What is New in the Management of Age-Related Macular Degeneration?

Age-related macular degeneration (AMD) is a multifactorial disease with characteristics that include drusen, hyperpigmentation and/or hypopigmentation of the retinal pigment epithelium (RPE), geographic atrophy (GA) and, in a subset of patients, late-stage choroidal neovascularization (CNV). It is the leading cause of blindness in the developed world among aging adults. It damages the integrity of the Bruch’s membrane and other tissues underlying the macula. Drusen, acellular deposits of lipids, proteins, and inflammatory mediators, are present in nonneovascular AMD, which is often called dry or atrophic AMD. Neovascular AMD also called wet or exudative AMD is characterized by a CNV emanating from the choroid through Bruch’s membrane and proliferating below or above the RPE, below the retina in the macular region, resulting in severe visual loss in advanced stages . Dry AMD is typically gradual and insidious and may not progress to total vision loss. It is the more common form, but wet AMD, which accounts for only about 15% of cases of all AMD, is responsible for nearly 80% of AMD-related cases of severe vision loss. To date, there have been considerable advances in the management of wet AMD, but there is still no established treatment for the most prevalent dry form of AMD. Left untreated, patients with dry AMD are at risk for substantial vision loss and progression to wet AMD. The National Eye Institute (NEI), the Macular Degeneration Foundation, Inc., the Macular Degeneration Partnership and Macular Degeneration Support provide the following recommendations for slowing down, or preventing the progression of, both dry and wet AMD. • Diet and weight control: Studies suggest that eating antioxidantrich foods such as fresh fruits, dark green leafy vegetables (a good source of lutein) and at least one serving of fish per week may delay the onset or reduce the severity of dry AMD; in addition, obesity may increase the risk for progression to advanced AMD. • Nutritional supplements: Supplements containing high doses of antioxidant vitamins, copper, and zinc may reduce the risk of What is New in the Management of Age-Related Macular Degeneration? Reema Bansal, Amod Gupta Advanced Eye Centre, Post Graduate Institute of Medical Education and Research,Chandigarh, India