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Age-related Macular Degeneration (AMD) is a multifactorial disease involving genetic and environmental influences. Complement Factor H (CFH) and HTRA1/LOC387715 are the two main loci associated with AMD. A genetic understanding of AMD may allow for early diagnosis and treatment.
The causative factors for AMD have not been elucidated, but disease development is likely a combined result of gene vulnerability interacting with predisposing and often modifiable risk factors. Many studies have linked AMD to the effects of oxidative stress. Several of the risk factors discussed below are thought to further increase oxidative damage and/or limit the retina’s ability to repair. While...
Classifying AMD helps physicians counsel patients, make treatment decisions, and standardize clinical trials. The presentation of AMD can vary widely and thus the differential diagnosis is large. Medical and ocular history, ophthalmoscopy, and ancillary testing can be used in combination to narrow the differential diagnosis. When the response to standard therapy is not typical, the diagnosis of AMD...
Digital fundus cameras and confocal scanning laser ophthalmoscopes have increased the efficiency and resolution of fundus photography. Autofluorescent images yield information about the functional status of the outer retina and retinal pigment epithelium (RPE). Fluorescein angiography remains invaluable for studying retinal vascular anatomy and physiology in eyes with neovascular age-related macular...
Age related macular degeneration (AMD) is the leading cause of blindness among adults over the age of 65 in the Western world. The prevalence of AMD is expected to increase dramatically, from 1.75 million in 2000 to 2.95 million in 2020, due to the rapidly aging population. Given the large and now increasing burden of disease, the identification of modifiable risk factors and new avenues for preventive...
VEGF is the most important regulator of angiogenesis and a potent promoter of vascular permeability in different ocular diseases, including AMD. For this reason, VEGF is a key target in treating ocular neovasculari-zation. Two anti-VEGF agents have achieved regulatory approval, with others in clinical trials. Clinical trials have shown that intravitreal ranibizumab is safe drug and effective, being...
Exudative AMD is the leading cause of blindness in people over 50 years old in the Western world. Choroidal neovascularization found in exudative AMD appears to be a multifactoral process involving inflammatory, vascular, and angiogenic components. Commercially available treatments for exudative AMD primarily target a solitary component of this multifactoral disease. Combining various treatment modalities...
Age-related macular degeneration (AMD) is broadly subdivided into the exudative (wet) and nonexudative (dry) subtypes. Hard and soft varieties of drusen can be clinically differentiated based on morphological appearance. Hard drusen are small discrete nodules that appear flat and have sharp borders. Soft drusen tend to be larger and more amorphous with borders that are less well defined. They frequently...
The treatment of neovascular age-related macular degeneration (AMD) will continue to evolve dramatically. Researchers are working to find new therapeutics targeting important pathways involved in angiogenesis, including: Vascular endothelial growth factor (VEGF) inhibition Vascular endothelial growth factor receptor (VEGFR) and platelet-derived growth factor receptor inhibition (PDGFR), including...
The Patient Protection and Affordable Care Act of 2010 funded the Patient-Centered Outcomes Research Institute to promote the use of comparative effectiveness analysis and cost-effectiveness analysis in the Unites States. There are four healthcare economic analysis variants: (1) cost-minimization analysis, (2) cost-benefit analysis, (3) cost-effectiveness analysis, and (4) cost-utility analysis....
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