- •Foreword
- •Preface
- •Contents
- •Contributors
- •Key Points
- •Introduction
- •Etiology
- •A Genetic Cause
- •Family Studies
- •Associations with Race
- •Specific Genes Conferring AMD Risk
- •Complement Factor H
- •C2-CFB Locus
- •Complement Component 3
- •Other Inflammatory Factor Variants
- •Toll-Like Receptor
- •VEGF-A
- •Genetic Variants on Chromosome 10q26
- •LOC387715/ARMS2
- •HTRA1
- •Other Genetic Variants
- •Apolipoprotein E
- •Fibulin 5
- •Hemicentin-1
- •LOC387715/HTRA1 and CFH
- •Genetic Predisposition to a Specific Late Phenotype
- •Conclusion
- •References
- •Key Points
- •Introduction
- •Smoking
- •Alcohol
- •Increased Light Exposure
- •Obesity
- •Exercise
- •Dietary Fat Intake
- •Phytochemicals
- •Ginkgo Biloba
- •Anthocyanins
- •Resveratrol
- •Epigallocatechin Gallate
- •Mineral Supplements
- •Summary
- •References
- •Key Points
- •Introduction
- •Classification
- •Nonexudative (Non-neovascular or Dry) AMD
- •Exudative (Neovascular or Wet) AMD
- •Retinal Angiomatous Proliferation
- •Polypoidal Vasculopathy
- •Diagnosis
- •Differential Diagnosis
- •Nonexudative AMD
- •Central Serous Chorioretinopathy (CSCR)
- •High Myopia
- •Stargardt’s Disease/Fundus Flavimaculatus
- •Cuticular Drusen
- •Pattern Dystrophy
- •Old Exudative AMD
- •Old Laser Scars
- •Other Conditions
- •Exudative AMD
- •Central Serous Chorioretinopathy
- •Idiopathic Polypoidal Choroidal Vasculopathy
- •Retinal Angiomatous Proliferation (RAP)
- •Presumed Ocular Histoplasmosis Syndrome (POHS)
- •Angioid Streaks
- •High Myopia
- •Cystoid Macular Edema
- •Traumatic Choroidal Rupture
- •Macular Hemorrhage
- •CNV Secondary to Laser
- •Idiopathic
- •Summary
- •References
- •Key Points
- •Introduction
- •Color Photography
- •Monochromatic Photography
- •Autofluorescence Imaging
- •Optical Coherence Tomography
- •Enhanced Depth Imaging
- •Fundus Angiography
- •Fluorescein Dye Characteristics
- •Indocyanine Green Dye Characteristics
- •Cameras and Angiography
- •Patient Consent and Instruction
- •Fluorescein Injection
- •Fluorescein Technique
- •Indocyanine Green Technique
- •The Macula
- •Deviations from Normal Angiographic Appearance
- •Indocyanine Green Angiographic Interpretation
- •Drusen
- •Choroidal Neovascularization
- •CNV and Fluorescein Angiography
- •Retinal Vascular Contribution to the Exudative Process
- •Fundus Imaging Characteristics of Therapies for Neovascular AMD
- •Thermal Laser
- •Photodynamic Therapy
- •Anti-VEGF Therapy
- •References
- •Key Points
- •Introduction
- •AREDS
- •Carotenoids
- •Beta-Carotene
- •Macular Xanthophylls
- •Fatty Acids
- •Vitamin E
- •Vitamin C
- •Zinc
- •Folate/B-Vitamins
- •AREDS2
- •Summary
- •References
- •6: Management of Neovascular AMD
- •Key Points
- •Introduction
- •Angiogenesis
- •An Overview of VEGF
- •VEGF-A Isoforms
- •VEGF-A Physiological Response
- •VEGF-A Response in Retinal Diseases
- •Antiangiogenic Drugs
- •Pegaptanib
- •Drug Overview
- •Published Trials
- •Bevacizumab
- •Drug Overview
- •Published Studies
- •Ranibizumab
- •Drug Overview
- •Published Trials
- •Safety Data
- •Upcoming Clinical Trials
- •Promising VEGF Inhibitors
- •Conclusion
- •References
- •Key Points
- •Introduction
- •Antinflammatory Therapy
- •Verteporfin Angioocclusive Therapy
- •Antiangiogenic Therapy
- •Rationale for Combination Therapy in the Treatment of Exudative AMD
- •Clinical Data Examining Combination Therapy for Exudative AMD
- •Verteporfin Therapy in Combination with Triamcinolone
- •Verteporfin PDT Therapy in Combination with Anti-VEGF Agents
- •Triple Therapy for Exudative Age-Related Macular Degeneration
- •Summary
- •References
- •Key Points
- •Drusen
- •Geographic Atrophy
- •Imaging Modalities in Dry AMD
- •Clinical Trials for Dry AMD
- •Study Design
- •Risk Reduction in Dry AMD
- •AREDS
- •Laser/CAPT
- •Anecortave Acetate
- •Control of Disease Progression
- •Visual Cycle Inhibition: Antioxidants
- •Antioxidants
- •Complement
- •Neuroprotective Agents
- •Modulators of Choroidal Circulation
- •Recovery
- •Gene Therapy
- •Stem Cell Therapy
- •Retinal Prostheses
- •Summary
- •References
- •Key Points
- •Introduction
- •Emerging and Future Therapies
- •Ranibizumab
- •Bevacizumab
- •VEGF Trap-Eye
- •Bevasiranib
- •Vatalanib
- •Pazopanib
- •Sirna-027
- •Anti-VEGFR Vaccine Therapy
- •Radiation
- •Epi-Rad90™ Ophthalmic System
- •IRay
- •Infliximab
- •Sirolimus
- •Gene Therapy
- •AdPEDF.11
- •AAV2-sFLT01
- •Other Pathways
- •Squalamine Lactate
- •Combretastatin A4 Phosphate/CA4P
- •Volociximab
- •NT-501, Ciliary Neurotrophic Factor
- •Sonepcizumab
- •Summary
- •References
- •Key Points
- •Introduction
- •Evidence-Based Medicine
- •Interventional Evidence
- •Masking
- •Dropout Rate
- •Validity
- •Risk Reduction
- •Pharmacoeconomic Analysis
- •Cost-Minimization Analysis
- •Cost-Benefit Analysis
- •Cost-Effectiveness Analysis
- •Quality-of-Life Instruments, Function-Based
- •Quality-of-Life Instruments, Preference-Based
- •Utility Acquisition
- •Utility Gain
- •Decision Analysis
- •Comparative Effectiveness (Human Value Gain)
- •Value Trumps Cost
- •Costs
- •Cost Basis
- •Cost Perspective
- •Cost-Utility Ratio
- •Cost-Effectiveness Standards
- •Discounting
- •Standardization
- •Patient Respondents
- •Cost Perspective
- •The Future
- •Macroeconomic Costs and AMD
- •Employment and Wage Loss
- •Gross Domestic Product (GDP)
- •Other Costs
- •Financial Return on Investment (ROI)
- •References
- •Index
20 |
H.R. Coleman |
|
|
Fig. 2.1 Gingko biloba (From: http://upload.wikimedia. org/wikipedia/commons/2/2a/Ginkgo_biloba_leaf_3.jpg)
generally inconsistent, particularly concerning their relationship to AMD, because it is difficult to control other influencing lifestyle choices [22]. A few of the more commonly known compounds are reviewed here.
Ginkgo Biloba
Ginkgo biloba is one of the oldest living tree species (Fig. 2.1). Its leaves contain flavonoid glycosides that have been studied for their role in reduction of platelet aggregation, increased vasodilatation, and quenching of free radicals – the latter of which has sparked interest for its use on AMD. To date, there are no studies that demonstrate a definite positive effect on AMD, but also there have been few reports of toxicity, although it can increase the risk of bleeding in anticoagulated patients. Clinical trials have used between 120 and 240 mg daily [23, 24]. Dietary supplements generally provide 40–80 mg in a single dose.
Anthocyanins
Anthocyanins, also known as berry extracts, are water-soluble flavonoid pigments found in fruit such as blueberries, cranberries, bilberries, blackberries, blackcurrants, red currants, cherries, and purple grapes among others (Fig. 2.2). They act as potent antioxidants and are thought to reduce inflammation, aging, neurological diseases, cancer, and diabetes. In the retina, they are thought to
Fig. 2.2 Blueberries (From: http://upload.wikimedia.org/ wikipedia/commons/7/7e/Blueberries_on_branch.jpg)
Fig. 2.3 Red wine (From: http://commons.wikimedia. org/wiki/File:Red_wine_closeup_in_glass.jpg)
inhibit photo oxidation and membrane permeability changes that can lead to AMD [23].
Resveratrol
Resveratrol is a polyphenolic antioxidant found in red wine that appears to have antiinflammatory antioxidant and antiproliferative benefits (Fig. 2.3). Treatment with 50 and 100 mmol/L resveratrol has recently been shown to have significantly reduced in vitro the proliferation of retinal pigment epithelium cells by 10–25%, respectively, and as such is a compound of interest for ongoing studies [25].
