Preventative ophthalmology. Age-related macular degeneration

This report was designed to review the current knowledge about preventing the development or progression of age-related macular degeneration (AMD) and visual loss associated with this entity in practical terms for the comprehensive ophthalmologist.

Animal studies, epidemiologic studies, and clinical trials identified through the use of MEDLINE, a reference list of articles reviewed, and personal contact with experts in this area provided information reviewed for this report.

Reports concerning ultraviolet and visible light provide limited, inconsistent, and conflicting data to support the theory that light exposure leads to AMD. Micronutrient supplementation is a provocative but largely unproven hypothesis. Positive associations of cigarette smoking and cardiovascular disease or certain risk factors for cardiovascular disease with AMD provide potential clues as to the underlying pathogenesis of AMD and are yet another reason to treat these health problems. Drusen may disappear after laser to the macula; however, this intervention will require careful, randomized, prospective trials to determine if this therapy can reduce the risk of choroidal neovascularization and visual loss developing in patients with AMD.

It is reasonable to have individuals wear sunglasses for comfort and possible protection from ultraviolet light exposure to all ocular structures (especially the lens) at little or no risk to the patient. Physicians probably should be reluctant to prescribe micronutrients or suggest other interventions (such as laser to drusen) until their health claims have been substantiated and their long-term safety soundly established.