Ординатура / Офтальмология / Английские материалы / Optical Coherence Tomography in Age-Related Macular Degeneration_Coscas_2009

Gabriel COSCAS

Professeur Emérite des Universités

Hôpital de Créteil. Département d’ophtalmologie de Créteil Université Paris XII – Val de Marne gabriel.coscas@gmail.com

ISBN 978-3-642-01468-0 Springer Medizin Verlag Heidelberg

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VII

Over recent decades, as a result of progress in basic and clinical research, our knowledge on age-related macular degeneration (AMD) has been improved and refined, leading to a renewed interest in this disease

However, the etiology, pathophysiology, clinical features, and natural history of AMD remain unclear. Until these unknowns can be elucidated, the primary objective for all ophthalmologists is to diagnose AMD as early as possible in order to optimize the use of new treatment options.

Gabriel COSCAS has trained a large number of ophthalmologists and whole generations of retinal specialists all over the world. He is renowned in France and worldwide for his remarkable clinical knowledge of AMD, which is based on his considerable personal experience.

This book provides precise and sometimes surprising answers to our questions. As an experienced, critical, and well-informed clinician, he provides us yet again with a book that illustrates his exceptional capacity for analysis, classification, and synthesis. All aspects that ophthalmologists need to understand are explained by rich imaging, based on all types of imaging modalities and supported by OCT.

A wide range of fundus imaging modalities are now available, and this book explains the respective value of each technique. The information provided by OCT is presented logically by comparison with plain films, autofluorescence, fluorescein angiography, or indocyanine green angiography. Meticulous biomicroscopic examination of macular changes and the essential value of fluorescein angiography for the detection of anatomical alterations of the macula and for precise evaluation of lesions and their course by indocyanine green angiography have naturally led Gabriel COSCAS to analyze the new data provided by OCT.

As a result of an original and often innovative approach combined with an acute sense of clinical observation, Gabriel COSCAS has described and classified new clinical signs.

The retina exerts a continuous fascination for clinicians who specialize in this field. In particular, the macula is the subject of intellectual curiosity reflected by an urgent desire to understand the physiological and pathological mechanisms and to continually develop new treatments.

Gabriel COSCAS has always expressed his passion for this tiny zone, which allows for the miracle of reading. This book should trigger a renewed interest in AMD, stimulated by the author’s relevant comments and discussions.

Rapid or even dramatic progress has been made in the field of AMD over recent years, leading to a constant revision of our basic concepts. The research subtending this progress has also revealed unexpected aspects of this disease. The pathogenesis of AMD is being completely restructured, which will probably lead to a new definition of this disease.

Current treatment modalities for neovascularization have provided a definite advancement, but response to treatment is difficult to analyze. A large part of this book is therefore devoted to recent therapeutic approaches and assessment of response after the various treatments.

The meticulous analysis of a series of clinical cases will undoubtedly be highly appreciated, as it provides the reader with a real reflection of the author’s extensive clinical experience. These new treatment modalities require particularly attentive and specific follow-up to determine the optimal strategy. Precise analysis of imaging signs guides the choice of first-line treatment and subsequent treatments in the case

IX

It is a great pleasure for me to address, in the context of this Annual Report, all of my French and international ophthalmology friends and all those who want to share the recently acquired information provided by optical coherence tomography.

These Annual Reports have become a French tradition, based on an in-depth study over several years to clarify the clinical results of a new method of investigation. A teamwork approach progressively collected the elements of a prolonged clinical experience, then analyzed and summarized these data to illustrate, by means of selected images, the main signs visualized by OCT that has rapidly become a field of major interest to ophthalmologists.

It is an even greater pleasure for me and for all of the Créteil School, in that we experienced and have tried to share, the clinical and scientific revolution of the era of angiography and laser, which allowed us to visualize retinal capillaries and choroidal neovascularization and attempt to halt the progression of these lesions by photocoagulation.

The “era” of OCT appears us to have evolved in three phases:

The first phase consisted of visualization of indirect signs: exudates and fluid accumulation, so inappropriately called “retinal” thickening.

The second phase was that which provided, by means of Spectral-Domain technology, much sharper images of lesions, detachments, and inflammatory reactions. In particular, this new imaging modality allows exact correlations with angiography on each examination and during follow-up.

The third phase has just begun, with analysis and monitoring of alterations of the outer layers and photoreceptor cell damage.

Major advancements have already been made, as OCT now combines the data of morphological imaging and functional imaging to provide real “non-invasive optical biopsies.”

With this tradition and with this future, this book is therefore dedicated to all those who inspired me with my love for this field, all those who taught me, all those who have accompanied me for more than fifty years of ophthalmology, and of course, to all of the younger generations.

The tenderness, advice, and confidence of my mother and father are still very clear in my mind: they still help me, guide me, and accompany me with the same tenderness and same confidence as that of my par- ents-in-law.

My wife Gisèle, my daughters Florence and Brigitte, and each of my five grandchildren form my family circle. I compensate for my lack of time by my intense love and recognition for their tenderness and for the pride that they inspire in me. Each one leads his or her own life, but we are all united to overcome our difficulties and share our happiness. Their support, their affection, their understanding, and the interest that they have shown in this new project have been extremely valuable to me.

Créteil has remained at the center of my work. My continued participation in the work of the Créteil School that I love so much, and in the innovations provided by Gisèle Soubrane, has been a privilege and a source of happiness. This school is a place of permanent and daily enrichment, due to its warm and unending welcome, its original points of view, and our fascinating discussions. My friendly discussions

XForeword

with Eric Souïed, particularly on his recent studies, have highlighted the role of genetics and nutritional and environmental factors. Each new generation of associate professors, assistants, interns, and residents from all over the world has provided new points of view and all therefore participated in the elaboration of this book.

I would also like to thank the leading international experts who contributed to the prestige of this “Report” and the Sociétés d’Ophthalmologie de France, such as Professors Cynthia Toth from Durham, Yasuo Tano* from Osaka, Marc De Smet from Amsterdam, Giovanni Staurenghi from Milan, Bruno Lumbroso from Rome, and Giuseppe Carella from Milan.

My four closest colleagues, Florence Coscas, Sabrina Vismara, Alain Zourdani, and C. Iole Li Calzi, accompanied me daily and contributed their youth, their effort, and their assistance to collect and select an immense amount of documentation. It was a true pleasure to work with them and nothing could have been done without them. I would also like to thank all of my colleagues at Créteil and at the Odéon Center, and all of the ophthalmologists who sent me their clinical cases or valuable comments.

Christian Lamy was an efficient, intelligent, and understanding publisher for the French edition of this book. For the English edition, I am thankful to have had the guidance and support of Hanna Hensler-Fritton and the rest of my colleagues at Springer Publishing, who worked so diligently to bring this book to fruition.

I would like to acknowledge the contribution of Ricky Zolf, Anthony Saul, Jean Pierre Hubschman, Irena Tsui, and Tina-Marie Gauthier, who assisted me in the preparation of this book, providing English-language translation, review, and editing.

The Sociétés d’Ophthalmologie de France and their presidents, and President Christophe Baudouin and Sec- retary-General Pierre Larricart in Paris, have once again entrusted me with this task and have provided me with continuing friendship and support. This tradition of Annual Reports will surely continue.

While writing this book, I thought of you dear Readers each day, and it is a great pleasure to dedicate this book to each of you

*Professor Yasuo Tano passed away on January 31, 2009. In addition to his valuable contribution to this book, Professor Tano will be remembered for his leadership in the global advancement of ophthalmology.