Degeneration, macular

Ranibizumab Anti-FAB fragment of VEGF Macular degeneration... 

Ferrara N, Damico L, Shams N, et al (2006) Developmemt of Ranibizumab, an anti-vascular endothelial growth factor antigen binding fragment, as therapy for neovascular age-related macular degeneration. Retina 26 859-870... 

LUTTY G, GRUNWALD J, MAjji A B, UYAMA M and YONEYA s (1999) Changes in choriocapillaris and retinal pigment epithelium (RPE) in age-related macular degeneration. Mol Vis. 5 35-8. 

COOPER D A, ELDRiDGE A L and PETERS J c (1999) Dietary carotenoids and certain cancers, heart disease and age-related macular degeneration a review of recent research , iVMtr Rev, 57, 201-14. 

Snodderly, D.M., Evidence for protection against age-related macular degeneration by carotenoids and antioxidant vitamins. Am. J. Clin. Nutr, 62, 1448S, 1995. 

Beatty, S. et al.. The role of oxidative stress in the pathogenesis of age-related macular degeneration, Surv. Ophthalmol, 45, 115, 2000. 

Landrum, J.T. et al., The macular pigment a possible role in protection from age-related macular degeneration, Adv. Pharmacol, 38, 537, 1997. 

In the Unites States, the daily intake of 3-carotene is around 2 mg/day Several epidemiological studies have reported that consumption of carotenoid-rich foods is associated with reduced risks of certain chronic diseases such as cancers, cardiovascular disease, and age-related macular degeneration. These preventive effects of carotenoids may be related to their major function as vitamin A precursors and/or their actions as antioxidants, modulators of the immune response, and inducers of gap-junction communications. Not all carotenoids exert similar protective effects against specific diseases. By reason of the potential use of carotenoids as natural food colorants and/or for their health-promoting effects, research has focused on better understanding how they are absorbed by and metabolized in the human body. 

Astaxanthin is a powerful bioactive antioxidant and has demonstrated efficacy in animal and human models of macular degeneration, a cause of blindness in a large population. It is also helpful in treating Alzheimer s and Parkinson s diseases and is known to offer protection against cancer. 

Tso and Lam suggested that astaxanthin could be useful for prevention and treatment of neuronal damage associated with age-related macular degeneration and may also be effective in treating ischemic reperfusion injury, Alzheimer s disease, Parkinson s disease, spinal cord injuries, and other types of central nervous system injuries. Astaxanthin was found to easily cross the blood-brain barrier and did not form crystals in the eye. 

In a 20-week multicenter intervention trial with lutein in healthy human subjects, no changes were noted in hematological or biochemical parameters after continuous daily lutein doses of 15 mg (0.25 mg/kg body weight, assuming a body weight of 60 kg). A relatively large number of human studies have examined correlations between macular degeneration and dietary intake of lutein or zeaxanthin, intakes via dietary supplements, and serum concentrations. 

There is no cure for age-related macular degeneration and the efficacy of most treatments is low. 

Age-related macular degeneration (AMD) is the primary cause of irreversible vision loss in developed countries (Figs. 60-2 and 60-3). The prevalence increases with age.20 In the United States, 1.75 million people age 40 or older have AMD another 7 million people are at substantial risk of developing it. Because of the rapid aging of the United States population, it is projected that almost 3 million people will develop AMD by 2020.21 The causes of AMD are not completely known (Table 60-7). 

FIGURE 60-3. The scene in Fig. 60-2 as it might be viewed by a person with age-related macular degeneration. (From the National Eye Institute, National Institutes of Health Ref. No. EDS05. Accessed online at http //www.nei.nih.gov/photo/)... 

Drusen ablation may help patients with multiple large drusen in both eyes that have not progressed to neovascular macular degeneration. These laser treatments may lead to resolution of the drusen and improved visual acuity. However, it is not clear if progression to choroidal neovascular membranes and neovascular macular degeneration is reduced.23 There is a possibility that the laser treatments may induce choroidal neovascularization and retinal atrophy.22... 

There are no approved pharmacologic treatments for atrophic AMD. The Age-Related Eye Disease Study showed that a supplement containing ascorbic acid 500 mg, vitamin E 400 IU, beta carotene 15 mg, zinc oxide 80 mg, and cupric oxide 2 mg reduced the rate of clinical progression of all types of AMD by 28% in patients with at least intermediate macular degeneration. No benefit was seen in patients with earlier stages of age-related maculopathy however, the duration of the study may have been insufficient to detect this benefit.25... 

Comer GM, Ciulla TA, Criswell MH, Tolentino M. Current and future treatment options for nonexudative and exudative age-related macular degeneration. Drugs Aging 2004 21 967-992. Donahue SP, Khoury JM, Kowalski RP. Common ocular infections. A prescriber s guide. Drugs 1996 52 526-540. 

Preferred Practice Patterns from the American Academy of Ophthalmology. Online at http //www.aao.org/aao/education/ library/ppp/index.cfm. Available for keratitis, blepharitis, conjunctivitis, dry eye, and age-related macular degeneration. Wilson SA, Last A. Management of corneal abrasions. Am Fam Physician 2004 70 123-128. 

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