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Age related macular degeneration

BMJ 2000; 321 doi: (Published 09 December 2000) Cite this as: BMJ 2000;321:1425

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New hope for a common problem comes from photodynamic therapy

  1. Neil M Bressler, physician,
  2. James P Gills, professor of ophthalmology (
  1. Retinal Vascular Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205-2005, USA

    Age related macular degeneration is the commonest cause of severe loss of central vision in people aged over 50 in the Western world.1 The vision loss results from loss of function of the macula, the centre of the retina, which is responsible for central visual tasks such as reading, driving, and recognising faces. Macular degeneration has until recently been untreatable, but laser treatments have become available within the past few years that can halt progression of the disease and the consequent loss of vision in some patients.

    The early stages of macular degeneration (usually without significant vision loss) include the formation of drusen,2 which can be seen with the direct ophthlamoscope (after dilatation of the pupil) as small yellow deposits in the centre of the retina. Drusen are extremely common, detected in at least 10% of everyone over 65.1 Although their cause is unknown, their progression is well documented.

    Significant vision loss may occur from neovascular or non-neovascular abnormalities. In neovascular (sometimes termed “wet”) age related macular degeneration, abnormal new blood vessels from the choroidal layer of the eye that nourishes the outer retina grow and proliferate with fibrous tissue within drusen material.2 This choroidal neovascularisation causes acute loss of vision as transudate or haemorrhage accumulates within and …

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