[Age-related macular degeneration]

Age-related macular degeneration (AMD) is the commonest overall cause of irreversible blindness in patients aged 50 or over in the western world. It is a spectrum of related diseases that have in common the progressive decline of vision as a consequence of dysfunction of the central retina and its underlying supporting elements, principally the retinal pigment epithelium and choroid in older adults. The disease has been traditionally classified into early and late stages with its dry and wet forms. Patients with age-related maculopathy should consider taking a dietary supplement such as that used in AREDS. There is no effective treatment for geographic atrophy. The exudative AMD is approached depending on the type and localisation of choroidal new vessels. Laser photocoagulation has only been shown to be beneficial for extra and juxtafoveal well defined lesions. PDT with verteporfin is effective in the management of patients with subfoveal predominantly classic lesions. A variety of molecules such as bevacizumab, pegaptanib sodium and ranibizumab, specifically targeted to different pathologic pathways in AMD, have been identified to their therapeutic potential. Research is actively being pursued in preclinical models both in academic laboratories and in the pharmaceutical industry, including multiple early stage clinical trials. There is no strong evidence to support benefits of submacular surgery in the management of neovascular AMD.