilitation. The patient’s commitment to the rehabilitation measures for the adaptation of the central visual field of the operated eye with the peripheral vision of the second eye is crucial for success of the IMT macular telescope implantation procedure.

Bevacizumab in Wet AMD treatment: A tribute to the thirteen years of experience from the beginning of the anti-VEGF era in Romania.

This study aimed to identify and describe anatomical and functional changes on short (1–3 months) and medium (6–12 months) term after intravitreal injections of bevacizumab (Avastin, Genentech) in patients with choroidal neovascularization (CNV) in the context of exudative form of age-related macular degeneration (AMD). We performed a retrospective, analytical, interventional study, based on a series of cases with exudative form of AMD, which also comprised a prospective component related to the inclusion and treatment of the patients with a very new interventional method for that time (2006) and the follow-up of the effects of intravitreal injection of bevacizumab (1.25 mg) therapy in three monthly doses for short (1–3 months) and medium (6–18 months) periods of time. The follow-up of these patients was made by determining visual acuity (VA) as best corrected visual acuity (BCVA) at baseline and at every visit, slit lamp examination with contact or noncontact lenses each time, and optical coherence tomography and/or angiofluorography, applied only for certain patients, at various times of the study. In total, 376 intravitreal injections were administered to 117 eyes of 96 patients. The VA improved in the assessment of 3 months in 77 eyes (66%), either subjective (by the patient) or objectively quantified (by the physician). In 40 eyes (34%), there was no change in VA. In patients for whom optical coherence tomography could be performed, a significant reduction of the macula's thickness was found. The use of bevacizumab in subretinal neovascular membrane treatment is effective and safe on short and medium term, with the improvement of BCVA and reduction of macular edema in a significant number of cases.

The Use of Nutraceuticals in Patients with “Dry” Form of Age-Related Macular Degeneration on the Background of Accelerated Aging

The lutein-containing vitamin-mineral complex Retinorm, developed on the basis of the formula AREDS 2, with an optimal content of vitamins and minerals involved in antioxidant protection, is a potentially promising ophthalmic geroprotector.Purpose: to evaluate the effectiveness of vitamin-mineral complex “Retinorm” in patients with the dry form of AMD and accelerated pace of aging.Patients and Methods. The study involved 40 patients with a dry form of AMD (stage 2.3 according to AREDS classification) with an accelerated rate of aging (biological age of patients was measured by the method of Tokar, 1990). Gender distribution: men — 15 (37.5 %), women — 25 (62.5 %). The mean age of patients was 67.3 ± 6.8 years. Patients were divided into 2 groups. Patients of the study group (n = 20) were assigned “Retinorm” 1 capsule 3 times a day for 16 weeks. Patients of the control group (n = 20) were treated with “Lutein Forte” 1 capsule 2 times a day for 16 weeks. Visometry, perimetry, optical coherence tomography of the macular zone, measurement of biological age at the beginning of the study, at 2 and 4 months of the study, the tolerability of treatment in patients with a dry form of age — related macular degeneration on the background of taking dietary supplements-vitamin and mineral complexes with lutein and zeaxanthin.Results and discussion. As a result of treatment, there were the positive dynamics in terms of visometry and perimetry in the main and control groups. There were no negative dynamics of the indicators of thickness of the retina (in the area of the fovea), and increased macular volume in the main group. In the control group there was a weak tendency to the growth of these indicators. We found a significant positive effect of Retinol on the biological age of patients to 4 months of therapy. It allows to consider the drug as a promising ophthalmoscopy an agent. The results of the study showed the effectiveness of the inclusion of “Retinorm” in patients with the dry form of AMD. The proven geroprotective effect of “Retinorm” with good tolerability of treatment and the absence of side effects from all organ systems with a long term of administration allows us to recommend it for wide use in patients with a dry form of age-related macular degeneration, including patients with an accelerated rate of aging.

A Study to Test How Well Different Doses of BI 754132 Are Tolerated in Patients With an Advanced Form of Age-related Macular Degeneration Called Geographic Atrophy

A Study to Test How Well Different Doses of BI 754132 Are Tolerated in Patients With an Advanced Form of Age-related Macular Degeneration Called Geographic Atrophy

Response to Aflibercept Therapy in Three Types of Choroidal Neovascular Membrane in Neovascular Age-Related Macular Degeneration: Real-Life Evidence in the Czech Republic

Purpose To present a cohort of treatment-naive patients with the neovascular form of age-related macular degeneration (nAMD) treated with aflibercept in a fixed regimen and evaluate the treatment response of three types of choroidal neovascular membrane (CNV)—occult (Type 1), classic (Type 2), and minimally classic (Type 4). Methods This was a multicentre, prospective, observational consecutive case series study. Patients diagnosed with three types of CNV of nAMD were treated in a fixed regimen (3 injections every 4 weeks, and then injections at 8 week intervals). The follow-up period was 48 weeks. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured using Early Treatment Diabetic Retinopathy Study (ETDRS) charts and spectral-domain optical coherence tomography (OCT). The measurements were taken at the baseline and then at 16, 32, and 48 weeks. Results The treatment-naive group was composed of 135 eyes of 135 patients in the study. 61 eyes had Type 1 lesions of CNV, 50 eyes had Type 2 lesions, and 24 eyes had Type 4 lesions. Mean baseline BCVA ± SD for Type 1 lesions was 56.1 ± 10.8 ETDRS letters, and then 62.2 ± 12.9 letters, 61.2 ± 13.7 letters, and 62.8 ± 15.1 letters at 16, 32, and 48 weeks, respectively. Mean baseline CRT ± SD for Type 1 lesions was 442.4 ± 194.9 μm, and then 302.5 ± 144.4 μm, 299.7 ± 128.5 μm, and 277.7 ± 106.5 μm at 16, 32, and 48 weeks, respectively. Mean baseline BCVA ± SD for Type 2 lesions was 55.6 ± 9.9 ETDRS letters, and then 62.5 ± 11.1 letters, 60.7 ± 13.0 letters, and 62.5 ± 14.2 letters at 16, 32, and 48 weeks, respectively. Mean baseline CRT ± SD. For Type 4 lesions mean baseline BCVA ± SD was 56.7 ± 9.0 ETDRS letters, and then 59.1 ± 10.6 letters, 59.5 ± 11.4 letters, and 59.2 ± 12.6 letters at 16, 32, and 48 weeks respectively. Mean baseline CRT ± SD for Type 4 lesions was 492.1 ± 187.0 μm, and then 333.3 ± 137.5 μm, 354.4 ± 175.0 μm, and 326.7 ± 122.4 μm at 16, 32, and 48 weeks respectively. All these changes were statistically significant (p < 0.005). Conclusions The primary outcome of our study is that the treatment with aflibercept in nAMD patients led to statistically significant improvement in BCVA and to a decrease in CRT throughout the follow-up period in both occult and classic types of CNV. The minimally classic type of CNV demonstrated a poorer functional and anatomical response to treatment.

Increased serum proteins in non-exudative AMD retinas

The blood retinal barrier (BRB) closely regulates the retinal microenvironment. Its compromise leads to the accumulation of retinal fluid containing potentially harmful plasma components. While eyes with non-exudative age-related macular degeneration (AMD) were previously felt to have an intact BRB, we propose that the BRB in non-exudative AMD eyes may be subclinically compromised, allowing entry of retina-toxic plasma proteins. We test this hypothesis by measuring retinal levels of abundant plasma proteins that should not cross the intact BRB. Two cohorts of frozen, post mortem neurosensory retinas were studied by Western analysis. One cohort from Alabama had 4 normal controls and 4 eyes with various forms of AMD. Another cohort from Minnesota had 5 intermediate AMD eyes and 5 normals. Both cohorts were age/post mortem interval (PMI) matched. The non-exudative AMD retinas in the Alabama cohort had significantly higher levels of albumin and complement component 9 (C9) than normal controls. The positive control exudative AMD donor retina had higher levels of all but one serum protein. In both macular and peripheral neurosensory retina samples, intermediate AMD retinas in the Minnesota cohort had significantly higher levels of albumin, fibrinogen, IgG, and C9 than controls. Our results suggest that there may be moderate subclinical BRB leakage in non-exudative AMD. Potentially harmful plasma components including complement or iron could enter the neurosensory retina in AMD patients prior to advanced disease. Thus, therapies aiming to stabilize the BRB might have a role in the management of non-exudative AMD.

Риск развития разрывов ретинального пигментного эпителия на фоне анти-VEGF терапии у пациентов с экссудативной формой возрастной макулярной дегенерации

Риск развития разрывов ретинального пигментного эпителия на фоне анти-VEGF терапии у пациентов с экссудативной формой возрастной макулярной дегенерации

Лечение влажной формы возрастной макулярной дегенерации: возможности и перспективы

Лечение влажной формы возрастной макулярной дегенерации: возможности и перспективы

Patient-, Caregiver-, and Eye Care Professional-reported Burden of Geographic Atrophy Secondary to Age-related Macular Degeneration

Objective Geographic atrophy (GA) is a progressive, irreversible advanced form of age-related macular degeneration. There is limited information on the burden of illness of GA from patient, caregiver, and eye care professional perspectives. This study identifies key factors that should be included for assessment in future studies of patients with GA. Methods In this cross-sectional qualitative study, patients with symptomatic GA (n = 8), their caregivers (n = 6), and eye care professionals who treat patients with GA (n = 5) were interviewed at US sites. Interview guides were designed to evaluate the understanding of the disease, costs and burden of illness, use of vision aids or services, and impact on emotional or psychological well-being and on daily activities. Results Half of the patients mentioned social, psychological, or helplessness issues. Patients reported the impact of GA on sports and outdoor hobbies, meals or food preparation, religious activities, and long-distance travel. Patients reported having stopped driving or changing driving patterns as a major concern. 38% of all patients reported previously modifying their work schedules due to vision impairment. All patients reported the use of at least one vision aid, with 88% of patients purchasing the aids out of pocket. Caregivers reported modifying their schedules to provide assistance as needed and expressed frustration over their inability to improve patients’ health. Eye care professionals noted the emotional impact of vision loss, accidents, and injuries, and identified mental health as a key topic for patients with GA. Conclusions Although limited by size, this study indicates that GA has a major negative impact on patients’ and caregivers’ social functioning and health-related quality of life. This study has identified indirect resource use, including caregiving needs, and direct patient out-of-pocket costs as factors relevant to patients with GA. Future larger studies are needed to further characterize the burden of illness of GA for patients and caregivers.

Seeing is not believing

An 84-year-old woman with a history of dry age-related macular degeneration presented with an acute inability to read, but intact writing ability (pure alexia or alexia without agraphia). She denied any difficulty speaking, paresthesias, or hemiparesis. Her visual acuity was 20/20 in each eye. Macular examination, optical coherence tomography, and fluorescein angiography demonstrated the previously diagnosed macular drusen and geographic atrophy of the retinal pigment epithelium consistent with the dry form of age-related macular degeneration both eyes. Automated perimetry revealed a right homonymous hemianopsia. Neuroimaging confirmed a left occipital ischemic infarction with involvement of the splenium of the corpus callosum producing the classic disconnection syndrome of alexia without agraphia.

COLORADO AGE-RELATED MACULAR DEGENERATION REGISTRY: Design and Clinical Risk Factors of the Cohort.

To study new and existing risk factors related to age-related macular degeneration (AMD) phenotypes in a Colorado cohort. Age-related macular degeneration was categorized into early, intermediate, or advanced forms. Controls (n = 180) were patients with cataract and no AMD. Demographic and clinical data were gathered by patient interview and verified by chart review. Image data were reviewed by vitreoretinal specialists. Statistical analysis included univariable and multivariate logistic regression analysis (P < 0.05). Among the 456 patients with AMD, 157 (34.4%), 80 (17.6%), and 219 (48.0%) had the early/intermediate, geographic atrophy, and neovascular forms of the disease, respectively. Adjusted for age, African-American race was associated with a reduced risk of early/intermediate (adjusted odds ratio [AOR] = 0.08, confidence interval [CI] = 0.01-0.67) and neovascular AMD (AOR = 0.15, CI = 0.03-0.72). A family history of AMD was a risk factor for early/intermediate (AOR = 4.08, CI = 2.30-7.25), geographic atrophy (AOR = 8.62, CI = 3.77-19.7), and neovascular AMD (AOR = 3.76, CI = 2.16-6.56). A history of asthma was related to the early/intermediate form of AMD (AOR = 2.34, CI = 1.22-4.46). Studying AMD in specific populations may reveal novel risk factors such as our finding of a relationship between asthma history and AMD.