Clinical Review

Age related macular degeneration

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c981 (Published 26 February 2010) Cite this as: BMJ 2010;340:c981
  1. Usha Chakravarthy, professor of ophthalmology and vision sciences1,
  2. Jennifer Evans, PhD2,
  3. Philip J Rosenfeld, professor of ophthalmology3
  1. 1Centre for Vascular and Vision Sciences, Institute of Clinical Science, Belfast BT12 6BA
  2. 2International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  3. 3Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
  1. Correspondence to: U Chakravarthy u.chakravarthy{at}qub.ac.uk

    Summary points

    • The late stage manifestations of age related macular degeneration, neovascularisation and geographic atrophy, cause severe loss of central vision

    • Standard care for neovascular age related macular degeneration is treatment with monoclonal antibodies that inhibit vascular endothelial growth factor. A fifth of those treated do not respond to treatment and a further quarter may lose the initial gains in visual acuity over time.

    • No proven treatments exist for geographic atrophy. The preventive effects of supplementation with macular carotenoids (lutein/zeaxanthin) and omega-3 fatty acids are under investigation.

    Age related macular degeneration, as the term implies, affects older adults and accounts for about half of all vision impairment or blind registrations in the developed world.1 Its prevalence is increasing with the demographic shift towards an ageing society. Recent evidence from large scale population based epidemiological studies confirms that it is also a major cause of sight loss in the developing world, in countries such as India,2 where life expectancy continues to rise. The two vision threatening manifestations of age related macular degeneration occur either as a consequence of neovascularisation, which causes an acute exudative pathology, or from cell loss due to geographic atrophy. Both neovascular age related macular degeneration and geographic atrophy result in reduced central vision with inability to undertake tasks that require visual discrimination, such as reading, driving, and recognising faces. The main aims of treatment are either to prevent the progression of early features to the late stage manifestations or to treat the symptoms of advanced disease if these do occur. Currently, intravitreal treatment with humanised monoclonal antibodies against vascular endothelial growth factor is used to ameliorate the acute manifestations of neovascular age related macular degeneration. This review examines the pathogenesis of age related macular degeneration and recent advances in its management.

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