Macular Degeneration

Anonymous00046. · Agency for Healthcare Research and Quality, Rockville, Maryland, USA. · Ann Intern Med. · Pubmed #19581645 No free full text.

Abstract: DESCRIPTION: Update of the 1996 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for visual impairment. METHODS: The USPSTF reviewed evidence published since its last review on screening adults 65 years or older in the primary care setting for visual acuity impairment associated with uncorrected refractive errors, cataracts, and age-related macular degeneration. RECOMMENDATION: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for visual acuity for the improvement of outcomes in older adults. (I statement).

Anonymous117059. · No affiliation provided · Klin Monatsbl Augenheilkd. · Pubmed #17657689 No free full text.

Abstract: The basic conditions in the management of exudative age-related macular degeneration have changed considerably since the last statement of the German professional associations in 2006. While Pegaptanib was approved in Germany already in 2006 Ranibizumab was approved for the treatment of exudative macular degeneration in Germany in February 2007. More over the quality assurance regulations for the photodynamic treatment of choroidal neovascularizations with Verteporfin were modified including the treatment of occult lesions and implementing a simplified classification of extra- and subfoveal lesions. Consequently modification of the recommendations for the non-surgical treatment of exudative age-related macular degeneration appeared inevitable.

O'Brien TP. · The Wilmer Ophthalmology Institute, The Johns Hopkins Hospital, Baltimore, MD 21287-0682, USA. · Curr Med Res Opin. · Pubmed #16004683 No free full text.

Abstract: This analysis provides guidelines for the proper use of topical ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs), discusses their effect on inflammation, and their role in the prevention of cystoid macular edema (CME). A novel treatment strategy is presented for recommended topical ophthalmic NSAID dosing in patient populations based on risk factors for CME. The article reviews current topical ophthalmic NSAIDs, as well as a newest generation of pro-drug NSAIDs. In addition, combination therapy of NSAIDs and corticosteroids are discussed, along with a general review of therapeutic guidelines for dosing regimens, and benefits and risks of therapy. The goal of this analysis is to provide a suggested therapeutic regimen with topical NSAIDs to assist in achieving optimal clinical and functional outcomes.

Solomon SD, Bressler SB, Hawkins BS, Marsh MJ, Bressler NM, Anonymous00106. · Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205-2005, USA. · Retina. · Pubmed #15805900 links to  free full text

Abstract: PURPOSE: To describe the guidelines followed by the Submacular Surgery Trials (SST) Research Group in the interpretation of color fundus photographs and fluorescein angiograms of subfoveal choroidal neovascular lesions evaluated in the SST and to assist ophthalmologists in applying the results of the SST. METHODS: Stereoscopic color fundus photographs and fluorescein angiograms of the study eye and nonstudy eye of 1,015 patients with subfoveal choroidal neovascular lesions secondary to age-related macular degeneration, ocular histoplasmosis syndrome, or idiopathic choroidal neovascularization (CNV) were obtained and graded by certified SST fundus photograph readers at the baseline examination in three randomized clinical trials comparing surgery with observation. Adherence to the inclusion and exclusion criteria and ocular features that might affect visual outcome were documented. Stereoscopic color fundus photography and fluorescein angiography were repeated 1 month after randomization for patients assigned to surgery to provide documentation that surgery was performed and to assess compliance with the surgery protocol. Photographs and fluorescein angiograms of both the study eye and the fellow eye in all patients then were obtained 3 months, 6 months, and 12 months after randomization and then annually up to 48 months. The kappa statistic was used to evaluate interobserver reliability of photograph gradings. RESULTS: Lesion components at baseline included classic CNV, occult CNV, and features contiguous to CNV, including blood, fibrous tissue, hypofluorescence not corresponding to blood, serous detachment of the retinal pigment epithelium, and prior areas of laser photocoagulation. At follow-up, fluorescein leakage from CNV was assessed peripheral to or within the area of the retinal pigment epithelium abnormality after surgery. The lesion at follow-up could include any of the features identified at baseline as well as retinal pigment epithelium abnormalities, such as mottling of the retinal pigment epithelium with a subtle transition to normal retinal pigment epithelium or a very sharply demarcated, markedly hypopigmented area that was easily distinguished from the surrounding retinal pigment epithelium. kappa statistics for interobserver reliability ranged from good (0.47) to excellent (1.00) for features graded at baseline and follow-up. CONCLUSIONS: Although some of the definitions essential to the interpretation of the SST are similar to those used in the Macular Photocoagulation Study and randomized clinical trials of photodynamic therapy with verteporfin, this guideline provides new information regarding lesion components at baseline as well as standardized descriptions of lesions after submacular surgery. These descriptions from the SST assist in understanding what lesions were studied, when additional treatment was considered after surgery, and how anatomical results should be interpreted.

Anonymous00131. · No affiliation provided · Retina. · Pubmed #15689800 No free full text.

Abstract: Guidelines originally were published in 2002 based on best available scientific data as well as consensus of expert opinion in the absence of controlled clinical trial data to assist ophthalmologists with selection of patients for whom photodynamic therapy with verteporfin (Visudyne, Novartis AG, Basel, Switzerland), termed "verteporfin therapy," should be considered, and to offer suggestions regarding initial treatment, follow-up, and additional courses of treatment at follow-up. Consensus was based on results of clinical trials and expert opinion. Additional input and advice were received from representatives on behalf of the American Society of Retina Specialists, the Macula Society, and the Retina Society, as well as principal investigators of randomized clinical trials evaluating verteporfin therapy. Since 2002, additional information relevant to clinical care was published in the peer-reviewed literature; therefore, revisions to the originally published guidelines judged warranted are provided here. Patient selection criteria include the following: (1) in cases due to age-related macular degeneration (AMD), lesion composition of (a) predominantly classic choroidal neovascularization (CNV), (b) occult with no classic CNV with presumed recent disease progression, or (c) relatively small minimally classic lesions; (2) CNV location subfoveal or so close to the foveal center that conventional laser photocoagulation treatment almost certainly would extend under the center; (3) etiology of CNV from AMD, pathologic myopia, or other causes in which the outcome without treatment is likely to be worse than with treatment; and (4) vision at a level where further loss would be recognized as detrimental to the quality of life of the patient. Criteria include lesion size for AMD patients with either a minimally classic lesion composition (where treatment usually should be considered only for relatively smaller lesions) or occult with no classic lesions (where treatment usually should be considered for relatively smaller lesions or those >4 Macular Photocoagulation Study disc areas with a relatively lower or poorer best-corrected visual acuity) but not patient age, history of systemic arterial hypertension, or prior laser photocoagulation. Therapy should be initiated ideally within 1 week of the initial fluorescein angiogram on which the clinical decision to treat is based. Patients should return for follow-up at least as often as every 3 months (+/-2 weeks) after any initial or subsequent treatment to determine if there is fluorescein leakage from CNV. Additional courses of treatment should be considered as often as every 3 months (+/-2 weeks) if fluorescein leakage from CNV is noted at that time. Additional courses of treatment could be deferred if the biomicroscopic and fluorescein angiographic appearances of the lesion are unchanged and show minimal fluorescein leakage, especially when there is no subretinal fluid or fluorescein leakage from CNV underlying the center of the foveal avascular zone. Patients should avoid exposure of skin or eyes to direct sunlight or bright indoor light for 48 hours after treatment or until resolution of any swelling or discoloration from extravasation. Follow-up of relatively larger minimally classic lesions and occult with no classic lesions that initially do not undergo therapy appears indicated so therapy can be considered if a predominantly classic lesion develops or, in the case of occult with no classic lesions, if visual acuity declines slightly to a lower (poorer) level without a marked increase in lesion size. Additional revisions of these guidelines may be required as new data become available.

Anonymous00215, Anonymous00216, Anonymous00217. · Novartis Ophthalmics Inc., Duluth, GA 30097, USA. · Retina. · Pubmed #11884872 No free full text.

Abstract: OBJECTIVE: Guidelines were developed based on best available scientific data as well as consensus of expert opinion in absence of controlled clinical trial data to: 1) assist ophthalmologists with selection of patients for whom photodynamic therapy with verteporfin, termed "verteporfin therapy," should be considered; and 2) offer suggestions regarding treatment, follow-up, and re-treatment. METHODS: Consensus from roundtable of retina specialists who either participated in randomized clinical trials evaluating verteporfin therapy or had clinical experience with verteporfin therapy was based on results of these trials and expert opinion. Additional input and advice were received from representatives on behalf of the Macula Society, the Retina Society, and the Vitreous Society, as well as principal investigators of randomized clinical trials evaluating verteporfin therapy. RESULTS: Patient selection criteria included the following: 1) in cases due to age-related macular degeneration (AMD), lesion composition either predominantly classic choroidal neovascularization (CNV) or occult with no classic CNV; 2) CNV location subfoveal or so close to the foveal center that conventional laser photocoagulation treatment almost certainly would extend under the center; 3) lesion etiology from AMD, pathologic myopia, or other causes in which the outcome without treatment is likely to be worse than with treatment; 4) vision at a level where further loss would be recognized as detrimental to the quality of life of the patient. Criteria did not include lesion size, except in cases composed of occult with no classic CNV in AMD in which therapy for lesions >4 Macular Photocoagulation Study (MPS) disc areas usually should be considered only when presenting with lower levels of best-corrected visual acuity. Criteria also did not include patient age, history of systemic arterial hypertension, or prior laser photocoagulation. Therapy should occur ideally within 1 week of the initial fluorescein angiogram on which the clinical decision to treat is based. Patients should return for follow-up at least as often as every 3 months after any initial or subsequent treatment to determine if there is fluorescein leakage from CNV. Re-treatment should be considered as often as every 3 months if fluorescein leakage from CNV is noted at that time. Re-treatment could be deferred if the biomicroscopic and fluorescein angiographic appearance of the lesion is unchanged and shows minimal leakage, especially when there is no subretinal fluid or fluorescein leakage from CNV underlying the center of the foveal avascular zone. Patients should avoid exposure of skin or eyes to direct sunlight or bright indoor light for 48 hours after treatment or until resolution of any swelling or discoloration from extravasation. CONCLUSION: These recommendations provide guidelines on the role of verteporfin therapy in the management of CNV due to AMD and other causes. Revisions of these guidelines may be required as new data become available.

Anonymous60008. · No affiliation provided · Can J Ophthalmol. · Pubmed #10959464 No free full text.

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Chen YX. · No affiliation provided · Zhonghua Yan Ke Za Zhi. · Pubmed #19576058 No free full text.

Abstract: Age-related macular degeneration (AMD) is the leading cause of blindness in developed countries. The impact of AMD to the economics, society and the patients are huge. However, the awareness of AMD is alarmingly low. Even in developed countries, the awareness of AMD is below 30%. In terms of the risk factors of AMD, the awareness is also quite low, e.g., only 32% were aware of the causal link between smoking and AMD. Although cataract is the leading cause of the blindness in China, as the economic and social progress, as the coming of the aging society, as people pursuing higher quality of life, AMD will become a unignoring public health problem. Thus, it is urgent to take action now to increase the public awareness of AMD.

Spaide RF. · No affiliation provided · Am J Ophthalmol. · Pubmed #19540983 No free full text.

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Beck RW. · No affiliation provided · Arch Ophthalmol. · Pubmed #19506202 No free full text.

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Finger RP, Krohne TU, Charbel Issa P, Fleckenstein M, Scholl HP, Holz FG. · No affiliation provided · Retina. · Pubmed #19430277 No free full text.

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Rosenfeld PJ, Goodman KW. · No affiliation provided · Am J Ophthalmol. · Pubmed #19376327 No free full text.

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Jampol LM, Fishman GA. · No affiliation provided · Arch Ophthalmol. · Pubmed #19365043 No free full text.

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Kim IK, Gragoudas ES. · No affiliation provided · Br J Ophthalmol. · Pubmed #19244026 No free full text.

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Kaiser PK. · No affiliation provided · Br J Ophthalmol. · Pubmed #19174397 No free full text.

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Vojniković B, Coklo M, Bosnar A. · No affiliation provided · Coll Antropol. · Pubmed #19140269 No free full text.

Abstract: After testing all types of implanted IOLs with spectrophotometer, author estimated that filtering of sun light is not successful, leaving open the possibility of development of AMD after cataract surgery. This is especially serious problem in implantation of IOLs to children. Until recently, implantation of intraocular lenses without or with inappropriate UV protection was not considered a serious problem. Nowadays we know that, especially in children, such treatment is no longer acceptable and results in AMD. It is only a matter of time when the first lawsuit will appear on it. We suggest obligatory eye protection after cataract surgery (aphakic and pseudophakic eyes) with Medical filters (Yellow-Green: 550-600 nm) and regular ophthalmic controls.

Mainster MA, Turner PL. · No affiliation provided · Am J Ophthalmol. · Pubmed #19100352 No free full text.

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Schaal S, Tezel TH, Kaplan HJ. · No affiliation provided · Ocul Immunol Inflamm. · Pubmed #19065414 No free full text.

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Woo JH, Au Eong KG. · No affiliation provided · Singapore Med J. · Pubmed #19037547 links to  free full text

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Fung AE, Bhisitkul RB. · No affiliation provided · Br J Ophthalmol. · Pubmed #19029158 No free full text.

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Iida T. · No affiliation provided · Nippon Ganka Gakkai Zasshi. · Pubmed #18949908 No free full text.

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Hunyor AP. · No affiliation provided · Clin Experiment Ophthalmol. · Pubmed #18925912 No free full text.

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Waisbourd M, Leibovitch I, Loewenstein A, Yassur Y. · No affiliation provided · Harefuah. · Pubmed #18814519 No free full text.

Abstract: Age-related macular degeneration is the leading cause of blindness and visual impairment in the developed world. The recently introduced anti-vascular endothelial growth factor (VEGF) intravitreal injections of Ranibizumab (Lucentis) and Bevacizumab (Avastin) generated a heated academic argument: on the one hand Lucentis is the only drug that was proven effective and relatively safe in large prospective double-blinded studies, albeit this drug is expensive and might cost up to $1000 per single injection. On the other hand, Avastin is widely used worldwide as a low cost alternative for Lucentis, with an estimated cost of about $120 per injection, although its efficacy and side effects were investigated only in smaller retrospective studies. The ophthalmic community still lacks definite information regarding which is the preferred drug, and awaits the results of a large prospective study comparing the two drugs.

Kim A, Stark WJ. · No affiliation provided · Am J Ophthalmol. · Pubmed #18804560 No free full text.

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Wei WB, Mo J. · No affiliation provided · Zhonghua Yan Ke Za Zhi. · Pubmed #18785539 No free full text.

Abstract: Choroidal neovascularization (CNV) especially CNV secondary to age related macular degeneration is becoming an increasing socio-medical problem as the global population aging. Recently, with novel insights in the pathogenesis of the disease, anti-angiogenesis pharmacotherapy blated its way into ophthalmogical practice and significantly changed the management of CNV, since at the first time achieving improvement in visual function. However, facing such promising drugs, we still need to take caution with the safety, long-time efficacy; to investigate more reasonable dosing schedule; to study the combined treatment strategies and so on,finally to find out the best individual clinical care for our patients.