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. 2008 Nov 22;372(9652):1835-45.
doi: 10.1016/S0140-6736(08)61759-6.

Age-related macular degeneration

Hanna R Coleman  1 , Chi-Chao Chan, Frederick L Ferris 3rd, Emily Y Chew
Affiliations

Age-related macular degeneration

Hanna R Coleman et al. Lancet. .

Abstract

Age-related macular degeneration is the leading cause of blindness in elderly populations of European descent. The most consistent risk factors associated with this ocular condition are increasing age and cigarette smoking. Genetic investigations have shown that complement factor H, a regulator of the alternative complement pathway, and LOC387715/HtrA1 are the most consistent genetic risk factors for age-related macular degeneration. Although the pathogenesis of this disease is unknown, oxidative stress might have an important role. Treatment with antioxidant vitamins and zinc can reduce the risk of developing advanced age-related macular degeneration by about a quarter in those at least at moderate risk. Intravitreal injections of ranibizumab, a monoclonal antibody that inhibits all forms of vascular endothelial growth factor, have been shown to stabilise loss of vision and, in some cases, improve vision in individuals with neovascular age-related macular degeneration. These findings, combined with assessments of possible environmental and genetic interactions and new approaches to modulate inflammatory pathways, will hopefully further expand our ability to understand and treat age-related macular degeneration.

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Conflict of interest statement

Conflict of interest statement

FLF is one of the inventors on US patent 6660297 (Nutritional supplement to treat macular degeneration), owned by Bausch and Lomb. He has assigned his interest in the patent to the US Government and receives government compensation. All other authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Left eye of a patient with intermediate age-related macular degeneration with large drusen
Figure 2
Figure 2
Geographic atrophy involving the centre of the fovea, with sharply demarcated loss of normal retinal pigment epithelial cells and evidence of deeper larger choroidal vessels
Figure 3
Figure 3
Neovascular age-related macular degeneration, with retinal haemorrhage, lipids, or retinal hard exudate and subretinal fluid
Figure 4
Figure 4. A typical large drusen (arrow) composed of hyaline deposits with granular ground substance from the inner aspect of Bruch’s membrane
The underlying retinal pigment epithelium cells are thin and compressed. Photoreceptors appear to be mildly atrophied in an age-related macular degeneration eye.
Figure 5
Figure 5
Macrophages (arrows) in and surrounding a small choroidal neovascular lesion, with breaks at Bruch’s membrane
Figure 6
Figure 6
Dense collagen fibrous tissue (asterisk) between the degenerative photoreceptor cells and Bruch’s membrane and a large feeder vessel (arrow) penetrating through the macular scar
Figure 7
Figure 7
Positive HtrA1 immunoreactivity (arrows) in soft drusen
See this image and copyright information in PMC

References

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