A ge-related macular degeneration is the leading cause of irreversible blindness in people 50 years of age or older in the developed world. 1,2 More than 8 million Americans have age-related macular degeneration, and the overall prevalence of advanced age-related macular degeneration is projected to increase by more than 50% by the year 2020. 3 Recent advances in clinical research have led not only to a better understanding of the genetics and pathophysiology of age-related macular degeneration but also to new therapies designed to prevent and help treat it. This article reviews the clinical and histopathological features of agerelated macular degeneration, as well as its genetics and epidemiology, and discusses current management options and research advances. Nor m a l R e t ina l A rchi tec t ur eThe macula is the central, posterior portion of the retina (Fig. 1A). It contains the densest concentration of photoreceptors within the retina and is responsible for central high-resolution visual acuity, allowing a person to see fine detail, read, and recognize faces. Posterior to the photoreceptors lies the retinal pigment epithelium. It is part of the blood-ocular barrier and has several functions, including photoreceptor phagocytosis, nutrient transport, and cytokine secretion. Posterior to the retinal pigment epithelium lies Bruch's membrane, a semipermeable exchange barrier that separates the retinal pigment epithelium from the choroid, which supplies blood to the outer layers of the retina (Fig. 1B). 4 Ch a nge s w i th AgeWith age, one change that occurs within the eye is the focal deposition of acellular, polymorphous debris between the retinal pigment epithelium and Bruch's membrane. These focal deposits, called drusen, are observed during funduscopic examination as pale, yellowish lesions and may be found in both the macula and peripheral retina ( Fig. 2A). Drusen are categorized as small (<63 μm in diameter), medium (63 to 124 μm), or large (>124 μm) on the basis of studies that classified the grade of age-related macular degeneration. 5,6 On ophthalmoscopic examination, the diameter of large drusen is roughly equivalent to the caliber of a retinal vein coursing toward the optic disk. Drusen are also categorized as hard or soft on the basis of the appearance of their margins. Hard drusen have discrete margins; conversely, soft drusen generally have indistinct edges, are usually large, and can be confluent. 5Pathoph ysiol ogy of Age-R el ated M acul a r Degener ationThe clinical hallmark and usually the first clinical finding of age-related macular degeneration is the presence of drusen. In most cases of age-related macular degen-The New England Journal of Medicine Downloaded from nejm.org at MICHIGAN STATE UNIV LIB on March 17, 2013. For personal use only. No other uses without permission.

The risk of serious adverse events reported after IVT injection is low. Nevertheless, careful attention to injection technique and appropriate postinjection monitoring are essential because uncommon injection-related complications may be associated with permanent vision loss.

No abstract

Type 2 diabetes patients with macular oedema experience a decreased VR-QOL compared with type 1 diabetic patients with diabetic retinopathy, glaucoma or cataracts. However, VR-QOL in type 2 diabetic patients with macular oedema was similar to those individuals with ARMD.

No abstract