Summary for the Clinician

›Microperimetry provides more information about functional deterioration of the macula in eyes with early and advanced AMD than could be obtained by visual acuity.

›Visual function changes in AMD are characterized by the progressive deterioration of retinal Þxation and central sensitivity. Even eyes with early AMD and normal visual acuity show retinal sensitivity changes. In geographic atrophy, microperimetry represents a useful prognostic biomarker. When CNV appears, Þxation deteriorates limiting reading ability, and ultimately a dense central scotoma with totally eccentric Þxation develops.

›Longer duration of disease is a key factor associated with worse Þxation patterns and more retinal sensitivity deterioration.

›A better understanding of the characteristics of visual function loss in AMD, obtained with microperimetry, may contribute to the clinical care of AMD patients. Microperimetry integrates other imaging techniques and allows: to monitor any phases of the disease; to optimize timing, patient selection, and treatment options in eyes with subfoveal CNV due to AMD; and to adequately quantify the beneÞcial or detrimental effects of any treatment.

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Core Messages

›Nutrition, cigarette smoking, and plasma homocysteine may be modiÞable risk factors which provide therapeutic targets in the management of AMD.

›Data regarding therapeutic interventions for primary prevention of AMD are limited and thus far inconclusive.

›The preponderance of data regarding nutrients and AMD come from observational data. A limited number of randomized controlled trials are available to validate observational data regarding risk factors and potential therapeutic interventions for AMD.

›The Age-Related Eye Disease Study (AREDS) demonstrated that daily oral supplementation of a combination of antioxidant vitamins and zinc has been shown to reduce progression to advanced AMD among patients who are at

intermediate to high risk of progression of disease [1].

›The WomenÕs Antioxidant and Folic Acid Cardiovascular Study (WAFACS) demonstrated that daily long-term supplementation with folic acid, pyridoxine, B12, and cyanocobalamin reduced risk of advanced AMD in a population of female health care professionals with, or at risk for, cardiovascular disease.

›The more efÞcacious combination of nutrients and antioxidants has not yet been determined.

›Preliminary observational data suggests that omega-3 fatty acids and carotenoids, speciÞcally lutein and zeaxanthin, may play a role in prevention and treatment of AMD. Presently, there are insufÞcient data from randomized controlled clinical trials to make therapeutic recommendations.

A.D. Meleth (*) ¥ N. Krishnadev ¥ E.Y. Chew National Eye Institute, National Institutes of Health, Bethesda, MD, USA

e-mail: meletha@mail.nih.gov; krishnadevn@mail.nih.gov; echew@nei.nih.gov

V.R. Raiji

Department of Ophthalmology, George Washington University, Washington, DC, USA

e-mail: veena.raiji@gmail.com

12.1 Introduction

Age-related macular degeneration (AMD) is the leading cause of blindness among adults over the age of 65 years, of northern European descent in the developed countries. In the USA, the prevalence of AMD is expected to increase dramatically, from 1.75 million in 2000 to 2.95 million in 2020, due to the rapidly ageing population [1]. Given the large and now increasing burden of disease to families and to society, the identiÞcation of modiÞable risk factors and new avenues for preventive treatment have become increasingly important.