Preface

Research has yielded major discoveries about the etiology, pathophysiology, and treatment of agerelated macular degeneration over the last decade. Indeed, the desire to summarize and synthesize this new information for clinicians and scientists involved in age-related macular degeneration patient care and research resulted in the first edition of this book. Since then five years have flown by, and the pace of basic science and translational research in age-related macular degeneration has accelerated. The resultant novel discoveries have improved and will continue to improve the daily lives of our patients. These novel therapies offer not only sight saving, less destructive forms of treatment for exudative age-related macular degeneration, but also treatments that can improve visual acuity. In addition, preventive treatments are being developed for non-exudative age-related macular degeneration. The goal of this second edition is to inform the reader about the latest information available on the pathophysiology, diagnosis, management, and treatment of age-related macular degeneration.

A significant amount of new information is presented throughout this second edition. I asked retinal experts to first summarize the established information and then to present the most novel developments in their field. The first section of this book includes the pathophysiology, epidemiology, and genetics of age-related macular degeneration. Updated light and electron microscopic findings of age-related macular degeneration are presented to facilitate the understanding of its ultrastructural pathophysiology. Such an understanding is useful in directing future areas of research towards a cure. At the time of the first edition, the genetics of age-related macular degeneration was largely unknown, and the role of the immune system was mostly a theoretical one. Since then, the key role of the immune system on the pathophysiology of age-related macular degeneration has been shown by such findings as complement factor H and HTRA1 gene associations with exudative agerelated macular degeneration.

The second section focuses on the clinical diagnosis and treatment of age-related macular degeneration. The clinical findings seen in the nonexudative and exudative forms are discussed. Additional color photos have been added and are

shown within each chapter (instead of the color insert used in the first edition). The natural history data of untreated age-related macular degeneration is retained and contrasted with the outcomes from treatment trials.

The third section on imaging includes newly added chapters on fundus autofluorescence and quantitative imaging techniques. The imaging modalities are discussed with attention to their usefulness in planning treatment and assessing treatment responses of age-related macular degeneration patients.

The next sections present in-depth information on current and experimental forms of treatment for non-exudative and exudative forms of age-related macular degeneration. The presentation of the treatment options includes a discussion of the mechanism of action, the clinical treatment technique, the targeted patient population, the expected outcomes, and a balanced discussion of both positive and negative aspects of each treatment.

The following section of this book focuses on visual rehabilitation and active areas of basic science research that may lead to other forms of treatment in the near future. It is a reality that despite the recent progress in treatments, some patients still lose visual acuity. For these patients, visual rehabilitation remains extremely important. An updated discussion of the available low vision devices and the psychosocial aspects of visual loss are included to help counsel patients with agerelated macular degeneration and visual loss. The progress in the areas of retinal prostheses and retinal pigment cell transplantation are presented. These areas of research may one day lead to future treatments that help to overcome visual loss and damage. Progress in these areas renews our hope for the future generations afflicted with age-related macular degeneration. Promising new therapies will need to undergo clinical trials to evaluate clinical efficacy. The last section of this book therefore presents the essentials of clinical trial design.

As in the first edition, no single manageable volume can compile and analyze all of the existing knowledge concerning age-related macular degeneration. I have attempted to distill the most clinically salient and exciting research information from the vast body of knowledge for inclusion in this second edition. If this book can once again serve as a first-hand

xPREFACE

resource for researchers and clinicians in the area of age-related macular degeneration, then my goal has been achieved. It is my hope that the information presented herein continues to incite inquiry and ignite research that may unearth those enigmatic answers to questions about the etiology of and cure for age-related macular degeneration.

I wish to thank my outstanding contributors without whom this book would not be possible. Their

eagerness to collaborate, their scholarship, and their expertise made my job as editor of this book extremely enjoyable, educational, and satisfying. I wish to thank my administrative assistants, Francine and Annel, for their invaluable secretarial assistance. I wish to thank my editors at Informa Healthcare for their assistance in compiling this book.

Jennifer I. Lim