Cases Of Neovascular Age-related Macular Degeneration Research Articles

Toll-like Receptor Polymorphisms and Age-Related Macular Degeneration: Replication in Three Case–Control Samples

Innate immunity appears to play a key role in age-related macular degeneration (AMD). Although two previous studies reported that gene variations in Toll-like receptor (TLR)-3 and -4 are associated with AMD, other studies have not confirmed these associations. In this study, three independent samples (two U.S. clinic-based case-control study samples and one Australian population-based study sample) were used to further assess the association of the polymorphisms rs3775291 in TLR3 and rs4986790 in TLR4 with AMD. AMD cases and unrelated controls were collected from the National Eye Institute Clinical Center (NEI, n = 320), the Age-Related Eye Disease Study (AREDS, n = 483), and the Blue Mountains Eye Study (BMES, n = 852). DNA extracted from subjects was genotyped for rs3775291 and rs4986790, and the associations with AMD were investigated. Neither of the two polymorphisms rs3775291 and rs4986790 had a statistically significant association with AMD in any of the three sample sets or in combinations of the sets. Analysis of the combined geographic atrophy or neovascular AMD cases in the NEI, AREDS, and BMES sample sets also failed to demonstrate statistically significant associations of those two single nucleotide polymorphisms with advanced AMD. Even with previously verified samples sets and adequate study powers, the results did not confirm the reported associations of TLR3 rs3775291 and TLR4 rs4986790 with AMD in the three independent samples, individually or combined.

Prospective study of lutein/zeaxanthin intake and risk of age-related macular degeneration

BackgroundThe association between lutein/zeaxanthin intake and age-related macular degeneration (AMD) risk may differ by smoking status, vitamin C and E intakes, and body fatness. ObjectiveThe objective was to evaluate the association between lutein/zeaxanthin intake and AMD risk by smoking status, intake of antioxidant vitamins, and body fatness. DesignWe conducted a prospective follow-up study of 71 494 women and 41 564 men aged ≥50 y and had no diagnosis of AMD or cancer. Diet was assessed with a validated semiquantitative food-frequency questionnaire. ResultsDuring up to 18 y of follow-up, we documented 673 incident cases of early AMD and 442 incident cases of neovascular AMD with a visual loss of 20/30 or worse due primarily to AMD. Lutein/zeaxanthin intake was not associated with the risk of self-reported early AMD. There was a statistically nonsignificant and nonlinear inverse association between lutein/zeaxanthin intake and neovascular AMD risk; the pooled multivariate relative risks for increasing quintiles of intake were 1.00 (referent), 0.80, 0.84, 0.97, and 0.72 (95% CI: 0.53, 0.99) (P for trend = 0.14). For early AMD, the association with lutein/zeaxanthin intake did not vary by smoking status, intakes of vitamins C and E, or body mass index. For neovascular AMD, a nonlinear inverse association was found among never smokers. ConclusionsThese data do not support a protective role of lutein/zeaxanthin intake on risk of self-reported early AMD. The suggestion of inverse associations related to the risk of neovascular AMD needs to be examined further.

Altersbedingte Makuladegeneration

More than 50% of all Europeans over 65 years of age have alterations to the fundus that should give rise to the suspicion of incipient age-related macular degeneration (AMD). Demographic changes in the German population and the longer life expectancy now are causing a rapid increase in the absolute number of AMD patients. On the one hand, new treatment options are causing an increase in treatment costs; on the other, social costs are also rising because patients are often left with some sight impairment. The authors attempt to forecast prevalence and incidence on the basis of the epidemiological data known for Germany and, using model calculations, to highlight trends that illustrate the increasing socioeconomic significance of this disease. Forecasts show that the number of patients with advanced AMD will increase from 710,000 at present to over a million by 2020. In the same period, the number of patients with neovascular AMD will increase from 485,000 to 700,000. There are currently 50,000 new cases of neovascular AMD every year in Germany, and it has only just become possible to treat these with the new anti-VEGF drugs. The new treatment options will cause additional annual costs of 1.1-2.9 billion euro for Germany alone. The new treatment options for AMD will lead to a pronounced reduction in the number of visually impaired and blind people. However, this progress cannot be achieved without the financial resources dedicated to ophthalmology being approximately doubled.

NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

This review summarizes the data reported in peer-reviewed literature and presents current knowledge on differentiation, natural history, and therapeutic outcomes of neovascular age-related macular degeneration (AMD). The MEDLINE database was searched to review natural history of neovascular AMD and therapeutic effects of available treatments. The search produced>7,000 articles. Research suggests that fluorescein angiographic characterization of location, composition, and size of neovascular lesions may be important in prognosis and should be considered for evaluation of treatment benefits in conjunction with evidence of recent disease progression for lesions not composed of predominantly classic choroidal neovascularization (CNV). Laser photocoagulation, photodynamic therapy with verteporfin, and administration of pegaptanib sodium reduce the risk of vision loss in selected cases of neovascular AMD, while submacular surgery can reduce the risk of severe visual acuity loss in selected cases of predominantly hemorrhagic CNV; further approaches are under investigation. Visual prognosis of neovascular AMD is variable according to lesion location, composition, and size. Often, lesions have a poor prognosis, resulting in rapid and progressive loss of visual acuity and contrast sensitivity. Such losses have a profound effect on patients' quality of life and ability to perform everyday tasks. Reducing the risk of further loss of visual acuity and contrast sensitivity might enable patients with neovascular AMD to maintain better functional abilities.

Photodynamic therapy for age-related macular degeneration: a candid appraisal

N APRIL 2000, THE FOOD AND DRUG ADMINISTRATION approved photodynamic therapy with verteporfin (Visudyne) for the treatment of predominantly classic choroidal neovascularization associated with age-related macular degeneration (AMD). Soon afterward, Visudyne became the first line of treatment for eligible cases of neovascular AMD. However, with time, the benefits of this treatment have been disappointing, leading to renewed interest in alternative, potentially more efficacious therapies. Photodynamic therapy is a concept that was first discussed in the early 1900s. Although originally conceived as an oncology treatment to occlude tumor vasculature, photodynamic therapy appeared applicable to ophthalmology, owing to the accessibility of the retina to directed light exposure. In this treatment, a photosensitizer with a specific absorbance profile is administered, followed by exposure of the photosensitizer to an appropriate wavelength of light that elevates the photosensitizer to a higher energy state creating a cascade of photochemical events. For choroidal neovascularization, verteporfin (6 mg/m) is infused intravenously over a 10-minute period, and 5 minutes later, the lesion is exposed to a 689 nm light dose of 50 J/cm for 83 seconds. With this protocol, the laser excites the photosensitizer, which then is thought to generate singlet oxygen and reactive oxygen intermediates that damage cellular structures. Specifically, preclinical studies in experimental animals demonstrated that verteporfin selectively occluded experimentally induced choroidal neovascularization with minimal associated effects to surrounding normal tissues.