Core Messages

›The overall goal of treating dry AMD is to target the underlying cause of the disease and prevent, or at least slow, the loss of vision, which requires the preservation of the choroid, RPE, and photoreceptors.

›Currently, there is no proven drug treatment for dry AMD; however, the cessation of smoking and treatments based on the AREDS vitamin formula combined with a healthy diet are considered the only options for slowing disease progression.

›A number of pharmaceutical agents are currently under evaluation for the treatment of dry AMD using strategies such as neuroprotection, suppression of inßammation, and prevention of oxidative damage.

17.1Introduction

Age-related macular degeneration (AMD) is the leading cause of irreversible blindness among individuals over the age of 60 in industrialized countries [1]. It is estimated that approximately 30% of adults

Z. Yehoshua ¥ P.J. Rosenfeld (*)

Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA

e-mail: zyehoshua@med.miami.edu; prosenfeld@med.miami.edu

over the age of 75 have some sign of AMD and that approximately 10% of these patients demonstrate advanced or late stages of the disease [2]. The vast majority of AMD patients have the nonexudative or dry form of the disease, characterized by a constellation of clinical features, including drusen, pigment abnormalities (focal hyperor hypopigmentation of the retinal pigment epithelium [RPE]), and geographic atrophy (GA) of the macula. As deÞned by the Age-Related Eye Disease Study (AREDS), the severity of AMD can be classiÞed into three categories: early, intermediate, and advanced. Dry AMD slowly progresses to produce a greater number and distribution of drusen and pigmentary abnormalities leading to areas of GA. The increase in size or area of drusen or pigment abnormalities of the RPE predict the likelihood of developing vision-threatening lesions in AMD, which include central GA and neovascularization, the advanced forms of AMD [3]. Patients with nonexudative AMD, even in the late atrophic stages, can maintain good central vision until the disease progresses to involve the fovea or the preferred retinal locus for Þxation.

17.2Current Treatment Options for Dry AMD

The Age-Related Eye Disease Study (AREDS), a multicenter, randomized, controlled clinical trial demonstrated that oral supplementation using a combination of vitamin C, vitamin E, beta-carotene, zinc oxide, and cupric oxide in patients with intermediate or advanced AMD in one eye reduced the relative risk of developing advanced AMD in the other eye by 25% [4].